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  • 1.
    Hafskjold, L.
    et al.
    University College of Southeast Norway, Drammen, Norway.
    Eide, T.
    University College of Southeast Norway, Drammen, Norway.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundling, V.
    University College of Southeast Norway, Kongsberg, Norway .
    van Dulmen, S.
    University College of Southeast Norway, Drammen, Norway .
    Eide, H.
    University College of Southeast Norway, Drammen, Norway .
    Older persons’ worries expressed during home care visits: Exploring the content of cues and concerns identified by the Verona coding definitions of emotional sequences2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 12, p. 1955-1963Article in journal (Refereed)
    Abstract [en]

    Objective Little is known about how older persons in home care express their concerns. Emotional cues and concerns can be identified by the Verona coding definitions of emotional sequences (VR-CoDES), but the method gives no insight into what causes the distress and the emotions involved. The aims of this study are to explore (1) older persons’ worries and (2) the content of these expressions. Methods An observational exploratory two-step approach was used to investigate audiotaped recordings from 38 Norwegian home care visits with older persons and nurse assistants. First, 206 cues and concerns were identified using VR-CoDES. Second, the content and context of these expressions were analysed inductively. Results Four main categories emerged: worries about relationships with others, worries about health care-related issues, worries about aging and bodily impairment, and life narratives and value issues, with several subcategories showing the causes of worry and emotions involved. Conclusion The two-step approach provides an in-depth knowledge of older persons’ worries, causes of worries, and their related emotions. Practice implications The subcategories described in a language close to the experience can be useful in practice development and communication training for students and health care providers.

  • 2.
    Holmström, Inger
    et al.
    Uppsala University, Uppsala, Sweden.
    Halford, Christina
    Uppsala University, Uppsala, Sweden.
    Rosenqvist, Urban
    Uppsala University, Uppsala, Sweden.
    Swedish health care professionals' diverse understandings of diabetes care2003In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 1, p. 53-58Article in journal (Refereed)
    Abstract [en]

    Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.

  • 3.
    Holmström, Inger
    et al.
    Health Services Research, Uppsala, Sweden .
    Larsson, Jan
    Health Services Research, Uppsala, Sweden .
    Lindberg, Eva
    Health Services Research, Uppsala, Sweden .
    Rosenqvist, Urban
    Health Services Research, Uppsala, Sweden .
    Improving the diabetes-patient encounter by reflective tutoring for staff2004In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 53, no 3, p. 325-332Article in journal (Refereed)
    Abstract [en]

    There is relative consensus about the advantages of patient-centred consultations. However, they have not been easy to realise in clinical praxis. The aim of this study was to investigate whether an intervention focused on health care professionals' understanding of the diabetes-patient encounter could facilitate a patient-centred way to encounter these patients. Two GPs and two nurses participated in the year-long intervention. The intervention focused on the staff's understanding of the encounter. Staff video recorded four to five encounters each and reflected together with a supervisor on their understanding of the encounters and how they were conducted. The encounters were analysed with the Verona-MICS/Dr coding system and patients' comments were analysed separately. The content of the consultations and how they were conducted was also assessed. There was a significant change of two patient-centred items by the staff over time. Two staff seemed to change their educational model. Modern theories of competence development seem to be useful in clinical settings.

  • 4.
    Holmström, Inger
    et al.
    Health Services Research, Uppsala Science Park, Uppsala, Sweden .
    Rosenqvist, Urban
    Health Services Research, Uppsala Science Park, Uppsala, Sweden .
    A change of the physicians' understanding of the encounter parallels competence development2001In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 42, no 3, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Patients today complain that physicians do not listen. There is a need to improve the professional competence in the patient encounter. According to theory, competence is a result of how people perceive their work. Observation and reflection can improve the competence. The aim of this study was to investigate if physicians can develop a more patient-centred consultation style by an experienced-based specialist course and how such a development is related to the physicians understanding of the task. The physicians video recorded consultations and reflected on these. The video consultations were analysed with a time study and Pendleton et al.’s consultation schedule [Pendleton D, Schoefield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.]. Before–after questions were answered. The study indicates that seven out of 10 physicians participating in the course had developed a patient-centred attitude and acted according to it. The time study gave ambiguous results. This study implicates that it is possible to initiate competence development by influencing the understanding of the encounter.

  • 5.
    Holmström, Inger
    et al.
    Uppsala Universitet.
    Röing, Marta
    Uppsala Universitet.
    The relation between patient-centeredness and patient empowerment: a discussion on concepts2010In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 79, no 2, p. 167-172Article in journal (Refereed)
    Abstract [en]

    Objective: The concepts of patient-centeredness and patient empowerment offer opportunities for patients to increase their autonomy and involvement in their care and treatment. However, these concepts appear to be understood in different ways by professional groups involved in healthcare and research. To optimize understanding there is a need to create a common language. To explore and compare the concepts of patient-centeredness and patient empowerment, and clarify a possible relationship between the two from the perspective of the encounter between patients and their healthcare providers. Methods: Concept analysis approach in which the concepts are compared based on literature review. Results: Patient-centeredness can be the goal of an encounter between patient and caregiver. As a process, it is of great value in the process of patient empowerment. Patient empowerment appears to be broader than patient-centeredness, and may place greater demands on caregivers and the organisation of healthcare. Conclusion: Patient-centeredness and patient empowerment are complementary concepts which do not oppose one-another. Patient empowerment can be achieved by patient-centeredness, but patients can also empower themselves. Practice implications: Clarification of patient-centeredness and patient empowerment can facilitate their use by those involved in healthcare, improve the quality of healthcare, and aid future research. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

  • 6.
    Håkansson Eklund, Jakob
    et al.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kumlin, Tomas
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Kaminsky, Elenor
    Uppsala Univ, Dept Publ Hlth & Caring Sci, Uppsala, Sweden..
    Skoglund, Karin
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Malardalen Univ, Sch Hlth Care & Social Welf, Postbox 883, SE-72123 Vasteras, Sweden..
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Sundler, Annelie J.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, SE-50190 Boras, Sweden..
    Conden, Emelie
    Uppsala Univ, Vastmanland Hosp, Clin Res Ctr, Uppsala, Sweden..
    Summer Meranius, Martina
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    "Same same or different?" A review of reviews of person-centered and patient-centered care2019In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 102, no 1, p. 3-11Article, review/survey (Refereed)
    Abstract [en]

    Objective: To provide a synthesis of already synthesized literature on person-centered care and patient-centered care in order to identify similarities and differences between the two concepts. Methods: A synthesis of reviews was conducted to locate synthesized literature published between January 2000 and March 2017. A total of 21 articles deemed relevant to this overview were synthesized using a thematic analysis. Results: The analysis resulted in nine themes present in person-centered as well as in patient-centered care: (1) empathy, (2), respect (3), engagement, (4), relationship, (5) communication, (6) shared decision-making, (7) holistic focus, (8), individualized focus, and (9) coordinated care. The analysis also revealed that the goal of person-centered care is a meaningful life while the goal of patient-centered care is a functional life. Conclusions: While there are a number of similarities between the two concepts, the goals for person-centered and patient-centered care differ. The similarities are at the surface and there are important differences when the concepts are regarded in light of their different goals. Practice implications: Clarification of the concepts may assist practitioners to develop the relevant aspects of care. Person-centered care broadens and extends the perspective of patient-centered care by considering the whole life of the patient.

  • 7.
    Kjeldmand, Dorte
    et al.
    University of Uppsala, Uppsala, Sweden.
    Holmström, Inger
    University of Uppsala, Uppsala, Sweden.
    Rosenqvist, Urban
    University of Uppsala, Uppsala, Sweden.
    Balint training makes GPs thrive better in their job2004In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 55, no 2, p. 230-235Article in journal (Refereed)
    Abstract [en]

    In this study, we examined Balint group participants' sense of control and satisfaction in their work situation and their attitudes towards caring for patients with psychosomatic problems. Forty-one GPs filled in a questionnaire with a 10-point visual analogue scale. Of these, 20 had participated in Balint groups for more than one year and 21 were a reference group. The Balint physicians reported better control of their work situation (e.g. taking coffee breaks and participating in decision making), thought less often that the patient should not have come for consultation or that psychosomatic patients were a time-consuming burden, and were less inclined to refer patients or take unneeded tests to terminate the consultation with the patient. These results might indicate higher work-related satisfaction and better doctor-patient relationship.

  • 8.
    Kjeldmand, Dorte
    et al.
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    Rosenqvist, Urban
    Uppsala universitet, Sweden.
    How patient-centred am I?: A new method to measure physicians' patient-centredness2006In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 62, no 1, p. 31-37Article in journal (Refereed)
    Abstract [en]

    Objective

    To describe a new method to determine physicians’ self-perceived degree of patient-centredness. A pilot study combining qualitative and quantitative methods.

    Methods

    Forty-one general practitioners (GPs) answered a questionnaire consisting of three open-ended questions about their view of the consultation and by choosing among 28 roles of the physician in the physician–patient relationship. Twenty of the GPs had participated in Balint groups while 21 had had no access to Balint group. Patient-centredness is central to Balint groups and consequently Balint group participants would be expected to be patient-centred.

    Results

    The answers to the two parts were divided into three groups each, patient-centred, non-patient-centred and intermediary, and analysed statistically. Significantly more Balint participants were patient-centred than the reference group.

    Conclusion

    The instrument describes physicians’ self-perceptions of their patient-centredness and can distinguish a group of patient-centred physicians from a group of non-patient-centred physicians.

    Practice implications

    The instrument can be useful to evaluate educational programmes and detect decline in patient-centredness as early sign of burnout.

  • 9.
    Mårdby, Ann-Charlotte
    et al.
    Dept. of Public Health and Community Medicine, University of Gothenburg, Sweden.
    Åkerlind, Ingemar
    Mälardalen University, School of Health, Care and Social Welfare.
    Hedenrud, Tove
    Dept. of Public Health and Community Medicine, University of Gothenburg, Sweden.
    Different development of general beliefs about medicines during undergraduate studies in medicine, nursing and pharmacy2009In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 75, no 2, p. 283-289Article in journal (Refereed)
    Abstract [en]

     Objective: To analyze differences in general beliefs about medicines between healthcare students and to see if health education was of importance to general beliefs about medicines.

    Method: The participants were students of medicine, pharmacy, pharmaceutical bioscience, dispensing pharmacy, nursing and economics (comparison group) at the University of Gothenburg. Data were collected twice in 2003 and 2005. A questionnaire was used comprising background questions and the general part of Beliefs about Medicines Questionnaire.

    Results: The questionnaire was completed by 460 of 642 (71.7%) first-year and 293 of 398 (73.6%) thirdyear students. Over 70% were women and two-thirds were under 25 years of age. Medical and pharmacy students saw medicines as less harmful than nursing students did. Stage of education was also important: third-yearmedical and pharmacy students saw medicines as more beneficial and less harmful than firstyear students did. Experience of medicine use was relevant to general beliefs about medicines.

    Conclusion: Different beliefs exist between healthcare professions owing to different types and stages of education, which could result in different messages being given to the patient.

    Practice implications: It is important to educate future healthcare professionals about the potential effect  of beliefs on communication.

  • 10.
    Röing, Marta
    et al.
    Uppsala universitet, Sweden.
    Hirsch, Jan-Michaél
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    The uncanny mouth - a phenomenological approach to oral cancer2007In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 67, no 3, p. 301-306Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this retrospective qualitative study was to describe how patients with oral cancer experience their sickness and treatment. Methods: A purposeful sample of seven patients with oral cancer was interviewed. Data were analysed using a phenomenological approach outlined by van Manen. Results: The essence of the patients' experiences can be described as embodiment in a mouth that has become unreal, or 'uncanny'. At treatment start the body is invaded by cancer, during treatment there is no escape from a wounded mouth, at treatment end the mouth is disabled. Conclusions: The findings indicate that oral cancer patients' need for support may increase as treatment progresses and may be greatest at end of radiotherapy, as they return home with mouths that have not recovered after treatment and do not function normally. Practice implications: This suggests the importance of understanding the patients' situation during treatment and their desire for a return to normal living and normal mouth functions at treatment end. If possible, plans for oral rehabilitation should be considered in initial treatment planning. As the treatment of oral cancer is multiprofessional, this knowledge may be useful in guiding the organization of oral cancer care and multiprofessional collaboration.

  • 11.
    Sundler, Annelie Johansson
    et al.
    Univ Boras, Fac Caring Sci Work Life & Social Welf, SE-50190 Boras, Sweden..
    Höglander, Jessica
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Håkansson Eklund, Jakob
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Eide, Hilde
    Univ Coll Southeast Norway, Fac Hlth Sci, Postbox 7053, N-3007 Drammen, Norway..
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.
    Older persons' expressions of emotional cues and concerns during home care visits. Application of the Verona coding definitions of emotional sequences (VR-CoDES) in home care2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 2, p. 276-282Article in journal (Refereed)
    Abstract [en]

    Objective: This study aims to a) explore to what extent older persons express emotional cues and concerns during home care visits; b) describe what cues and concerns these older persons expressed, and c) explore who initiated these cues and concerns. Methods: A descriptive and cross-sectional study was conducted. Data consisted of 188 audio recorded home care visits with older persons and registered nurses or nurse assistants, coded with the Verona coding definitions on emotional sequences (VR-CoDES). Results: Emotional expressions of cues and concerns occurred in 95 (51%) of the 188 recorded home care visits. Most frequent were implicit expressions of cues (n = 292) rather than explicit concerns (n = 24). Utterances with hints to hidden concerns (63,9%, n = 202) were most prevalent, followed by vague or unspecific expressions of emotional worries (15,8%, n = 50). Most of these were elicited by the nursing staff (63%, n = 200). Conclusion: Emotional needs expressed by the older persons receiving home care were mainly communicated implicitly. To be attentive to such vaguely expressed emotions may demand nursing staff to be sensitive and open. Practice implications: The VR-CoDES can be applied on audio recorded home care visits to analyse verbal and emotional communication, and may allow comparative research. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

  • 12.
    Sundling, Vibeke
    et al.
    Univ Coll Southeast Norway, Norway.
    Sundler, Annelie J.
    University of Borås, Sweden.
    Holmström, Inger K.
    Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare. Uppsala Univ, Sweden.
    Kristensen, Dorte Vesterager
    Univ Coll Southeast Norway, Norway.
    Eide, Hilde
    Univ Coll Southeast Norway, Norway.
    Mindfulness predicts student nurses' communication self-efficacy: A cross-national comparative study2017In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 100, no 8, p. 1558-1563Article in journal (Refereed)
    Abstract [en]

    Objectives: The aim of this study was to compare student nurses' communication self-efficacy, empathy, and mindfulness across two countries, and to analyse the relationship between these qualities. Methods: The study had a cross-sectional design. Data was collected from final year student nurses in Norway and Sweden. Communication self-efficacy, empathy, and mindfulness were reported by questionnaires; Clear-cut communication with patients, Jefferson Scale of Empathy, and Langer 14 items mindfulness scale. Results: The study included 156 student nurses, 94 (60%) were Swedish. The mean communication self-efficacy score was 119 (95% CI 116-122), empathy score 115 (95% CI 113-117) and mindfulness score 79 (95% CI 78-81). A Mann-Whitney test showed that Swedish students scored significantly higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. When adjusted for age, gender, and country in a multiple linear regression, mindfulness was the only independent predictor of communication self-efficacy. Conclusion: The Swedish student nurses in this study scored higher on communication self-efficacy, empathy, and mindfulness than Norwegian students did. Student nurses scoring high on mindfulness rated their communication self-efficacy higher. Practice implications: A mindful learning approach may improve communication self-efficacy and possibly the effect of communication skills training. 

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