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  • 1.
    Alizadeh, Neda
    et al.
    School of Occupational Therapy, Dalhousie University, Halifax, Canada.
    Packer, Tanya
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. School of Health Administration, Dalhousie University, Halifax, Canada.
    Chen, Yu-Ting
    Department of Occupational Therapy, National Cheng Kung University, Tainan, Taiwan.
    Alnasery, Yaser
    School of Occupational Therapy, Dalhousie University, Halifax, Canada; College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
    What we know about fatigue self-management programs for people living with chronic conditions: a scoping review2023Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 114, artikel-id 107866Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Objective: The significant impact of fatigue on the lives of patients with chronic conditions has demanded a response. One response has been the development and testing of self-management programs. Little is known about what these programs have in common or how they differ. This scoping review compared the key components of fatigue self-management programs.

    Methods: Scoping review methodology was employed. Databases of CINAHL, Academic Search Premier, PsycINFO, Cochrane and Medline were searched to identify relevant sources. Results: Included fatigue programs were compared using a three-component framework: 1) self-management strategies; 2) active patient participation; and 3) self-management support. Although all programs included some aspects of these components, the extent varied with only a few domains of these components found across all programs.

    Conclusion: The three self-management components employed in this study showed potential benefits in identifying similarities and differences across fatigue programs with comparable and distinct underlying theories. This three-component framework could facilitate identification of domains associated with positive outcomes. Practice implications: It is essential that authors of programs provide detailed descriptions to enable inter-program comparison. The three-component framework chosen for this review was capable of describing and comparing fatigue self-management programs, paving the way for more effective interventions.

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  • 2.
    Audulv, Åsa
    et al.
    Department of Health Sciences, Mid Sweden University, Sweden.
    Asplund, Kenneth
    Norbergh, Karl-Gustav
    Who's in charge?: The role of responsibility attribution in self-management among people with chronic illness2010Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 81, nr 1, s. 94-100Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To explore how responsibility attribution influences self-management regimens among people with chronic illness.

    Methods: This qualitative content analysis included 26 interviews with people living with chronic illness.

    Results: The participants attributed responsibility to internal, external or a combination of these factors, meaning that they either assumed responsibility for self-management or considered other people or factors responsible. Internal responsibility was associated with a multifaceted self-management regimen, whereas external responsibility was related to “conventional” self-management such as taking medication, managing symptoms and lifestyle changes.

    Conclusion: How responsibility is attributed is vital for the way in which individuals perform self-management. In this study, those who attributed responsibility to external factors mainly performed recommended behaviours to control their illness. In contrast, to take charge of their illness and be an active participant in the care, individuals must take responsibility for themselves, i.e. internal responsibility.

    Practice implications: Health-care providers should acknowledge and support individuals’ wishes about various levels of responsibility as well as different kinds of patient–provider relationships.

  • 3.
    Audulv, Åsa
    et al.
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    Ghahari, Setareh
    Kephart, George
    Warner, Grace
    Packer, Tanya L.
    The Taxonomy of Everyday Self-management Strategies (TEDSS): A framework derived from the literature and refined using empirical data2019Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, nr 2, s. 367-375Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To extend our understanding of self-management by using original data and a recent concept analysis to propose a unifying framework for self-management strategies.

    METHODS: Longitudinal interview data with 117 people with neurological conditions were used to test a preliminary framework derived from the literature. Statements from the interviews were sorted according to the predefined categories of the preliminary framework to investigate the fit between the framework and the qualitative data. Data on frequencies of strategies complemented the qualitative analysis.

    RESULTS: The Taxonomy of Every Day Self-management Strategies (TEDSS) Framework includes five Goal-oriented Domains (Internal, Social Interaction, Activities, Health Behaviour and Disease Controlling), and two additional Support-oriented Domains (Process and Resource). The Support-oriented Domain strategies (such as information seeking and health navigation) are not, in and of themselves, goal focused. Instead, they underlie and support the Goal-oriented Domain strategies. Together, the seven domains create a comprehensive and unified framework for understanding how people with neurological conditions self-manage all aspects of everyday life.

    CONCLUSIONS: The resulting TEDSS Framework provides a taxonomy that has potential to resolve conceptual confusion within the field of self-management science.

    PRACTICE IMPLICATIONS: The TEDSS Framework may help to guide health service delivery and research.

  • 4.
    Audulv, Åsa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Department of Nursing Science, Mid Sweden University, Sweden.
    Hutchinson, Susan
    Warner, Grace
    Kephart, George
    Versnel, Joan
    Packeref, Tanya L.
    Managing everyday life: Self-management strategies people use to live well with neurological conditions2021Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 104, nr 2, s. 413-421Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This paper uses the Taxonomy of Everyday Self-management Strategies (TEDSS) to provideinsight and understanding into the complex and interdependent self-management strategies peoplewith neurological conditions use to manage everyday life.

    Methods: As part of a national Canadian study, structured telephone interviews were conducted monthlyfor eleven months, with 117 people living with one or more neurological conditions. Answers to fiveopen-ended questions were analyzed using qualitative content analysis. A total of 7236 statements wereanalyzed.

    Results: Findings are presented in two overarching patterns: 1) self-management pervades all aspects oflife, and 2) self-management is a chain of decisions and behaviours. Participants emphasizedmanagement of daily activities and social relationships as important to maintaining meaning in theirlives.

    Conclusion: Managing everyday life with a neurological condition includes a wide range of diversestrategies that often interact and complement each other. Some people need to intentionally manageevery aspect of everyday life.

    Practice implications: For people living with neurological conditions, there is a need for health providersand systems to go beyond standard advice for self-management. Self-management support is besttailored to each individual, their life context and the realities of their illness trajectory.

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  • 5.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Bent
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Graneheim, Ulla H.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, nr 2, s. 187-192Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Boström, Eva
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lundman, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, nr 2, s. 187-192Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Grankvist, Olov
    et al.
    Department of Obstetrics and Gynecology, Sunderby Hospital, Norrbotten County Council, Luleå , Sweden.
    Olofsson, Anders D
    Umeå universitet, Samhällsvetenskapliga fakulteten, Pedagogiska institutionen.
    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.2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 96, nr 1, s. 50-54Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Hellström, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Dialogue medicine: a health-liberating attitude in general practice1998Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 35, nr 3, s. 221-231Artikel i tidskrift (Refereegranskat)
    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.

  • 9.
    Hellström, Olle
    Department of Health and Society, Linköping University, Linköping, Sweden.
    Health promotion and clinical dialogue1995Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 25, nr 3, s. 247-256Artikel i tidskrift (Refereegranskat)
    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.

  • 10.
    Hellström, Olle
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Socialmedicin.
    Lindqvist, P
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mattsson, Bengt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    A phenomenological analysis of doctor-patient interaction: a case study1998Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 33, nr 1, s. 83-89Artikel i tidskrift (Refereegranskat)
    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.

  • 11.
    Hult, Anna
    et al.
    Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
    Lundgren, Ewa
    Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
    Fröjd, Camilla
    Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
    Lindam, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Jangland, Eva
    Department of Surgical Sciences (EL), Nursing Research (AH, CL, EJ), Uppsala University, Uppsala, Sweden.
    Patient complaints about communication in cancer care settings: Hidden between the lines2023Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 114, artikel-id 107838Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate patient complaints in cancer care settings reported to patient advisory committees (PACs) and describe the frequency and content of communication failures across all reports.

    Methods: Content analysis, with a summative approach, was applied to cancer care complaints (2016–2020) by 692 patients to PACs in one Swedish healthcare region.

    Results: More than half the patients reported communication failures. Patients reported not receiving proper information, not being listened to, and being treated disrespectfully or impersonally. Communication failures occurred in different stages of the patients’ cancer care, from diagnostic workup to end-of-life. Compared with the results of the PACs, communication failures were underreported, and were often combined with complaints in other categories.

    Conclusions: Communication failures are hidden “between the lines” and do not appear clearly in existing reporting systems. Healthcare must utilize the knowledge conveyed by patient complaints and create conditions and environments that support healthcare providers in delivering person-centered care.

    Practice Implication: A summary picture of patients’ complaints in Swedish cancer care is provided. These results could be used to further improve the patient complaint system. Above all, the results could serve as a “wake-up call” about the importance of communication and a valuable resource in improving cancer care.

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  • 12.
    Jutterström, Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandström, Herbert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Isaksson, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Nurse-led patient-centered self-management support improves HbA1c in patients with type 2 diabetes: A randomized study2016Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, nr 11, s. 1821-1829Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Kaati, Gunnar
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Bygren, Lars-Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Vester, Monica
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Karlsson, AnnBrith
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sjöström, Michael
    Outcomes of comprehensive lifestyle modification in inpatient setting2006Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 62, nr 1, s. 95-103Artikel i tidskrift (Refereegranskat)
    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.

  • 14. Packer, Tanya L.
    et al.
    Fracini, America
    Audulv, Åsa
    Department of Nursing Science, Mid Sweden University, Sundsvall, Sweden.
    Alizadeh, Neda
    van Gaal, Betsie G.I.
    Warner, Grace
    Kephart, George
    What we know about the purpose, theoretical foundation, scope and dimensionality of existing self-management measurement tools: A scoping review.2018Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, nr 4, s. 579-595Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To identify self-report, self-management measures for adults with chronic conditions, and describe their purpose, theoretical foundation, dimensionality (multi versus uni), and scope (generic versus condition specific).

    METHODS: A search of four databases (8479 articles) resulted in a scoping review of 28 self-management measures.

    RESULTS: Although authors identified tools as measures of self-management, wide variation in constructs measured, purpose, and theoretical foundations existed. Subscales on 13 multidimensional tools collectively measure domains of self-management relevant to clients, however no one tool's subscales cover all domains.

    CONCLUSIONS: Viewing self-management as a complex, multidimensional whole, demonstrated that existing measures assess different, related aspects of self-management. Activities and social roles, though important to patients, are rarely measured. Measures with capacity to quantify and distinguish aspects of self-management may promote tailored patient care.

    PRACTICE IMPLICATIONS: In selecting tools for research or assessment, the reason for development, definitions, and theories underpinning the measure should be scrutinized. Our ability to measure self-management must be rigorously mapped to provide comprehensive and system-wide care for clients with chronic conditions. Viewing self-management as a complex whole will help practitioners to understand the patient perspective and their contribution in supporting each individual patient.

  • 15.
    Persson, Margareta
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Winkvist, Anna
    Inst. för medicin, avd för klinisk näringslära, Sahlgrenska Akademin, Göteborgs Universitet.
    Mogren, Ingrid
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    "Mission Impossible"? Midwives' experiences counseling pregnant women with gestational diabetes mellitus.2011Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 84, nr 1, s. 78-83Artikel i tidskrift (Refereegranskat)
    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.

  • 16.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Does advocating screening for distress in cancer rest more on ideology than on science?2017Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 5, s. 858-860Artikel i tidskrift (Refereegranskat)
  • 17.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Including physiological variables in studies might confuse more than clarify2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 94, nr 1, s. 140-140Artikel i tidskrift (Övrigt vetenskapligt)
  • 18.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Patients with cancer react differently - Training in breaking bad news can therefore not be reduced to learning pre-defined behaviours2017Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 10, s. 1955-1956Artikel i tidskrift (Refereegranskat)
  • 19.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Patients with cancer react differently: training in breaking bad news can therefore not be reduced to learning pre-defined behaviours2017Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, nr 10, s. 1955-1956Artikel i tidskrift (Övrigt vetenskapligt)
  • 20.
    Salander, Pär
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    We should be more attentive and critically scrutinize the philosophical assumptions included in study designs2013Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 92, nr 2, s. 281-282Artikel i tidskrift (Refereegranskat)
  • 21.
    Salander, Pär
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Sandström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    A Balint-inspired reflective forum in oncology for medical residents: Main themes during seven years2014Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 97, nr 1, s. 47-51Artikel i tidskrift (Refereegranskat)
    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.

  • 22. Schulz, Peter J.
    et al.
    Lindahl, Bernt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för hållbar hälsa.
    Hartung, Uwe
    Näslund, Ulf
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nordin, Steven
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    The right pick: Does a self-assessment measurement tool correctly identify health care consumers with inadequate health literacy?2022Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 105, nr 4, s. 926-932Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim of this study was to investigate whether a self-report measurement instrument (the Brief Health Literacy Screen, BHLS) correctly identifies healthcare consumers with inadequate health literacy. The yardstick for assessing the tool was the Newest Vital Sign (NVS).

    Methods: The study used baseline data from the Västerbotten Intervention Programme - VIsualiZation of Asymptomatic Atherosclerotic disease for Optimum Cardiovascular Prevention (VIPVIZA), a randomized controlled trial that is nested within the Västerbotten Intervention Program (VIP) in Sweden. Our analyses were computed on a subsample of 460 persons who underwent the measure of both health literacy scales. ROC analysis was used for the crucial computations.

    Results: The potential of the BHLS to identify healthcare consumers with inadequate health literacy remained unsatisfying for the complete sample, but reached an acceptable level for women and persons with only basic education.

    Conclusions: The relationship is somewhat weaker than in comparable research in various other European countries. The differences might partly have been caused by the use of self-perception questions. Self-delusions, invariably a part of self-perception, may have affected the respective measure. Practice implications: Caution is advised when patients’ health literacy is assessed by only a few questions for self-report.

  • 23.
    Sjöling, Mats
    et al.
    Umeå universitet, Medicinsk fakultet, Kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Nordahl, Gunnar
    Olofsson, Niclas
    Asplund, Kenneth
    The impact of preoperative information on state anxiety, postoperative pain and satisfaction with pain management2003Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, nr 2, s. 169-176Artikel i tidskrift (Refereegranskat)
    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.

  • 24. Warner, Grace
    et al.
    Packer, Tanya L.
    Kervin, Emily
    Sibbald, Kaitlin
    Audulv, Åsa
    Department of Nursing Sciences, Mid Sweden University, Sundsvall, Sweden.
    A systematic review examining whether community-based self-management programs for older adults with chronic conditions actively engage participants and teach them patient-oriented self-management strategies2019Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, nr 12, s. 2162-2182Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To identify whether community-based Self-Management Programs (SMPs) actively engaged, or taught, individuals patient-oriented strategies; and whether having these attributes led to significant differences in outcomes.

    METHODS: This systematic review included randomized controlled trials (RCTs)and cluster RCTs reporting on community-based SMPs with a group component for older adults with chronic conditions. The ways SMPS actively engaged participants and whether they taught patient-oriented strategies were analyzed. All study outcomes were reported.

    RESULTS: The 31 included studies demonstrated community-based SMP programs actively engaged participants and provided strategies to improve health behaviour or care of their condition. Few included strategies to help manage the impact of conditions on their everyday lives. Seventy-nine percent of studies reported significant differences; variations in sample sizes and outcomes made it difficult to conclude whether having these attributes led to significant differences.

    CONCLUSION: SMPs are not supporting older adults to use strategies to address the impact of conditions on their everyday lives, addressing the needs of older adults with multiple conditions, nor assessing outcomes that align with the strategies taught.

    PRACTICE IMPLICATIONS: Health-care providers delivering SMPs to older adults need to tailor programs to the needs of older adults and assess whether participants are using strategies being proposed.

  • 25. Zoffmann, Vibeke
    et al.
    Hörnsten, Åsa
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    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-determination2016Ingår i: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, nr 3, s. 400-407Artikel i tidskrift (Refereegranskat)
    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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