Vibeke Zoffmann

Life Versus Disease in Difficult Diabetes Care: Conflicting Perspectives Disempower Patients and Professionals in Problem Solving

Conflicts in problem solving are known from diabetes research on patients with good glycemic control but have rarely been studied in the care of patients with poor glycemic control. Equally, the different perspectives of health care providers and patients have not been a focus in previous studies. The authors studied the interactions between health care providers and 11 diabetes patients with poor glycemic control in a grounded theory study at a Danish university hospital. Keeping Life and Disease Apart was identified as a core category. It involved a pattern of conflicts both between and within patients and health professionals, which disempowered them in problem solving. Three approaches to problem solving were identified: A compliance-expecting approach kept the pattern unchanged, a failure-expecting approach deadlocked the pattern, and a mutuality-expecting approach appeared to neutralize the conflict.

Realizing Empowerment in Difficult Diabetes Care: A Guided Self-Determination Intervention

Although health professionals advocate empowerment in patient care, they often fail to realize it in practice. Through grounded theories we previously explained why barriers to empowerment were seldom overcome in diabetes care. Zoffmann used these theories as a basis for developing a decision-making and problem-solving method called guided self-determination (GSD). To realize empowerment, health professionals need detailed knowledge of the barriers, their own roles in these barriers, ways to overcome them, and recognizable evidence of having succeeded. Through theory-driven, qualitative evaluation, the previously developed grounded theories helped us recognize changes consistent with empowerment in dyads of nurses and patients with poorly controlled type 1 diabetes. By completing GSD reflection, patients remarkably improved their ability to identify, express, and share unique and unexpected difficulties related to living with diabetes. As signs of empowerment, patients and health professionals accomplished shared decision making, resolved life–disease conflicts, and established meaningful and effective relationships.

Relationships and Their Potential for Change Developed in Difficult Type 1 Diabetes

Few researchers have explored how relationships between patients and providers might change problem solving in clinical practice. The authors used grounded theory to study dyads of 11 people with diabetes and poor glycemic control, and 8 nurses interacting in diabetes teams. Relational Potential for Change was identified as a core category that involved three types of relationships. Professionals mostly shifted between less effective relationships characterized by I-you-distant provider dominance and I-you-blurred sympathy. Although rarely seen, a third relationship, I-you-sorted mutuality proved more effective than the others in exploiting the Relational Potential for Change. The three types of relationship differed in (a) scope of problem solving, (b) the roles assigned to the patient and the professionals, (c) use of difficult feelings and different points of view, and (d) quality of knowledge achieved as the basis for problem solving and decision making. The authors discuss implications for practice and further research.

Can sharing experiences in groups reduce the burden of living with diabetes, regardless of glycaemic control?

Diabet. Med. 29, 251–256 (2012)

Mechanical Restraint—Which Interventions Prevent Episodes of Mechanical Restraint?—A Systematic Review

PURPOSE To identify interventions preventing mechanical restraints. DESIGN AND METHODS Systematic review of international research papers dealing with mechanical restraint. The review combines qualitative and quantitative research in a new way, describing the quality of evidence and the effect of intervention. FINDINGS Implementation of cognitive milieu therapy, combined interventions, and patient-centered care were the three interventions most likely to reduce the number of mechanical restraints. PRACTICE IMPLICATIONS There is a lack of high-quality and effective intervention studies. This leaves patients and metal health professionals with uncertainty when choosing interventions in an attempt to prevent mechanical restraints.

Mechanical restraint in psychiatry: preventive factors in theory and practice. A Danish-Norwegian association study.

PURPOSE To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. DESIGN AND METHODS This study employed a retrospective association design, and linear regression was used to assess the associations. FINDINGS Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). PRACTICE IMPLICATIONS None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures.

Surgical facial cancer treatment: the silencing of disfigurement in nurse-patient interactions.

TITLE Surgical facial cancer treatment: the silencing of disfigurement in nurse-patient interactions. AIM The aim of this study was to explore and explain how disfigurement is addressed in interactions between patient and nurse during the period in hospital immediately after undergoing disfiguring facial surgery. BACKGROUND Facial disfigurement as a result of head and neck or eye cancer surgery is associated with psychosocial problems; however no successful intervention program has been developed. Empirically derived knowledge about what goes on in the patient-nurse interaction is missing. METHOD A grounded theory design was used, with data derived from audio-recorded conversations between and individual interviews with 14 patients and their connected nurses, from three participating university hospitals. Data were collected in 2007. FINDINGS A substantive model with silencing disfigurement as a core category was developed. The model included three categories; minimizing disfigurement, disfigurement is a luxurious problem and another time, another place. A condition of implicit and unverified professional assumptions about addressing the issue of disfigurement became an underlying character. Without this the core category could not exist. CONCLUSION The model elucidates a silencing process maintained by preconceived assumptions which need to be challenged to help patients adjust to their changed appearance after facial cancer treatment.

Relationships over time of subjective and objective elements of recovery in persons with schizophreni

Recovery from schizophrenia involves both subjective elements such as self-appraised wellness and objective elements such as symptom remission. Less is known about how they interact. To explore this issue, this study examined the relationship over the course of 1 year of four assessments of symptoms with four assessments of self-reports of subjective aspects of recovery. Participants were 101 outpatients with schizophrenia. Symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS) while subjective recovery was assessed with the Recovery Assessment Scale (RAS). Separate Pearsons or Spearmans ranks correlation coefficients, calculated at all four measurement points, revealed the total symptom score was linked with lower levels of overall self-recovery at all four measurement points. The PANSS emotional discomfort subscale was linked with self-reported recovery at all four measurement points. RAS subscales linked to PANSS total symptoms at every time point were Personal confidence and hope, Goal and success orientation, and No domination by symptoms. Results are consistent with conceptualizations of recovery as a complex process and suggest that while there may be identifiably different domains, changes in subjective and objective domains may influence one another.

Flexible guided self-determination intervention for younger adults with poorly controlled Type 1 diabetes, decreased HbA1c and psychosocial distress in women but not in men: a real-life RCT

To report results from an 18–month randomized controlled trial (RCT) testing the effectiveness of a flexible guided self‐determination (GSD) intervention on glycaemic control and psychosocial distress in younger adults with poorly controlled Type 1 diabetes.

The effect of person-centred communication on parental stress in a NICU: a randomized clinical trial.

To investigate the effect of the Guided Family‐Centred Care intervention, developed by the lead author, on parental stress in a neonatal intensive care unit (NICU).