Anne Werner

Encountering the Continuing Challenges for Women With Chronic Pain: Recovery Through Recognition

This work is based on experiences from a group treatment for women with chronic musculoskeletal pain. The authors explored the nature and consequences of the reported benefits from being met with recognition in the groups, focusing the potential usefulness in everyday life. In-depth interviews of six participants of various age and backgrounds were conducted. The women’s answers reflected how recognition had enhanced strength, confidence, and awareness expressed as increased bodily, emotional, and social competence. This competence provided tools to handle their pain and illness. Achieving the sense of a better life with chronic pain represents an important recovery process. Because of the normative and gendered way the term “coping(ability)” has been used, the authors introduce recovery competence as a more fruitful concept.

Care challenges for informal caregivers of chronically ill lung patients: Results from a questionnaire survey

Aims: The article aims to answer who the informal caregivers of patients with chronic obstructive pulmonary disease (COPD) are, what kind of help they provide, and how they experience providing help to the patient. Method: Data from a questionnaire survey to next of kin of COPD patients carried through in Norway in December 2009 and January 2010 is explored. Result: About 70% of the patients have one or more informal caregivers, and a majority of the caregivers is the patient’s spouse, most often a wife. The help provided is, to a large extent, practical help like housework, garden work, and shopping. Another important support is to accompany the patient to health care. About 45% of the caregivers are part of the work force. Rather few of the respondents experience the caregiving as so demanding that they have chosen to work part-time or quit working. The most demanding part of being an informal caregiver is an overall worrying for the patient. Conclusions: Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and long-term care services in the future.

Patients with acute exacerbation of chronic obstructive pulmonary disease feel safe when treated at home: a qualitative study.

BackgroundThe design of new interventions to improve health care for patients with chronic obstructive pulmonary disease (COPD) requires knowledge about what patients with an acute exacerbation experience as important and useful. The objective of the study was to explore patients’ experiences of an early discharge hospital at home (HaH) treatment programme for exacerbations in COPD.MethodsSix exacerbated COPD patients that were randomised to receiving HaH care and three patients randomised to receiving traditional hospital care were interviewed in semi-structured in-depth interviews. Four spouses were present during the respective patients’ interviews. The interviews were audio-taped, transcribed and analysed by a four-step method for systematic text condensing.ResultsDespite limited assistance from the health care service, the patients and their spouses experienced the HaH treatment as safe. They expressed that information that was adapted to specific situations in their daily lives and given in a familiar environment had positive impact on their self-management of COPD.ConclusionThe results contribute to increased knowledge and awareness about what the patients experienced as important aspects of a HaH treatment programme. How adapted input from health services can make patients with exacerbation of COPD feel safe and better able to manage their disease, is important knowledge for developing new and effective health services for patients with chronic disease.

Children of parents with alcohol problems performing normality: A qualitative interview study about unmet needs for professional support

Background Children of parents with alcohol problems are at risk for serious long-term health consequences. Knowledge is limited about how to recognize those in need of support and how to offer respectful services. Method From nine interviews with adult children from families with alcohol problems, we explored childhood experiences, emphasizing issues concerning potentially unmet needs for professional support. Smarts perspective on family secrets and Goffmans dramaturgical metaphor on social order of the family focusing on the social drama and the dramaturgy enacted by the children supported our cross-case thematic analysis. Findings The social interaction in the family was disrupted during childhood because of the parents drinking problems. An everyday drama characterized by tension and threats, blame and manipulation was the backstage of their everyday life. Dealing with the drama, the children experienced limited parental support. Some children felt betrayed by the other parent who might trivialize the problems and excuse the drinking parent. Family activities and routines were disturbed, and uncertainty and insecurity was created. The children struggled to restore social order within the family and to act as normally as possible outside the family. It was a dilemma for the children to disclose the difficulties of the family. Conclusion Altogether, the children worked hard to perform a normally functioning family, managing a situation characterized by unmet needs for professional support. Adequate support requires recognition of the childrens efforts to perform a normally functioning family.Background Children of parents with alcohol problems are at risk for serious long-term health consequences. Knowledge is limited about how to recognize those in need of support and how to offer respectful services. Method From nine interviews with adult children from families with alcohol problems, we explored childhood experiences, emphasizing issues concerning potentially unmet needs for professional support. Smarts perspective on family secrets and Goffmans dramaturgical metaphor on social order of the family focusing on the social drama and the dramaturgy enacted by the children supported our cross-case thematic analysis. Findings The social interaction in the family was disrupted during childhood because of the parents drinking problems. An everyday drama characterized by tension and threats, blame and manipulation was the backstage of their everyday life. Dealing with the drama, the children experienced limited parental support. Some children felt betrayed by the other parent who might trivialize the problems and excuse the drinking parent. Family activities and routines were disturbed, and uncertainty and insecurity was created. The children struggled to restore social order within the family and to act as normally as possible outside the family. It was a dilemma for the children to disclose the difficulties of the family. Conclusion Altogether, the children worked hard to perform a normally functioning family, managing a situation characterized by unmet needs for professional support. Adequate support requires recognition of the childrens efforts to perform a normally functioning family.

Between ideals and reality in home-based rehabilitation

Abstract Setting and objective The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway’s health authorities. Design and subjects In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees – service providers and managers – in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. Results The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser–provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. Conclusion and implications A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. Key points Home-based rehabilitation is documented to be effective, and access to rehabilitation has been established in Norwegian law. The purchaser–provider organization, high rate of speed, and a scarcity of resources in home-based services hamper rehabilitation work. Healthcare providers find themselves squeezed between the health authorities’ overarching guidelines and requirements and the possibilities of achieving them. Rehabilitation must be placed on the agenda on the condition that authorities understand the clinical aspect of rehabilitation.

Recognition can leave room for disagreement in the doctor–patient consultation

OBJECTIVE We wanted to explore how recognising interaction, as described by psychologist Schibbye, is played out in a patient doctor encounter including the behaviour of both parties and their simultaneous communication. METHODS We selected videotapes from five doctor-patient encounters where a recognising attitude was identified. The episodes were analysed using a qualitative method for studying interaction and relationship at the micro-level. We describe an episode which is suitable for demonstrating how a recognizing attitude can leave room for disagreement. RESULTS The doctors recognising attitude with a basic respect for the other persons experience perspective has a crucial effect on the doctor-patient relationship. In this consultation, the doctor succeeds in taking the patients experience perspective by listening, wondering and exploring to check that he has interpreted the patient correctly. A potential conflict situation arises, but there is no conflict. When the relationship is characterised by recognition, disagreement is allowed, without doing any damage. CONCLUSION Schibbyes ideas and terms can provide new perspectives on the doctor-patient interaction. PRACTICE IMPLICATIONS For the doctor, a fundamental respect for the patients perspective may make it easier to tolerate when patients have values and preferences that conflict with the doctor or with sound medical practice.

Encounters with service professionals experienced by children from families with alcohol problems: A qualitative interview study

Aim: The aim of this study was to explore encounters with service professionals experienced in childhood and adolescence by children who grew up with parental alcohol abuse. We focused on their accounts from situations indicating children’s struggles or parental drinking problems. Methods: Semi-structured qualitative interview study was conducted with retrospective data from nine adults. Systematic text condensation was used to understand childhood experiences from encounters with professionals. Results: Participants believed that professionals rarely recognised their parents’ drinking problems. The children felt abandoned by professionals who must have noticed their struggles. Participants experienced that their appearance or behaviour was ignored and that they were not invited to talk. Professionals taking part in individual family members’ problems seemed to avoid subsequent involvement in underlying parental drinking. Even when problems were obvious, participants felt that professionals took no further action. Medical and social problems were managed within very confined perspectives. Conclusions: Specific commitment to confront cultural taboos is needed to attend to children’s unmet needs. Recognising each young person’s situation implies not only noticing that something is wrong, but also taking action. Children’s experiences of fragmented and confined approaches towards parental drinking problems may be counteracted by better collaboration between teachers, school nurses and GPs.

Development of a model for organisation of and cooperation on home-based rehabilitation – an action research project

Abstract Purpose: To use general policy guidelines and staff experience of rehabilitation work in two boroughs in Oslo to develop a model for organisation and cooperation in home-based rehabilitation. Method: The project was conducted as a collaboration between researchers and employees in the two boroughs. It was a practice-oriented study designed as an action research project combining knowledge generation and improvement of practice. Data were collected at seven meetings, and individual, qualitative interviews with a total of 24 persons were conducted in the period February 2010 to June 2011. Results: Home-based rehabilitation occurred rarely in the boroughs, and this field received little attention. However, this project provided a broad discussion of rehabilitation involving all parts of the organisation of both boroughs. In the course of the project, researchers and borough staff together developed a model for the organisation of and cooperation on rehabilitation including a coordinating unit assigned the paramount responsibility for the rehabilitation and an interdisciplinary team organising the collaboration on the practical level. Conclusions: When implementing a model like this in primary health services, we recommend involving several levels and service locations of the borough staff in order to legitimise the model in the organisation. Implications for Rehabilitation An increasing number of older people with chronic diseases in the Western world have caused increasing emphasis on rehabilitation in primary health care in patients’ homes. This study has elucidated challenging framework conditions for rehabilitation work in two Norwegian boroughs. To reduce municipal challenges we propose a rehabilitation model with a coordinating unit with the paramount responsibility for rehabilitation, and an interdisciplinary team constituting a suitable structure for collaboration.

Conveying hope in consultations with patients with life-threatening diseases: the balance between supporting and challenging the patient

Abstract Objective: There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. Design and methods: We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. Results: The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient’s views and communicate disagreement. Conclusions: The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient’s real concerns is essential for being able to relieve and comfort him and convey hope.

Searching for “transformative moments”: A qualitative study of nurses’ work during home visits to COPD patients and their caregivers in Norway

The integration of families into healthcare services is being emphasized increasingly in healthcare polices. The aim of this study was to investigate how professionals during home visits support both patients and caregivers in accepting and accommodating to illness.