Loni Ledderer

'An Arena for Sharing': Exploring the Joint Involvement of Patients and Their Relatives in a Cancer Rehabilitation Intervention Study

Background: Despite an increasing focus on cancer rehabilitation programs, there is limited knowledge about the experiences of residential rehabilitation focusing on both the patients and their relatives. Objective: The aim of this study was to explore the experienced benefits of the joint involvement of patients and their relatives in a 5-day residential cancer rehabilitation course, provided as part of a larger intervention study in Denmark. Methods: Ethnographic fieldwork, consisting of participant observations and informal conversations, was conducted with 20 individuals (10 patients and 10 relatives). In-depth interviews were conducted in the participants’ homes 1 month after the rehabilitation course. Data were analyzed by a constant comparative method. Results: Residential rehabilitation course was identified to serve as an “arena for sharing,” underpinned by 3 dimensions of sharing: sharing cancer experiences, sharing strategies, and sharing mutual care. Conclusion: Sharing in residential rehabilitation is experienced as useful for cancer patients and their relatives, to validate cancer-related strategies and strengthen mutual understanding within relationships. Implications for Practice: The results can guide the development of cancer rehabilitation to involve patients and their relatives and provide opportunity for sharing and empowerment on individual as well as couple and group levels.

Associations between degrees of task delegation and job satisfaction of general practitioners and their staff: a cross-sectional study

BackgroundIn recent years, the healthcare system in the western world has undergone a structural development caused by changes in demography and pattern of disease. In order to maintain the healthcare system cost-effective, new tasks are placed in general practice urging the general practitioners to rethink the working structure without compromising the quality of care. However, there is a substantial variation in the degree to which general practitioners delegate tasks to their staff, and it is not known how these various degrees of task delegation influence the job satisfaction of general practitioners and their staff.MethodsWe performed a cross-sectional study based on two electronic questionnaires, one for general practitioners and one for their staff. Both questionnaires were divided into two parts, a part exploring the degree of task delegation regarding management of patients with chronic obstructive pulmonary disease in general practice and a part concerning the general job satisfaction and motivation to work.ResultsWe found a significant association between perceived “maximal degree” of task delegation in management of patients with chronic obstructive pulmonary disease and the staff’s overall job satisfaction. The odds ratio of the staff’s satisfaction with the working environment displayed a tendency that there is also an association with “maximal degree” of task delegation. In the analysis of the general practitioners, the odds ratios of the results indicate that there is a tendency that “maximal degree” of task delegation is associated with overall job satisfaction, satisfaction with the challenges in work, and satisfaction with the working environment.ConclusionsWe conclude that a high degree of task delegation is significantly associated with overall job satisfaction of the staff, and that there is a tendency that a high degree of task delegation is associated with the general practitioners’ and the staff’s satisfaction with the working environment as well as with general practitioners’ overall job satisfaction and satisfaction with challenges in work. To qualify future delegation processes within general practice, further research could explore the reasons for our findings.

Work motivation, task delegation and job satisfaction of general practice staff: a cross-sectional study

Abstract Background. Recent research has shown that a high degree of task delegation is associated with the practise staff’s overall job satisfaction, and this association is important to explore since job satisfaction is related to medical as well as patient-perceived quality of care. Objectives. This study aimed: (1) to investigate associations between degrees of task delegation in the management of chronic disease in general practice, with chronic obstructive pulmonary disease (COPD) as a case and the staff’s work motivation, (2) to investigate associations between the work motivation of the staff and their job satisfaction. Methods. The study was based on a questionnaire to which 621 members of the practice staff responded. The questionnaire consisted of a part concerning degree of task delegation in the management of COPD in their respective practice and another part being about their job satisfaction and motivation to work. Results. In the first analysis, we found that ‘maximal degree’ of task delegation was significantly associated with the staff perceiving themselves to have a large degree of variation in tasks, odds ratio (OR) = 4.26, confidence interval (CI) = 1.09, 16.62. In the second analysis, we found that this perceived large degree of variation in tasks was significantly associated with their overall job satisfaction, OR = 2.81, confidence interval = 1.71, 4.61. Conclusion. The results suggest that general practitioners could delegate highly complex tasks in the management of COPD to their staff without influencing the staff’s work motivation, and thereby their job satisfaction, negatively, as long as they ensure sufficient variation in the tasks.

Dealing with cancer: a meta-synthesis of patients' and relatives' experiences of participating in psychosocial interventions

&NA; The aim was to synthesise patients’ and relatives’ experiences of participating in a psychosocial intervention related to having cancer. The study was a meta‐synthesis inspired by Noblit & Hares ‘meta‐ethnography’ approach. We systematically searched six databases and included 33 studies in the meta‐synthesis. Inclusion criteria were qualitative studies with relevance to the synthesis topic. The meta‐synthesis conceptualised the way in which participants develop their way of living with cancer, and the role psychosocial interventions play in helping them to live through the illness. Five themes symbolising the participants’ core experiences were identified: (1) Emotional relief and a sense of well‐being, (2) normalisation of experiences and a sense of control, (3) shared experience and a sense of community, (4) a safe place and (5) transformation and adaptability. The findings indicated that psychosocial interventions were used to try to deal with the changes in the human conditions caused by cancer. Sharing their experiences and forming social relationships helped the participants adapt to cancer. An existential perspective may provide a nuanced understanding of patients’ and relatives’ experiences of participating in psychosocial interventions.

Storytelling as part of cancer rehabilitation to support cancer patients and their relatives

ABSTRACT Previous research on psychosocial support for cancer-related concerns has primarily focused on either patients or their relatives, although limited research is available on how patients and their relatives can be supported together. The aim of this article is to explore the use of storytelling as a part of a residential cancer rehabilitation intervention for patients together with their relatives, with a specific focus on their management of cancer-related concerns. Ten pairs participated in the intervention and data were generated through ethnographic fieldwork, including participant observations, informal conversations and follow-up interviews conducted one month after completing the intervention. Analysis was performed drawing on narrative theory combined with social practice theory. The results demonstrate that the use of storytelling and metaphors intertwined with other course activities, such as dancing and arts & crafts, provided the patients and their relatives with strategies to manage cancer-related concerns, which they were later able to apply in their everyday lives. The study results may be useful to other professionals in clinical practice for rehabilitation purposes for addressing issues of fear and worry.

How Intersectoral Health Promotion Changes Professional Practices: A Case Study From Denmark

Intersectoral health promotion (IHP) has pushed health professions to engage in new tasks and interprofessional ways of working. We studied how care assistants from a nursing home and school teachers implemented a cookery project targeted at children (“Cool Beans”) as an example of an IHP project in Denmark. Our aim was to examine the impact of the IHP project on the practices of the professions involved. We used a qualitative case study to investigate joint care and teaching situations with the two professions and their users. Our data consisted of documents, participatory observations, and informal interviews (17 hours) as well as semistructured interviews with professionals (n = 4). We used a sociological institutional framework to analyze the professional practices emerging in joint care and teaching situations and identified three themes of new professional activities: (1) “interplay” related to making different generations collaborate on the tasks involved in the cookery session; (2) “care” concerned with caregiving activities; and (3) “learning” focused on schooling on healthy food and cooking. We conclude that changes in professional practices occurred informally and were induced by the concrete activities in the cookery project. The specific, practical tasks of the IHP project thus offered an important leverage for future interprofessional collaborations.

Management of Overweight during Childhood: A Focus Group Study on Health Professionals' Experiences in General Practice.

Background. Because of the increasing prevalence of overweight and obesity in childhood in the Western world, focus on the management in general practice has also increased. Objective. To explore the experiences of general practitioners (GPs) and practice nurses participating in a randomised controlled trial (RCT) comparing two management programmes in general practice for children who are overweight or obese. Methods. Three focus groups with GPs and nurses participating in the RCT. Transcribed data were analysed using systematic text condensation followed by thematic analysis. Results. Health professionals considered it their responsibility to offer a management programme to overweight children. They recognised that management of overweight during childhood was a complex task that required an evidence-based strategy with the possibility of supervision. Health professionals experienced a barrier to addressing overweight in children. However, increasing awareness of obesity in childhood and its consequences in society was considered helpful to reach an understanding of the articulations concerning how best to address the issue. Conclusions. Health professionals in general practice recognised that they have a special obligation, capacity, and role in the management of obesity in childhood. Implementation of future management programmes must address existing barriers beyond an evidence-based standardised strategy.