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  • 1.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Bent
    Umeå University, Faculty of Medicine, Department of Nursing.
    Graneheim, Ulla H.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to explore the interaction between diabetes specialist nurses (DSNs) and patients with type 2 diabetes (T2D) during group sessions about self-management. Methods: Ten DSNs and 44 patients were observed during group sessions about self-management, and thereafter the observations were analyzed using qualitative content analysis. Results: The interaction was characterized by three themes: becoming empowered, approaching each other from different perspectives, and struggling for authority. The interaction was not a linear process, but rather a dynamic process with distinct episodes that characterized the content of the sessions. Conclusion: It is important to achieve an interaction that is patient-centered, where the DSN is aware of each patient's individual needs and avoids responding to patients in a normative way. A satisfying interaction may strengthen patients' self-management, and also may strengthen the DSNs in their professional performance. Practice implications: Authority struggles between patients and DSNs could be a prerequisite for patients to become autonomous and decisive in self-management. DSNs might benefit from an increased awareness about this issue, because they can better support patients if they do not perceive authority struggles as threats to their professional role. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

  • 2.
    Boström, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lundman, Berit
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hällgren Graneheim, Ulla
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetesIn: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Article in journal (Refereed)
  • 3.
    Grankvist, Olov
    et al.
    Department of Obstetrics and Gynecology, Sunderby Hospital, Norrbotten County Council, Luleå , Sweden.
    Olofsson, Anders D
    Umeå University, Faculty of Social Sciences, Department of Education.
    Isaksson, Rose-Marie
    Department of Research, Norrbotten County Council, Luleå , Sweden & Division of Nursing, Department of Medical and Health Sciences, Linko¨ping University, Sweden.
    Can physicians be replaced with gynecological teaching women to train medical students in their first pelvic examination? A pilot study from Northern Sweden.2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 96, no 1, p. 50-54Article in journal (Refereed)
    Abstract [en]

    Objective The main objective was to gain a deeper understanding of how medical students perceive and experience learning from gynecological teaching women (GTW) instead of physicians in their first pelvic examination. A second aim was to describe how the women experience their roles as GTW.

    Methods Data were collected from individual interviews with 24 medical students from a medical school in Sweden and with 5 GTW. Discourse analysis was performed to acquire a deeper understanding of the informants’ experiences and to understand social interactions.

    Results Five themes revealed in the medical students’ experiences: “Hoping that anxiety will be replaced with security,” “Meeting as equals creates a sense of calm,” “Succeeding creates a sense of security for the future,” “Wanting but not having the opportunity to learn more,” and “Feeling relieved and grateful.” One theme revealed in the GTW experiences: “Hoping to relate in a trustworthy way.”

    Conclusion To replace physicians with GTW may facilitate the learning process and may also help medical students improve their communicative skills. Using GTW will hopefully further improve students’ basic medical examination techniques and physician–patient relationships.

    Practice implications Since GTW seems to increase self-confidence and skills of medical students performing their first pelvic examination we recommend that the use of GTW is considered in the training of medical students.

  • 4.
    Hellström, Olle
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Dialogue medicine: a health-liberating attitude in general practice1998In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 35, no 3, p. 221-231Article in journal (Refereed)
    Abstract [en]

    Dialogue medicine is presented as the prime means of understanding patients' illnesses. It is a practical attitude especially aimed to assist or inspire patients to consider, see and manage their illness–demanding efforts to unwittingly suppress or disguise such self-reproaching thoughts as are worse to bear than the feeling of being afflicted with a disease. Along with diagnosing patients' perceived bodily disorders, doctors can choose to see them as persons whose ailments stand for efforts to manage their existence as communicative human beings. The core of the paper is an encounter between the author and a female patient which illuminates the usefulness of genuine dialogue in medical practice. The paper illustrates how the dialogical attitude helps patients to see and manage their difficult life-situations and how the doctor can be inspired to change and develop and improve his/her skills as a dialogue partner. Doctors' dialogical attitude in the encounter encompasses for example openness, empathy, sensitivity, courage, attentiveness and responsiveness, accompanied by concern, trust, respect, affection, appreciation and hope. The philosophical and theoretical foundations of the concept of dialogue medicine are sketched out and some practically significant traits are described.

  • 5.
    Hellström, Olle
    Department of Health and Society, Linköping University, Linköping, Sweden.
    Health promotion and clinical dialogue1995In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 25, no 3, p. 247-256Article in journal (Refereed)
    Abstract [en]

    Clinical medicine would gain from a discussion of the significance of health promotion. Some central concepts are discussed: the diagnostic process; disease prevention vs. health promotion; the practical importance of the understanding of the difference between the 2 concepts health and absence-of-disease. The concept of health catches the intra-personal level, the undisrupted self, whereas absence of disease concerns the proper functioning of the organism, the human biology. By means of comparing 2 diagnoses, multiple sclerosis (MS) and fibromyagia syndrome (FS), it is argued that there are diagnoses of at least 2 distinct kinds. The diagnosis of MS is similar to a scientific discovery, whereas the diagnosis of FS is constructed more like criminal law. Consequently, diagnosis-based disease prevention and health promotion have to comply with a wide range reality. Finally, clinical dialogue is pointed out as a method that successfully combines diagnostic, preventive and promotive efforts, as well as clinical care and cure.

  • 6.
    Hellström, Olle
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Social medicine.
    Lindqvist, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mattsson, Bengt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    A phenomenological analysis of doctor-patient interaction: a case study1998In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 33, no 1, p. 83-89Article in journal (Refereed)
    Abstract [en]

    The fact that the biomedical model has been very successful in practice does not preclude that some health issues can be understood by way of other health care perspectives. Acquiring skills in meeting patients requires theories that structure other fields of knowledge than the biomedical sciences. An old man, who experiences himself as deeply misunderstood by the medical profession, is interviewed, his personal life-story is gone into and his case records and other available data are analysed. A phenomenological method is used, i.e. disciplined and rigorous reflection upon available data, remaining close to the particular pieces of the patient's narrative as they stand forth in their contextual relationships. The study shows that the doctors involved did not relate to the patient but to a biomedical image of him. His efforts to make himself understood were converted into instrumentally manageable disorders. Finally, dialogue medicine is briefly introduced as a model for counselling patients, especially when they need assistance to abandon the notion that they have been afflicted with a disease, a perception that might serve the purpose of keeping a threatening self-image out of consciousness.

  • 7.
    Jutterström, Lena
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 11, p. 1821-1829Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: The aim of this study was to evaluate the effect of a patient-centered self-management support, in type 2 diabetes (T2D) with regard to metabolic changes.

    METHODS: 182 patients were randomized into group intervention (GI), individual intervention (II) or internal controls (IC). An external control (EC) group was recruited from another county council. The intervention consisted of six sessions that featured themes, which regarded different views of their illness experiences. Data were collected in 2010 and 2011.

    RESULTS: HbA1c was significantly decreased at 12-month follow-up with 5mmol/mol in the GI and 4mmol/mol in the II. In the IC group, the HbA1c was close to baseline. The EC group had increased HbA1c, though not significantly. When the HbA1c difference at baseline was adjusted, there was a significant difference between intervention groups and the EC-group.

    CONCLUSION: Patient-centered self-management support, led by nurses, can lower HbA1c among patients with type 2 diabetes.

    PRACTICE IMPLICATIONS: It is possible to train diabetes specialist nurses in clinical patient-centered care, and simultaneously influence patients' metabolic balance positively.

  • 8.
    Kaati, Gunnar
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Bygren, Lars-Olov
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Vester, Monica
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Karlsson, AnnBrith
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Sjöström, Michael
    Outcomes of comprehensive lifestyle modification in inpatient setting2006In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 62, no 1, p. 95-103Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the effectiveness of a 4-week inpatient non-pharmacological risk factor modification programme for individuals with the metabolic syndrome. The aim of the program was to reduce patients' over risks for stroke and myocardial infarction.

    Methods: A prospective clinical study including 2468 patients - 1096 men and 1372 women - with and average age of 50 +/- 10 years. The patients were referred to the programme from primary care units and hospitals where treatment options were exhausted.

    Results: All risk factor levels for stroke and myocardial infarction decreased. The reduction of weight among men was 4.7 +/- 2.6 kg and 3.8 +/- 1.8 kg among women from an initial weight of 96 17 kg and 85 +/- 16 kg. respectively. The patients systolic and diastolic blood pressure decreased by 15/10 mm Hg for men and 14/9 min Hg among women from initial average for the whole population of 148/90 +/- 19/11 mm Hg and 146/87 +/- 19/12 min Hg, respectively. The greatest decrease in weight and blood pressure occurred in men and women with an initial body mass index of >= 30 and with a diastolic blood pressure of >= 90; in this group, the average reductions in weight were 5.8 +/- 2.4 kg for men and 4.4 +/- 1.7 kg for women; the reductions in systolisk/diastolisk blood pressure were 22/15 +/- 16/9 mm Hg (p < 0.001) for both men and women. A reduction of medication (DDD) although not a goal was also achieved.

    Conclusion: The results prove the value of a comprehensive and highly structured inpatient approach to lifestyle modification. Practice implications: The results should give cause to trials with half-way strategies integrating features from the inpatient programme into the design of risk factor interventions.

  • 9.
    Persson, Margareta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Winkvist, Anna
    Inst. för medicin, avd för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
    Mogren, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    "Mission Impossible"? Midwives' experiences counseling pregnant women with gestational diabetes mellitus.2011In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, no 1, p. 78-83Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Since not all pregnancy-related complications require hospitalization midwives often provide these women with antenatal care and counseling. This study explored the experiences of midwives providing antenatal care and counseling to pregnant women with gestational diabetes mellitus (GDM). METHODS: Twelve midwives participated in the interview study performed in the three northernmost counties in Sweden. Grounded theory was used for analysis. RESULTS: The emerging core category was 'Balancing fear of failure'. The unexpected disease increased the demands and the pressure. Three major conflicting situations were revealed. The midwives believed they were obligated to monitor and control the pregnancy, to initiate and motivate the necessary changes in lifestyle and provide empowering relationships with their patients. The fear of failure with these assignments made the midwives chose different strategies to manage the conflicting situations. CONCLUSIONS AND PRACTICE IMPLICATIONS: The midwives described conflicting encounters providing antenatal care to pregnant women with GDM. The fear of failing to fulfill the assignments caused by the GDM made the midwives chose strategies to handle the conflicting encounters. Similar conflicting situations might be present for other health care professionals promoting lifestyle changes. The challenges might be addressed with an organization focusing on support and coaching sessions.

  • 10.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Does advocating screening for distress in cancer rest more on ideology than on science?2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 5, p. 858-860Article in journal (Refereed)
  • 11.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Including physiological variables in studies might confuse more than clarify2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 1, p. 140-140Article in journal (Other academic)
  • 12.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Patients with cancer react differently - Training in breaking bad news can therefore not be reduced to learning pre-defined behaviours2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 10, p. 1955-1956Article in journal (Refereed)
  • 13.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Patients with cancer react differently: training in breaking bad news can therefore not be reduced to learning pre-defined behaviours2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 10, p. 1955-1956Article in journal (Other academic)
  • 14.
    Salander, Pär
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    We should be more attentive and critically scrutinize the philosophical assumptions included in study designs2013In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, no 2, p. 281-282Article in journal (Refereed)
  • 15.
    Salander, Pär
    et al.
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Sandström, Maria
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    A Balint-inspired reflective forum in oncology for medical residents: Main themes during seven years2014In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 97, no 1, p. 47-51Article in journal (Refereed)
    Abstract [en]

    Objective: Reflection groups for clinicians, often called Balint groups, are a way of refining professional competence in health care. This study presents a model for reflective practice in a group setting and describes the kinds of troublesome cases that medical residents are concerned about.

    Methods: From 2005 to 2012 a Balint-inspired reflective forum has been a part of the academic seminar program for physicians in training in a Department of Oncology at a Swedish university. The present study is focused on all 63 cases presented in the forum.

    Results: The cases were categorized into three kinds of challenges: Communication challenges in the patient-physician relationship, Communication challenges in organizational matters, and Communication challenges with close relatives of the patient.

    Conclusion: The study tells us something about the vulnerability of being a medical resident and the identified challenges have bearings on medical education curricula as well as on how the training of junior physicians is organized. Practice implications: The cases are contextual and multifaceted, and a forum of this kind might therefore be regarded as a potential way to develop professional competence and to refine communication in clinical practice. A structured evaluation of the forum would be valuable.

  • 16.
    Sjöling, Mats
    et al.
    Umeå University, Faculty of Medicine, Surgical and Perioperative Sciences, Anesthesiology and Intensive Care.
    Nordahl, Gunnar
    Olofsson, Niclas
    Asplund, Kenneth
    The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management2003In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 2, p. 169-176Article in journal (Refereed)
    Abstract [en]

    The primary objective of this study was to test whether specific information given prior to surgery can help patients obtain better pain relief after total knee arthroplasty (TKA). Secondary objectives were to study the impact of preoperative information on state and trait anxiety, satisfaction with pain management and satisfaction with nursing care. The study was an intervention study with two groups of equal size (n=30). The intervention group was given specific information while the control group received routine information. Pain assessments were made preoperatively and every 3h for the first three postoperative days, using the visual analogue scale (VAS). The results of this study suggest that information does influence the experience of pain after surgery and related psychological factors. The postoperative pain declined more rapidly for patients in the treatment group, the degree of preoperative state anxiety was lower and they were more satisfied with the postoperative pain management.

  • 17. Zoffmann, Vibeke
    et al.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Storbaekken, Solveig
    Graue, Marit
    Rasmussen, Bodil
    Wahl, Astrid
    Kirkevold, Marit
    Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    Objective: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. Methods: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. Results: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. Conclusion: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. Practice Implications: Professionals must critically consider the context in their choice of approach. (C) 2015 Elsevier Ireland Ltd. All rights reserved.

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