Marta Röing

The relation between patient-centeredness and patient empowerment: A discussion on concepts

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.

Perceptions among Swedish hospital physicians on prescribing of antibiotics and antibiotic resistance

Objective To explore and describe perceptions of antibiotic prescribing among Swedish hospital physicians, with special reference to whether the perceptions included awareness of antibiotic resistance (AR). Design A phenomenographic approach was used and data were collected in face-to-face interviews. Setting Hospitals in seven different counties in central Sweden. Participants A strategic sample of 20 hospital physicians specialising in internal medicine, surgery or urology. Main outcome The variation of perceptions of antibiotic prescribing. Results Five qualitative different perceptions were found. AR was considered in two of the perceptions. Reasons for not considering AR included a dominating focus on the care of the patient combined with lack of focus on restrictive antibiotic use, or uncertainty about how to manage infectious diseases or the pressure from the healthcare organisation. Parallels between the five perceptions and the stages in the transtheoretical model of health behaviour change were seen. Conclusions In three of the perceptions, AR was not considered when antibiotics were prescribed. Physicians who primarily express these three perceptions do not seem to be prepared to change to restrictive prescribing. Our findings can be useful in designing activities that encourage AR prevention. Organisational changes are also needed.

Making New Meanings of Being in the World After Treatment for Oral Cancer

When the mouth is affected by cancer, difficulties in satisfying basic human needs such as eating, tasting, swallowing, and speaking might arise, and the existential significance of the mouth might become obvious. How does it feel to live with these difficulties? What does it mean to be a human being living with the consequences of oral cancer? Five patients with oral cancer were interviewed a median time of 4 years after the beginning of treatment. A hermeneutic research approach was used to understand, explain, and interpret the transcribed interviews and showed how the consequences of oral cancer affected the being-in-the-world of the participants in three ways: existing as oneself, existing in the eyes of others, and existing with others. Against the background of the philosophy of Martin Heidegger, these findings illuminate how essential the mouth is to a human beings identity and existence.

Malpractice claims in swedish telenursing : Lessons learned from interviews with telenurses and managers

BackgroundThis study deals with serious malpractice claims within Swedish Healthcare Direct, the national telephone helpline in Sweden. At least 33 claims of malpractice have been filed since the service was created in 2003. Although a low number, consequences have been tragic. Research in Swedish telenursing on contributing systemic and organizational factors and consequences of malpractice claims is sparse. ObjectiveThe objective was to explore the direct experience of telenurses’ and call center managers’ involvement in actual malpractice claims—with focus on factors that may have contributed to the claims—and on the consequences of the claims. MethodsSix telenurses and five managers agreed to participate in open-ended interviews. A directed content analysis approach was chosen to analyze the transcribed interview texts. ResultsStress, shiftwork, fatigue, multitasking, understaffing, and factors embedded in the system could have contributed to the malpractice claims. Safety management was treated locally, with no attempts at organizational reforms. DiscussionThe solitary nature of the telenursing task emphasizes the importance of an organization, which works toward providing an environment where telenurses can feel safe and supported. This may require, in turn, a change in both organizational and professional attitudes toward safety and risk of error. The greatest hinder may be healthcare providers themselves. If the difficulties in recruiting participants for this study are any indication, reaching out to healthcare providers who remain silent may be the greatest challenge.

Ways of understanding the encounter with head and neck cancer patients in the hospital dental team – a phenomenographic study.

IntroductionHead and neck cancer is the sixth most common malignancy in the world. Fifty percent of the patients can be cured by surgery, radiotherapy or a combination approach. Head and neck cancer is life-threatening, and treatment may leave the patient with visible facial disfigurements and impairment of functions such as speech and eating. This affects not only the patient, but may arouse difficult feelings in the treatment staff. Dental personnel are involved in all facets of treatment, yet they have no specific training in cancer care.BackgroundThe aim of this study was to describe the variation in ways dental personnel understand and experience the encounter with head and neck cancer patients, as the way of understanding a certain phenomenon is judged to be fundamental to the way we act and form our beliefs.MethodsTwenty members of hospital dental teams were interviewed. The interviews focused on experiences of the encounter with head and neck cancer patients. A qualitative research approach, phenomenography, was used in analysing the interviews. The encounter was perceived in three qualitatively different ways: as an act of caring, as a serious and responsible task and as an overwhelming emotional situation. The results indicate that hospital dental personnel are not able to lean on education and professional training in finding ways of dealing with situations with strong emotional impact. This has implications for the treatment of patients with head and neck cancer, as well as education of dental personnel.

A Metasynthesis of Phenomenographic Articles on Understandings of Work Among Healthcare Professionals

Phenomenography is a qualitative research method based on the assumption that almost any phenomenon will be understood by a group of people in a limited number of ways. Our aim in this article was to identify the different ways work can be understood by healthcare professionals. In a world where the delivery of healthcare is continually changing, a metasynthesis of phenomenographic articles on healthcare professionals’ understandings can provide knowledge about the focus and meaning of work for these individuals today. Our metaethnographic synthesis of 14 selected phenomenographic articles identified five different ways of understanding work, ranging from a limited to an all the more comprehensive view on patients and their needs. This range of understandings reveals problem areas and challenges facing healthcare professionals today. The possibility exists as well that limited understandings of work may be negative consequences of current demands for efficiency and all the more limited healthcare resources.

It's a question of endurance – Patients with head and neck cancer experiences of 18F-FDG PET/CT in a fixation mask

PURPOSE This study aimed to explore how patients with head and neck cancer experienced undergoing an 18F-fluoro-deoxy-glucose positrons emissions tomography/computed tomography (18F-FDG PET/CT) examination in a fixation mask. METHOD Interviews were conducted with nine patients with known or suspected head and neck cancer who were scheduled for the examination for the first time. The phenomenological method according to van Manen and his four lifeworld existentials; lived space, lived body, lived time, and lived relation was used to analyse the interviews. RESULTS The thoughts and feelings of the patients during the PET/CT examination varied, some found it very difficult, while others did not. However, for all the patients, it was an experience that required some form of coping to maintain composure for example distraction. CONCLUSIONS PET/CT examnation in a fixation mask may be strenuous for some patients. Patients need more detailed information, including suggestions for coping behaviours, prior to the examination, as well as higher level of support during and after the examination. The results of this study may be used to improve patient care and optimize the procedure of PET/CT examination in a fixation mask.

(Tele) Health Promotion in Primary Healthcare Centers — An Exploratory Study

The area of interest in this study is nurses working with telenursing (telephone advice nursing) in primary healthcare centers, and if they can take on the role as promoters of health. Public health goals in recent years have placed increased emphasis on health promotion, for example prevention of the harmful effects of sunbathing, alcohol, drug and tobacco abuse, promotion of physical activity, and healthy diet habits. These goals may imply a new undertaking for healthcare providers. This study explores if, and how nurses working with telenursing in Swedish primary healthcare centers actively work with health promotion, and their perceptions of factors which may hinder and/or facilitate this work. Qualitative content analysis of open-ended interviews with eight nurses revealed hinders to health promotion related to the organization, the callers, and among the nurses themselves. If nurses working with telenursing are to work in a more health-promoting way, they need to have the support from leadership and politicians. A change in understanding of what telenursing services include seems to be needed, even among telenurses. Such a change could prove beneficiary to all citizens, and hence to the promotion of health.