Bibi Hølge-Hazelton

Continuing professional development for general practitioners: supporting the development of professionalism

Medical Education 2010: 44: 412–420

Gender in medicine — does it matter?:

Aims: A broad range of socio-cultural issues have been recognized as determinants for health and disease. A notion of gender neutrality is still alive in the medical culture, suggesting that gender issues are not relevant within this field. Methods: We have explored the claim that doctors encounter their patients as human beings, not as men or women, and discuss causes and consequences of such a claim. Results: Empirical evidence does not support such a claim — gender seems to have a strong impact on medical knowledge and practice. The concept andronormativity signifies a state of affairs where male values are regarded as normal to the extent that female values disappear or need to be blatantly highlighted in order to be recognized. We have applied this frame of reference to understand how the idea of gender neutrality has been established in medicine. The average medical practitioner, teacher, or researcher is a man. We suggest that notions of normality subtly construct gender in medicine in ways where men become normal, while women become deviant. Finally, we discuss strengths and pitfalls of three different strategies which have been used by gender researchers in health to challenge andronormativity: demonstrating gender differences, revealing the consequences of gendered power inequalities, and deconstructing the meaning of gender. Conclusions: We conclude that gender still matters in medicine.

When the spiral of action research collapses: Using the arts to interpret and continue the process in collective research dialogues

In the spiral of action research all participants are expected to work together towards a continuously developing fulfillment of the aims of the project. The data collection is supposed to lead to critical reflection, strategy development, and implementation in cycles, actively involving all participants and researchers. However, communicating processes that go wrong can be difficult. Facing the final communication of an action research project on medical education, we were invited to give a keynote lecture at a workshop with other action researchers. We used this invitation as an opportunity to reframe the researcher—practitioner collaborations as the culturally recognizable stories in the gap between research and practice. This allowed us to continue the action research cycle with a group of research peers that had not been part of the original project. Through the use of photos, music and film clips, and in the frame of a fairy tale, we worked as in a socio-drama, constructing two parallel and illustrated narratives, inviting the peer researchers at the workshop to reflect on our experiences, and to bring in their own experiences. This communication strategy helped us and the research peers to work through the emotional impact of our research. It also developed our understanding of the project process, and supported the peer researchers to tell and share their stories, giving them new insight into their own research processes.

Primary care for young adult cancer survivors: an international perspective.

PurposeInternationally, family physicians (FP) are not routinely involved in young adult cancer (YAC) care. In this short report, we would like to make a compelling argument for primary care involvement.MethodsComparative descriptions and literature review.ResultsCancer among YAs is rare and usually not the first thing that comes into the FP’s mind. Youth is sometimes mistakenly regarded as a protective factor. Across the countries, almost all YACs are treated in tertiary health care facilities with specialists providing the majority of care. Health care services are covered by the universal health insurance in Denmark, The Netherlands, and Canada but not in the US. Once the YAC has completed acute treatment and follow-up care, they often return to the care of the FPs who may potentially be expected to deal with and take action upon any possible medical, mental health, and psychosocial issues the YA cancer patient may present with. The role of the FP in follow-up care seems to be very limited.ConclusionsYACs in the western world seem to have comparable medical and psychosocial problems. However, the nature of health insurance is such that it impacts differently on the care of this group of cancer patients. Primary care features such as patient-centered, integrated, and comprehensive care over extended periods of time bring the FP into the unique position to provide follow-up for YAC. However, this will require integrating patient’s perspectives on their care, professional continuing medical education (CME) initiatives, and an enhanced cooperative effort between those delivering and coordinating cancer care.

Poethical: Breaking Ground for Reconstruction.

Departing from a methodological experiment performed by the authors, this article reflects on and discusses issues of ethics and politics in poetic strategies of ‘representation’. In relation to the experiment the article questions how to conceive the notion of connectedness between empirical time and the reconstruction of it in poststructuralist research. In continued reflection the article elaborates on the meaning and status of body and emotion in poststructuralist, feminist research. The article digs further into questions of poststructuralist epistemology and validity, and asks if poetic, open‐ended ways of presenting lived experience are especially ethical. These reflections lead to a discussion of the possibility of complex and ambiguous poetic representations being politically influential, i.e. how this research can matter to others.

Integrating nurse researchers in clinical practice - a challenging, but necessary task for nurse leaders.

AIM To create awareness among nurse leaders, of what they may need to consider, when integrating nurse researchers as advanced nurse practitioners (ANP) at PhD-level among their staff. BACKGROUND In a time of transition nurse leaders may be challenged by the change towards evidence-based clinical nursing, including integrating nurse researchers in ANP positions. METHODS A collective case study including three ANPs took place at a large regional hospital in Denmark. The cases were first analysed by focusing on the generic features, functions and skills of ANPs, and second by focusing on the approaches to evidence-based practice seen in the cases. RESULTS Regardless of same position, formal level of research expertise and overall responsibility, different approaches related to each ANPs professional profile, interest, academic ambitions and personality were seen. CONCLUSION Nurse leaders must ensure a process where the content and expectations of the particular role are mutually clarified and adjusted to the individual ANP and to the specific context, in order to create a harmonious match. IMPLICATIONS FOR NURSING MANAGEMENT In order to clarify expectations regarding the inclusion of nurse researchers as ANPs at PhD level, the paper provides firm recommendations that may guide the process.

Developing Evidence-Based Practice: Documenting a Tailored Writing Course for Healthcare Practitioners

Background: With the ambition of strengthening interdisciplinary and nursing research culture and research infrastructure at a regional hospital in Denmark, several initiatives were taken, one of which was a tailor-made writing course. Methods: The course was developed and implemented using an action research-inspired approach. Aims: The course had two aims. The first was to motivate practitioners to write articles about completed developmental or research projects, the second was to establish an environment where it would be possible for the healthcare practitioners to debate issues of evidence-based practice. Findings and conclusions: This article describes the development and implementation processes of three course processes and discusses how the use of a tailored writing course can contribute to the goal of strengthening the documentation of evidence-based practice in a regional hospital.

Generalist palliative care in hospital – Cultural and organisational interactions. Results of a mixed-methods study

Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse. Aim: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. Setting/participants: A Danish regional hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use of generalist palliative care clinical guideline’, suggesting that the guideline had not reached all levels of the organisation. Conclusion: Contrasting issues in the hospital’s provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture – interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.

In a Unique Position or Squeezed Out? The Professional Roles of General Practitioners in Cancer Care in General and of Young Adult Cancer Patients in Particular

Background. Exploring experiences of general practitioners (GPs), regarding roles in cancer care of young adults (YAs). Methods. Ten qualitative interviews with GPs were theoretically analyzed against professional characteristics. Findings. The GPs tended to make general statements, using everyday language, they experience that their patients disappear, they are seldom involved, and they lack knowledge. Conclusions. GPs have few experiences with YA cancer patients, but they have a potentially unique role in general primary cancer care if they develop their vocational vocabulary, relate more to relevant theory, and get a clearer vision of the content of the professional aspects of their work.Background. Exploring experiences of general practitioners (GPs), regarding roles in cancer care of young adults (YAs). Methods. Ten qualitative interviews with GPs were theoretically analyzed against professional characteristics. Findings. The GPs tended to make general statements, using everyday language, they experience that their patients disappear, they are seldom involved, and they lack knowledge. Conclusions. GPs have few experiences with YA cancer patients, but they have a potentially unique role in general primary cancer care if they develop their vocational vocabulary, relate more to relevant theory, and get a clearer vision of the content of the professional aspects of their work.

How general practitioners perceive and assess self-care in patients with multiple chronic conditions: a qualitative study

BackgroundIt is not known how general practitioners (GPs) perceive the concept of self-care and how they assess self-care ability in patients with multiple chronic conditions. As a part of the strategy to improve the care of people living with chronic conditions, disease management programs in Denmark require GPs and other health care workers to assess and support patients’ self-care ability. The aim of the present study was to explore GPs’ perceptions and assessment of self-care ability in patients with multiple chronic conditions who have difficulty following a given treatment.MethodsA qualitative study conducted through in-depth, semi-structured interviews with a purposive sample of 12 GPs in rural areas of Denmark with economically disadvantaged populations. The interviews involved 36 complex patient cases selected by the GPs themselves. Our analysis followed the principles of systematic text condensation.ResultsMost GPs in our study had a health-related perception of self-care, but some had a broader perception encompassing the situational context of the patient’s life. The GPs’ assessments of patients’ self-care ability were based on information from the ongoing and often long-term relationships with the patients. GPs identified four major factors that influenced patients’ self-care ability, which accumulated and fluctuated over time: multimorbidity, cognitive resources, material resources, and the patients’ social contexts.ConclusionsThe GPs in this study had dual perceptions of self-care, related to both the chronic health conditions and to the broader situational contexts of their patients’ lives. GPs’ assessments of self-care ability depended largely on their experiences from the doctor-patient relationship, and they emphasized that the factors affecting self-care ability were highly dynamic over the patient’s lifetime. However, these findings might be resisted by the Danish disease management programs, which tend to have a static and more narrow, health-related view of patient self-care. The Danish programs require GPs to assess self-care ability upfront at the beginning of treatment and do not consider whether a relationship with the patient is established. If GPs’ perceptions and assessments of self-care ability are not included in chronic disease management models, there is a risk that they vill be insufficiently implemented in general practice.