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  • 1.
    Holmström, Inger
    et al.
    Uppsala Science Park, Sweden.
    Larsson, Jan
    Uppsala Science Park, Sweden.
    A tension between genuine care and other duties: Swedish nursing students' views of their future work.2005In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 25, no 2, p. 148-155Article in journal (Refereed)
    Abstract [en]

    There is a current need for nurses to take on new roles due to changing health care policies, economic cut-backs and shortage of staff. It is therefore important to study nursing students' view of their future profession. The theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work is expressed in their actions. The aim of this study was to describe nursing students' understanding of their future professional role in health care. A purposeful sample of 12 nursing students wrote narratives. The texts were condensed in five steps using the Empirical Phenomenological Psychological Method. The essence of the students' view of their future work was A tension between genuine nursing care and other duties. Four themes constituted this essence: professional status, working conditions and stress, evidence-based nursing contra holistic care, teamwork, co-operation and disrespect, and intensive care instead of geriatrics. This study highlights pedagogic and practical problems that need to be constructively addressed. The nursing students' eagerness to care in a holistic way needs to be acknowledged and used in a fruitful way. This core function of nursing needs to be integrated with up-to-date nursing research.

  • 2.
    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.

  • 3.
    Larsson, Jan
    et al.
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    Defining and promoting excellence in anaesthesia: In Refresher course lectures, Euroanaesthesia 20062006Conference paper (Other academic)
  • 4.
    Larsson, Jan
    et al.
    Uppsala Academic Hospital, Uppsala, Sweden.
    Holmström, Inger
    Department of Public Health and Caring Sciences, Health Services Research, Uppsala, Sweden.
    Phenomenographic or phenomenological analysis: does it matter?: Examples from a study on anaesthesiologists' work2007In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 2, no 1, p. 55-64Article in journal (Refereed)
    Abstract [en]

    Phenomenography is a research approach developed from an educational framework. However, practised in other areas this research approach can be misunderstood as seems to be the case in some reports on allegedly phenomenographic studies. In this article, the authors show how the phenomenographic approach differs from a phenomenological one, using as an example an interview study on anaesthesiologists' understanding of work. Having performed both a phenomenographic and a phenomenological analysis of the same transcripts, the researchers compared the results from the two approaches. The result of the phenomenographic study was four ways of understanding work: (a) monitoring and controlling the patient's vital functions; (b) guiding the patient safely through the operation; (c) serving patients, other doctors and nurses; (d) leading the operating theatre and team. The phenomenological analysis showed the essence of being an anaesthesiologist: Carrying the responsibility for the patient's vital functions; always being alert, watching carefully over the patient's body, ready to act whenever the patient's life is in danger, however difficult the circumstances. The authors discuss the differences between the two research approaches, stressing the value of phenomenographic studies in educational settings as well as its limited value in research on patients' experiences of illness.

  • 5.
    Larsson, Jan
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Pionjärers arbete i motvind födde två nya medicinska specialiteter2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 36, p. 2525-2528Article in journal (Refereed)
    Abstract [en]

    [Pioneers' work against odds resulted in two new medical specialties]

    Torsten Gordh Sr and Ragnar Berfenstam are two influential Swedish doctors, who have worked in medical specialities of quite different character, namely social medicine and anaesthesiology. Still they have much in common: both introduced a new medical speciality in Sweden and both continued with research for many years after retirement. Two physicians with this background should have much to offer young doctors of today. We therefore performed an interview study to describe Torsten Gordh's and Ragnar Berfenstam's experiences as researchers and physicians. The study was based on in-depth interviews. The thematic analysis of the interview texts showed that the two pioneer physicians had to fight an uphill battle to introduce their new medical specialities. Both started new fields of scientific research; at the same time both were dedicated to their professional work. Torsten Gordhs and Ragnar Berfenstams were not only successful researchers but also proficient and considerate doctors for their patients.

  • 6.
    Larsson, Jan
    et al.
    Uppsala Academic Hospital, Uppsala, Sweden.
    Holmström, Inger
    University of Uppsala, Sweden.
    Lindberg, Eva
    University of Uppsala, Sweden.
    Rosenqvist, Urban
    University of Uppsala, Sweden.
    Trainee anaesthetists understand their work in different ways: implications for specialist education2004In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 92, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    Background. Traditionally, programmes for specialist educationin anaesthesia and intensive care have been based on lists ofattributes such as skills and knowledge. However, modern researchin the science of teaching has shown that competence developmentis linked to changes in the way professionals understand theirwork. The aim of this study was to define the different waysin which trainee anaesthetists understand their work.

    Methods. Nineteen Swedish trainee anaesthetists were interviewed.The interviews sought the answers to three open-ended questions.(i) When do you feel you have been successful in your work?(ii) What is difficult or what hinders you in your work? (iii)What is the core of your anaesthesia work? Transcripts of theinterviews were analysed by a phenomenographic approach, a researchmethod aiming to determine the various ways a group of peopleunderstand a phenomenon.

    Results. Six ways of understanding their work were defined:giving anaesthesia according to a standard plan; taking responsibilityfor the patient’s vital functions; minimizing the patient’ssuffering and making them feel safe; giving service to specialistdoctors to facilitate their care of patients; organizing andleading the operating theatre and team; and developing one’sown competence, using the experience gained from every new patientfor learning.

    Conclusions. Trainee anaesthetists understand their work indifferent ways. The trainee’s understanding affects bothhis/her way of performing work tasks and how he/she developsnew competences. A major task for teachers of anaesthesia isto create learning situations whereby trainees can focus onnew aspects of their professional work and thus develop newways of understanding it.

  • 7.
    Larsson, Jan
    et al.
    Uppsala Academic Hospital, Uppsala, Sweden.
    Holmström, Inger
    University of Uppsala, Uppsala, Sweden .
    Rosenquist, Urban
    University of Uppsala, Uppsala, Sweden .
    Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 47, no 7, p. 787-793Article in journal (Refereed)
    Abstract [en]

    Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work. Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed. Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly. Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

  • 8.
    Larsson, Jan
    et al.
    Uppsala Academic Hospital, Uppsala, Sweden .
    Holmström, Inger
    University of Uppsala, Uppsala, Sweden.
    Rosenqvist, Urban
    University of Uppsala, Uppsala, Sweden.
    Professional artist, good Samaritan, servant and co-ordinator: four ways of understanding the anaesthetist's work2003In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 47, no 7, p. 787-793Article in journal (Refereed)
    Abstract [en]

    Background: Evaluating clinical competence among anaesthetists has so far focused mostly on theoretical knowledge and practical skills. According to theory, however, the way anaesthetists understand their own work has also greatly influenced the development of professional competence. The aim of this study was to investigate how anaesthetists understand their work.

    Methods: Nineteen Swedish anaesthetists were interviewed. The interviews were open and sought answers to three questions 1) When do you feel you have been successful in your work?; 2) What is difficult or what hinders you in your work?; and 3) What is the core of your professional anaesthesia work? Phenomenographic analysis was performed.

    Results: Four ways of understanding the anesthesiologists' professional work were found: 1) Give anaesthesia and control the patient's vital functions; 2) Help the patient, alleviate his/her pain and anxiety; 3) Give service to the whole hospital to facilitate the work of other doctors and nurses, caring for severely ill patients; and 4) Organize and direct the operation ward to make the operations list run smoothly.

    Conclusions: This study shows that anaesthetists understand their work in qualitatively different ways, which can be assumed to affect their work actions and also the way their competence develops. This has implications for the education of anaesthetists; it is important to find ways of making anaesthetists in training consciously aware of the different ways their work can be understood, as this will give them better prerequisites for future competence development.

  • 9.
    Larsson, Jan
    et al.
    Uppsala universitet, Sweden.
    Rosenqvist, Urban
    Uppsala universitet, Sweden.
    Holmström, Inger
    Uppsala universitet, Sweden.
    Being a young and inexperienced trainee anaesthetist: a phenomenological study on tough working conditions2006In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 50, no 6, p. 653-658Article in journal (Refereed)
    Abstract [en]

     Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

    Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

    Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

    Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

    Background: Physicians at the beginning of their specialist education have been reported to be especially exposed to stress and difficult working conditions. Considerable worry has also been caused by reports about anaesthetists dying at a younger age than other specialists as well as by reports about higher than average suicide rates among anaesthetists. Maybe as a consequence, many young doctors are reluctant to choose anaesthesiology as their future specialty. The aim of this study was to investigate what difficulties trainee anaesthetists experience at work.

    Methods: Nineteen trainee anaesthetists in six Swedish hospitals were interviewed. Phenomenological analysis of the interview text was performed.

    Results: All trainees had experienced considerable, sometimes extreme demands at work. Most of them often felt insufficient and inadequate and had problems with the professional role. Support from consultants was sometimes lacking. Some trainees expressed deep feelings of loneliness and helplessness in difficult clinical situations.

    Conclusions: This study shows that trainee anaesthetists have to live up to high work demands, often with very little support. Because too much stress is an obstacle to professional learning, such working conditions are a hindrance to good specialist education. The first measure to be taken should be to ensure that all trainee anaesthetists always have easy access to senior cover.

  • 10.
    Larsson, Jan
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Rosenqvist, Urban
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Enjoying work or burdened by it? How anaesthetists experience and handle difficulties at work: a qualitative study2007In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 99, no 4, p. 493-499Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to explore difficulties at work fromanaesthetists’ own perspective and to examine how anaesthetistshandle and cope with situations that are perceived as difficultand potentially stressful.

    Methods: Two sets of interviews were conducted with 19 specialist anaesthetistsin Sweden. The first set of interviews aimed at finding howthe anaesthetists experienced difficulties at work. It consistedof in-depth interviews based on one open-ended question. Weanalysed the interviews with a phenomenological method, lookingfor themes in anaesthetists’ descriptions of difficultiesat work. In the second set, the interviews were semi-structuredwith open-ended questions, based on themes found in the firstinterview set. These interviews aimed at exploring how the intervieweesdescribed their ways of handling difficulties and how they copedwith potentially stressful situations.

    Results: Analysis of the first set of interviews resulted in five themes,describing how the anaesthetists experienced difficulties atwork. All interviewees talked about difficulties related tomore than one of the themes. The second set of interviews revealedtwo main categories of ways of handling difficulties. First,problem solving consisted of descriptions of methods for handlingdifficult situations which aimed at solving problems, and second,coping strategies described ways of appraising potentially stressfulsituations that minimized stress, despite the problem not beingsolved.

    Conclusions: The anaesthetists interviewed in this study maintained thatthey enjoyed work and could see no external obstacles to doinga good job. They had arrived at a reconciliation of their workwith its inherent difficulties and problems. Getting accessto their coping strategies might help young anaesthetists tocome to terms with their work.

  • 11.
    Larsson, Jan
    et al.
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Rosenqvist, Urban
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Holmström, Inger
    Uppsala universitet, Hälso- och sjukvårdsforskning, Sweden.
    Stressful threats or stimulating challenges: how experienced anaesthetists cope with difficult situations at work2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no Suppl. 118, p. 17-17Article in journal (Refereed)
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