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Ekman, N., Moons, P., Taft, C., Boström, E. & Fors, A. (2022). Observable indicators of person-centred care: an interview study with patients, relatives and professionals. BMJ Open, 12(4), Article ID e059308.
Open this publication in new window or tab >>Observable indicators of person-centred care: an interview study with patients, relatives and professionals
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e059308Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To identify key observable indicators of person-centred care (PCC) from interviews with patients, relatives and professionals with experience of receiving or working with PCC.

DESIGN: A qualitative interview study using deductive content analysis.

SETTING: Primary and hospital care settings in Western Sweden.

PARTICIPANTS: Twelve participants with extensive experience of receiving or working with PCC were interviewed: two patients, two patients representative with long-term conditions, one relative and informal carer, three registered nurses, one physician, two occupational therapists and one social worker/researcher.

RESULTS: Nine observable indicators were identified and subsumed under three predetermined categories: initiating, working and safeguarding the partnership. The first category comprised three subcategories: welcoming, interested and courteous reception; agreeing on structure and aims of the conversation; and eliciting patients' wishes for involvement of significant others. The second category comprised four subcategories: attentive, empathic and encouraging manner; promoting mutual understanding; promoting patient engagement; and encouraging and friendly body language. The last category consisted of two subcategories: collaboration and transparency in documentation and verifying that patient's and professional's views, goals and wants are correctly documented.

CONCLUSION: Our results underline the need for health professionals to actively and conscientiously convey to patients their interest in and respect for the patient as a person and their willingness to collaborate as partners in their care from the very outset of the interaction. Non-verbal behaviours were seen to play a major role in shaping patients' impressions of health professionals. Given that patients' first impressions were considered to impact the content, course and outcomes of the interaction, more research attention should be given to their implications for the effective delivery of PCC.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
Public Health, Qualitative Research, Quality in health care
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-194462 (URN)10.1136/bmjopen-2021-059308 (DOI)000784798300015 ()35443963 (PubMedID)2-s2.0-85128798570 (Scopus ID)
Funder
Swedish Research Council, 2009-1088
Available from: 2022-05-09 Created: 2022-05-09 Last updated: 2023-08-28Bibliographically approved
Ekman, N., Taft, C., Moons, P., Mäkitalo, Å., Boström, E. & Fors, A. (2020). A state-of-the-art review of direct observation tools for assessing competency in person-centred care. International Journal of Nursing Studies, 109, Article ID 103634.
Open this publication in new window or tab >>A state-of-the-art review of direct observation tools for assessing competency in person-centred care
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2020 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 109, article id 103634Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Direct observation is a common assessment strategy in health education and training, in which trainees are observed and assessed while undertaking authentic patient care and clinical activities. A variety of direct observation tools have been developed for assessing competency in delivering person-centred care (PCC), yet to our knowledge no review of such tools exists.

OBJECTIVE: To review and evaluate direct observation tools developed to assess health professionals' competency in delivering PCC.

DESIGN: State-of-the-art review DATA SOURCES: Electronic literature searches were conducted in PubMed, ERIC, CINAHL, and Web of Science for English-language articles describing the development and testing of direct observation tools for assessing PCC published until March 2017.

REVIEW METHODS: Three authors independently assessed the records for eligibility. Duplicates were removed and articles were excluded that were irrelevant based on title and/or abstract. All remaining articles were read in full text. A data extraction form was developed to cover and extract information about the tools. The articles were examined for any conceptual or theoretical frameworks underlying tool development and coverage of recognized PCC dimensions was evaluated against a standard framework. The psychometric performance of the tools was obtained directly from the original articles.

RESULT: 16 tools were identified: five assessed PCC holistically and 11 assessed PCC within specific skill domains. Conceptual/theoretical underpinnings of the tools were generally unclear. Coverage of PCC domains varied markedly between tools. Most tools reported assessments of inter-rater reliability, internal consistency reliability and concurrent validity; however, intra-rater reliability, content and construct validity were rarely reported. Predictive and discriminant validity were not assessed.

CONCLUSION: Differences in scope, coverage and content of the tools likely reflect the complexity of PCC and lack of consensus in defining this concept. Although all may serve formative purposes, evidence supporting their use in summative evaluations is limited. Patients were not involved in the development of any tool, which seems intrinsically paradoxical given the aims of PCC. The tools may be useful for providing trainee feedback; however, rigorously tested and patient-derived tools are needed for high-stakes use.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Observation-based methods, Patient-centred care, Person-centred care, State-of-the-art review
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-174421 (URN)10.1016/j.ijnurstu.2020.103634 (DOI)000578971400003 ()32531569 (PubMedID)2-s2.0-85086134831 (Scopus ID)
Funder
Swedish Research Council, 2009-1088
Available from: 2020-08-24 Created: 2020-08-24 Last updated: 2023-03-24Bibliographically approved
Boström, E., Ali, L., Fors, A., Ekman, I. & Andersson, A. E. (2020). Registered nurses' experiences of communication with patients when practising person-centred care over the phone: a qualitative interview study. BMC Nursing, 19(1), Article ID 54.
Open this publication in new window or tab >>Registered nurses' experiences of communication with patients when practising person-centred care over the phone: a qualitative interview study
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2020 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 19, no 1, article id 54Article in journal (Refereed) Published
Abstract [en]

Background: To explore registered nurses’ (RNs’) experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure.

Methods: Qualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis.

Results: The results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics.

Conclusions: PCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient’s capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties’ knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it.

Place, publisher, year, edition, pages
BioMed Central, 2020
Keywords
Person-centred care, Professional role, Telephone, Qualitative
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-173450 (URN)10.1186/s12912-020-00448-4 (DOI)000543327200001 ()32577097 (PubMedID)2-s2.0-85087175952 (Scopus ID)
Funder
Swedish Research Council, 521-2013-2723Region Västra Götaland
Available from: 2020-07-10 Created: 2020-07-10 Last updated: 2023-03-24Bibliographically approved
Boström, E. & Öresland, S. (2019). The (in)visible ‘mother’: Diabetes specialist nurses in Swedish primary healthcare. Nordic journal of nursing research, 39(1), 29-37
Open this publication in new window or tab >>The (in)visible ‘mother’: Diabetes specialist nurses in Swedish primary healthcare
2019 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 39, no 1, p. 29-37Article in journal (Refereed) Published
Abstract [en]

This study aimed to explore how diabetes specialist nurses (DSNs) discursively construct and reconstruct their professional position in their working relationships with physicians and thereby the relation with patients in primary healthcare in Sweden. Twenty-nine DSNs working in diabetes care from 21 primary healthcare centres were included in focus-group interviews. The interviews were analysed using discourse analysis. From a social constructionist perspective, findings showed that the working relationship between the DSNs, physicians and thereby the relation with patients was discursively constructed as a relationship within a gendered discourse. The DSNs constructed their subject position metaphorically as ‘mothers’ in this relationship. The construction of doing gender implies that the DSNs became visible as biological women, but invisible in being perceived as competent, well-educated professionals, because skills such as multitasking and versatility are often associated with female abilities.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
diabetes, discourse, gender, nurse, relationship
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158357 (URN)10.1177/2057158518775627 (DOI)2-s2.0-85132293614 (Scopus ID)
Available from: 2019-04-25 Created: 2019-04-25 Last updated: 2022-07-04Bibliographically approved
Boström, E., Isaksson, U., Lundman, B., Graneheim, U. H. & Hörnsten, Å. (2014). Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes. Patient Education and Counseling, 94(2), 187-192
Open this publication in new window or tab >>Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes
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2014 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Diabetes specialist nurse, Interaction, Patient, Self-management, Type 2 diabetes
National Category
Nursing Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-87421 (URN)10.1016/j.pec.2013.10.010 (DOI)000331923700007 ()
Available from: 2014-04-01 Created: 2014-03-31 Last updated: 2018-06-08Bibliographically approved
Boström, E., Isaksson, U., Lundman, B., Hällgren Graneheim, U. & Hörnsten, Å. (2014). Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes. Patient Education and Counseling, 94(2), 187-192
Open this publication in new window or tab >>Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes
Show others...
2014 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, no 2, p. 187-192Article in journal (Refereed) Published
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.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Diabetes specialist nurse, interaction, patient, self-management, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-80901 (URN)10.1016/j.pec.2013.10.010 (DOI)000331923700007 ()24268676 (PubMedID)2-s2.0-84892806949 (Scopus ID)
Projects
Diabetes intervention in Västerbotten , DIVA 2
Note

Originally included in thesis in manuscript form. 

Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2022-03-22Bibliographically approved
Boström, E., Isaksson, U., Lundman, B., Lehuluante, A. & Hörnsten, Å. (2014). Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses. Scandinavian Journal of Caring Sciences, 28(4), 675-682
Open this publication in new window or tab >>Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses
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2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, p. 675-682Article 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.

Keywords
Diabetes specialist nurse, intervention, pateint-centred care, pateint education, qualitative content analysis, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-80905 (URN)10.1111/scs.12092 (DOI)000345314000006 ()24164307 (PubMedID)2-s2.0-84969971487 (Scopus ID)
Projects
Diabetes intervention in Västerbotten DIVA 2
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2023-03-23Bibliographically approved
Boström, E. (2014). Personcentrerad vård fungerar men kan upplevas obekväm. Diabetesvård : tidning för Svensk förening för sjuksköterskor i diabetesvård (2-3), 10-11
Open this publication in new window or tab >>Personcentrerad vård fungerar men kan upplevas obekväm
2014 (Swedish)In: Diabetesvård : tidning för Svensk förening för sjuksköterskor i diabetesvård, ISSN 1652-697X, no 2-3, p. 10-11Article in journal (Other academic) Published
Abstract [sv]

Inledning:Diabetessjuksköterskans roll och de utmaningar som ligger i att praktisera personalcentrerad vård behöver tydliggöras.

Place, publisher, year, edition, pages
Svensk förening för sjuksköterskor i diabetesvård, 2014
Keywords
Personcentrerad vård diabetessjuksköterskan
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158494 (URN)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-30Bibliographically approved
Boström, E. (2014). Personcentrerad vård innebär en förändrad professionell roll för diabetssjuksköterskor. Best Practice (10), 16-18
Open this publication in new window or tab >>Personcentrerad vård innebär en förändrad professionell roll för diabetssjuksköterskor
2014 (Swedish)In: Best Practice, ISSN 1329-1874, no 10, p. 16-18Article in journal (Refereed) Published
Abstract [sv]

Diabetessjuksköterskor innom primärvården har en viktig uppgift i att stödja personer med typ 2 diabetes så att de kan bibehålla  en tillfredsställande livskvalitet och fördröja sjukdomens progression. Ett personcentrerat förhållningssätt förespråkas idag och innebär att den enskilda personen ses med unika egenskaper, preferenser och förmågor som tas tillvara och vars medbestämmande får betydelse vid upprättande av behandlingsmål.

Place, publisher, year, edition, pages
BestPractice ApS, 2014
Keywords
Diabetessjuksköterskor
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-158498 (URN)
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-06-10Bibliographically approved
Boström, E. (2013). Proximity and distance: challenges in person-centred care for diabetes specialist nurses in primary health care. (Doctoral dissertation). Umeå: Umeå Universitet
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. p. 63
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1593
Keywords
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: 2018-06-08Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5598-0737

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