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  • 1.
    Boman, Åse
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Fathers involved in children with type 1 diabetes: finding the balance between disease control and health promotion2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background:

    Type I diabetes is a chronic disease that places great demands on the child and family. Parental involvement has been found to be essential for disease outcome. However, fathers’ involvement has been less studied, even though high paternal involvement has been correlated with less disease impact on the family and higher quality of life among adolescents.

    Aim: The overall aim of the study was to explore and analyze constructions of fathers’ involvement in their child’s everyday life with type 1 diabetes from an ecological and health promotion perspective. Four specific aims were applied: 1) explore and describe discourses in health care guidelines for children with type 1 diabetes in Nordic countries, focusing on parents' positioning (I), 2) analyze how Swedish pediatric diabetes teams perceived and discussed fathers’ involvement in the care of their child with type 1 diabetes, and to discuss how the teams’ attitudes toward the fathers’ involvement developed during a focus group process (II), 3) explore and discuss how fathers involved in caring for their child with type 1 diabetes experience support from their pediatric diabetes team in everyday life with their child (III), and 4) analyze how involved fathers to children with type 1 diabetes understand their involvement in their child’s daily life and to discuss their perceptions from a health promotion perspective (IV).

    Material and methods: A qualitative and inductive approach was applied. Data were collected and analyzed during 2010-2012. The sample consisted of three pediatric guidelines originating from Norway, Denmark and Sweden (I), three Swedish pediatric diabetes teams (PDTs) (II), and 11 (III) and 16 (IV) fathers of children with type 1 diabetes who scored high involvement on the Parental Responsibility Questionnaire. Data were collected through repeated focus group discussions with the PDTs (II), online focus group discussions (III) and individual interviews (III, IV) with the fathers. Three analysis methods were applied: analysis of discourses (I), Constructivist Grounded Theory (II, III) and content analysis (IV).

    Findings: The findings illuminated the complex interaction between the pediatric guidelines, the PDTs and the fathers. Fathers highly involved in their child’s daily life experienced different levels of tension between the general recommendations and their personal experiences of living with a child with type 1 diabetes (III). The fathers regarded their involvement in their child’s diabetes care as additional to their general parenting, and a fine balance was identified between a health promotion perspective and a controlling involvement. The common denominator between the highly involved fathers was their use of parental leave (IV). The PDTs initially perceived fathers’ involvement as gendered and balanced on the mother’s agement, but as focus was set on fathers’ engagement the PDTs increased their awareness of this and started to identify and encourage their engagement II). At the macro-level, parents’ voices were diminished in Nordic pediatric diabetes guidelines in favor of an expert discourse (I).

    Conclusions: Fathers’ involvement concerning a child with type 1diabetes is constructed in a complex way, based on an interaction between the fathers’ perceptions of their additional involvement and the support provided by the PDTs; the PDTs’ perceptions of the fathers’ involvement; and how parents/fathers are constructed in pediatric diabetes guidelines. In order to promote the health and well-being of children with type 1 diabetes, fathers’ involvement needs to be taken into account in the pediatric guidelines as well as in clinical practice. 

  • 2.
    Boman, Åse
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Learning by supporting others: experienced parents' development process when supporting other parents with a child with Type 1 diabetes2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. E1171-E1178Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: This study's purpose was to describe and analyze coach-parents' development process when supporting parents of children recently diagnosed with Type 1 Diabetes Mellitus (T1DM).

    BACKGROUND: It has been found repeatedly that providing social support for families with a child diagnosed with T1DM promotes health and wellbeing for both the child and the parents. Less explored are the processes experienced by those who provide this support. However, research has found that acting as a provider of social support promotes personal development, strengthens communication skills, and increases self-confidence.

    METHODS: The study design was based on Constructivist Grounded Theory and data were collected, through Repeated Focus Group Discussions, from eight coach-parents at a Swedish hospital from 2012-2015.

    RESULTS: The core category in the data was identified as a learning process where coach-parents emphasized their own learning in the dyad supporter - supported, and in the interaction with other parents in the Repeated Focus Group Discussions. The coach-parents' motivation for participation was a wish to learn more and to help other parents in a life-changing situation. They also pointed out hindrances and their frustration when unable to provide support.

    CONCLUSIONS: This study leads to the conclusion that people who provide support benefit from doing so. Encountering people with similar experiences in a supportive situation promotes a reciprocal learning process, based on the supporter's wish to help people in a situation they recognize. A further conclusion is that social support is not only essential initially, but is also important over a longer period and that it follows various life stages.

    RELEVANCE TO CLINICAL PRACTICE: Setting up repeated focus group discussions might be a relevant and effective tool for pediatric diabetes nurses to use in promoting health and wellbeing for both families with a newly diagnosed child and experienced families. This article is protected by copyright. All rights reserved.

  • 3.
    Boman, Åse
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Bohlin, Margareta
    University West, Department of Social and Behavioural Studies, Division of Psychology, Pedagogy and Sociology.
    Eklöf, Mats
    University of Gothenburg, Department of Psychology, Gothenburg, Sweden.
    Forsander, Gun
    The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Munthe, Christian
    University of Gothenburg, Department of Philosophy, Linguistics and Theory of Science, Gothenburg, Sweden.
    Törner, Marianne
    Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Health care to empower self-care in adolescents with type 1 diabetes mellitus and an immigrant minority background2017In: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 5, article id 2050312117700056Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The pediatric diabetes team aims to support health, quality of life, and normal growth and development among adolescents with type 1 diabetes mellitus. Adolescents with an immigrant background have been found less successful in self-care. Previous research indicated that adolescents who had integrated the disease as a part of their self-image reasoned differently about their self-care to those who had not.

    OBJECTIVE: The aim of this study was to identify elements in the patient-pediatrician consultations that might influence such integration of the disease among adolescents with type 1 diabetes mellitus.

    METHODS: A total of 12 pediatrician-adolescent consultations were video-recorded and analyzed. The adolescents all had an immigrant background.

    RESULTS: Integration of the disease appeared enabled when responsibility was shared; when hope, autonomy, and emotions were confirmed; and when the pediatrician asked probing questions. Letting objective data dominate the adolescent's experiences, using risk as a motivator, neutralizing emotions in relation to having diabetes, and confirming forgetfulness, may instead inhibit disease integration.

    CONCLUSION: An extended person-centered approach with focus on the adolescent's experiences of everyday life with a chronic disease and less attention on physical parameters in the pediatrician-adolescent consultations may increase integration of the disease.

  • 4.
    Boman, Åse
    et al.
    University West, Department of Health Sciences, Specialist Nursing programme.
    Bohlin, Margareta
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies.
    Eklöf, Mats
    Forsander, Gun
    Törner, Marianne
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies. University of Gothenburg.
    Conceptions of diabetes and diabetes care in young people with minority background" 2014Conference paper (Refereed)
  • 5.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Bohlin, Margareta
    University West, Department of Social and Behavioural Studies, Division of Psychology and Organisation Studies.
    Eklöf, Mats
    University of Gothenburg, Gothenburg.
    Forsander, Gun
    University of Gothenburg, Gothenburg.
    Törner, Marianne
    University of Gothenburg, Gothenburg.
    Conceptions of Diabetes and Diabetes Care in Young People With Minority Backgrounds.2015In: Qualitative Health Research, ISSN 1049-7323, E-ISSN 1552-7557, Vol. 25, no 1, p. 5-15Article in journal (Refereed)
    Abstract [en]

    Adolescents with type 1 diabetes (T1DM) need stable self-care routines for good metabolic control to minimize future cardiovascular health complications. These routines are demanding, and might be particularly challenging in underprivileged groups. The aim of this study was to gain in-depth knowledge on the experience of adolescents with T1DM and a non-Swedish background regarding factors that might influence their ability to take care of themselves; in particular, factors that might influence diabetes management routines, their social situation, and the support they receive from caregivers. We interviewed 12 adolescents with T1DM and minority backgrounds. The results indicated resources and constraints in the adolescents' social context and in the health care organization. The adolescents developed conceptions that helped to explain and excuse their self-care failures, and their successes. These findings highlight the importance of integrating T1DM as part of the individual's personal prerequisites. We discuss implications for the organization of diabetes care for adolescents.

  • 6.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Borup, Ina
    Nordiska högskolan för folkhälsovetenskap NHV.
    Dahlborg-Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Povlsen, Lene
    Nordiska högskolan för folkhälsovetenskap.
    Swedish pediatric diabetes teams' perception of fathers' involvement: A Grounded Theory study2013In: Nursing and Health Sciences, ISSN 1441-0745, E-ISSN 1442-2018, Vol. 15, no 2, p. 179-185Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to analyze how Swedish pediatric diabetes teams perceived and discussed fathers' involvement in the care of their child with type 1 diabetes. It also aimed to discuss how the teams' attitudes towards the fathers' involvement developed during the data collection process. The Constructivist Grounded Theory design was used and data were collected during three repeated focus group discussions with three Swedish pediatric diabetes teams. The core category of the teams' perception of fathers' involvement emerged as: If dad attends, we are happy – if mom doesn't, we become concerned. Initially the teams balanced their perception of fathers' involvement on the mother's role as the primary caregiver. In connection with the teams' directed attention on fathers, in the focus group discussions, the teams' awareness of the importance of fathers increased. As a consequence, the team members began to encourage fathers' engagement in their child's care. We conclude that by increasing the teams' awareness of fathers as a health resource, an active health promotion perspective could be implemented in pediatric diabetes care.

  • 7.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Borup, Ina
    Nordic School of Public Health, Gothenburg.
    Povlsen, Lene
    Nordic School of Public Health, Gothenburg.
    Dahlborg Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Parents' discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with diabetes type 12012In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 26, no 2, p. 363-371Article in journal (Refereed)
    Abstract [en]

    The incidence of diabetes type 1 in children, the most common metabolic disorder in childhood, increases worldwide, with highest incidence in Scandinavia. Having diabetes means demands in everyday life, and the outcome of the child's treatment highly depends on parents' engagement and involvement. The aim of this study was to explore and describe discourses in health care guidelines for children with diabetes type 1, in Sweden, Norway and Denmark during 2007-2010, with a focus on how parents were positioned. As method a Foucauldian approach to discourse analysis was applied, and a six-stage model was used to perform the analysis. The findings shows a Medical, a Pedagogic and a Public Health discourse embedded in the hegemonic Expert discourse. The Expert discourse positioned parents as dependent on expert knowledge, as recipients of education, as valuable and responsible for their child's health through practicing medical skills. This positioning may place parents on a continuum from being deprived of their own initiatives to being invited to take an active part and could result in feelings of guilt and uncertainty, but also of security and significance. From this study we conclude that guidelines rooted in the Expert discourse may reduce opportunities for parents' voices to be heard and may overlook their knowledge. By broadening the selection of authors of the guidelines to include patients and all professionals in the team, new discourses could emerge and the parents' voice might be more prominent. © 2011 The Authors. Scandinavian Journal of Caring Sciences © 2011 Nordic College of Caring Science.

  • 8.
    Boman, Åse
    et al.
    University West, Department of Health Sciences, Specialist Nursing programme.
    Brink, Eva
    University West, Department of Health Sciences.
    Salutogen omvårdnad2015In: Salutogenes: om hälsans ursprung : [från forskning till praktisk tillämpning] / [ed] Eriksson, Monica, Stockholm: Liber, 2015, 1. uppl., p. 191-208Chapter in book (Other academic)
  • 9.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Povlsen, Lene
    Nordiska högskolan för folkhälsovetenskap.
    Dahlborg Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Borup, Ina
    Nordiska högskolan för folkhälsovetenskap.
    Hanås, Ragnar
    Uddevalla Hospital.
    If dad comes, we are happy - if mom fails to appear, we become desperate: A Grounded Theory study of Swedish diabetes teams perecption of fathers’ involvement in their child's everyday life2011In: 4th International Research Seminar on SALUTOGENESIS and meeting of the IUP-GWG-SAL: May 30-31, 2011, University West, Trollhättan, Sweden, 2011, p. 1-12Conference paper (Refereed)
    Abstract [en]

    Background: Since parental involvement is essential to the outcome of diabetes type 1 treatment in childhood and high paternal engagement in everyday life promote the child's health, it is of value to explore how professionals, the diabetes teams (DT), perceive fathers' involvement in their child with diabetes type 1.

    Method: The study design was Constructivist Grounded Theory and data was collected by Repeated Focus Groups discussions with three Swedish pediatric diabetes teams, between May 2010 and January 2011.

    Results: The core category for the diabetes teams' perception of fathers' involvement was If dad comes, we are happy – if mom fails to appear, we become desperate. The core category relied on three subcategories. Societal and cultural context where DTs perceived fathers involvement as having specific properties and specific areas of responsibility, Balancing where the DTs balanced the father's involvement against the mother's engagement and Becoming aware where the DTs raised awareness of the fathers from being a indistinct parents-unit till to identify and appreciate the father's engagement.

    Conclusions: Perceiving fathers as equal caregivers, and becoming aware of fathers as a health resource, could support an active health promotion perspective in pediatric diabetes care. 

  • 10.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Povlsen, Lene
    Nordic School of Public Health NHV, Gothenburg.
    Dahlborg Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Hanas, Ragnar
    Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla.
    Borup, Ina
    Nordic School of Public Health NHV, Gothenburg.
    Fathers' encounter of support from paediatric diabetes teams: the tension between general recommendations and personal experience2013In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 21, no 3, p. 263-270Article in journal (Refereed)
    Abstract [en]

    The purpose of this grounded theory study was to explore and discuss how fathers involved in caring for a child with type 1 diabetes experienced support from Swedish paediatric diabetes teams (PDTs) in everyday life with their child. Eleven fathers of children with type 1 diabetes, living in Sweden and scoring high on involvement on the Parental Responsibility Questionnaire, participated. Data were collected from January 2011 to August 2011, initially through online focus group discussions in which 6 of 19 invited fathers participated. Due to high attrition, the data collection continued in eight individual interviews. A semi-structured interview guide was used, and the fathers were asked to share experiences of their PDT's support in everyday life with their child. A simultaneous and constant comparison approach to data collection and analysis allowed the core category to emerge: the tension between general recommendations and personal experience. This core category illuminates how the fathers experienced tension between managing their unique everyday life with their child and balancing this to meet their PDT's expectations with regard to blood glucose levels. The core category was supported by two categories: the tension between the fathers'and their PDT's knowledge, whereby fathers reported discrepancies between their PDT's medical knowledge and their own unique knowledge of their child; and the tension between the fathers'and their PDT's goals, whereby the fathers identified differences between the familys' and their PDT's goals. As a dimension of the core category, fathers felt trust or distrust in their PDT. We conclude that to achieve high-quality support for children with diabetes and to enhance their health and well-being, involved fathers' knowledge of their unique family situation needs to be integrated into the diabetes treatment.

  • 11.
    Boman, Åse
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Povlsen, Lene
    Nordic School of Public Health, Gothenburg.
    Dahlborg Lyckhage, Elisabeth
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Hanas, Ragnar
    Department of Pediatrics, NU Hospital Group, Uddevalla Hospital, Uddevalla.
    Borup, Ina
    Nordic School of Public Health NHV, Gothenburg.
    Fathers of Children With Type 1 Diabetes: Perceptions of a Father's Involvement From a Health Promotion Perspective2014In: Journal of Family Nursing, ISSN 1074-8407, E-ISSN 1552-549X, Vol. 20, no 3, p. 337-354Article in journal (Refereed)
    Abstract [en]

    This study describes how fathers of children diagnosed with type 1 diabetes understand their involvement in their child's daily life from a health promotion perspective. Sixteen Swedish fathers of children living with type 1 diabetes were interviewed. Manifest and latent content analysis was used to identify two themes: the inner core of the father's general parental involvement and the additional involvement based on the child's diabetes. The former was underpinned by the fathers' prioritization of family life and the fathers being consciously involved in raising the child, and the latter by the fathers promoting and controlling the child's health and promoting and enabling the child's autonomy. The results highlight that the quality of the fathers' involvement is essential in the management of a child's chronic illness. It is important for pediatric diabetes health care professionals to assess the quality of fathers' involvement to promote the child's health.

  • 12.
    Dahlborg Lyckhage, Elisabeth
    et al.
    University West, Department of Nursing, Health and Culture, Division of Advanced Nursing.
    Boman, Åse
    University West, Department of Nursing, Health and Culture, Division of Advanced Nursing.
    Analysis of discourses in a health care context2010In: Challenging the Boundaries, Vancouver, Canada, 3-5 October 2010, 2010Conference paper (Refereed)
    Abstract [en]

    Abstract

    To develop nursing as a critical normative science (Kirkevold, 2009), a description of the various care areas and different health phenomena is needed. This is being done on the basis of various qualitative methods´; hence within nursing discourse analysis is used to a limited extent. The aim of this paper is to exemplify phenomenon and topics within nursing that have been studied by using discourse analysis. The examples are from studies conducted during the previous years by the authors. Discourses within palliative care based on documents and observations (2009), nursing as a subordinated profession, based on media analysis (2009), and an ongoing study about discourses within care of children with diabetes based on policy documents in the Nordic countries.

    Discourse analysis provides data, such as interviews, actions and documents to be analyzed in a broader system of knowledge (Wilkinson & Kitzinger, 2000., Lupton, 1993). A discourse is a “systems of thought and systematic ways of carving out reality and is composed by structures of knowledge that influences systems of practice” (Chambon, 1999). All discourses are textual and an inter-textual drawing upon other texts, contextually embedded in historical political and cultural settings. A given text also transforms in a manner that is socially constrained and conditional upon relations of power (Foucault 1979). As Bacchi (2005) urges it is possible to adopt a more comprehensive dual-focus agenda in discourse analysis, taking into account the dual movement of discourse: the way discourse speaks us and the way we speak the discourse.

  • 13.
    Dahlborg Lyckhage, Elisabeth
    et al.
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Pennbrant, Sandra
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    Boman, Åse
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Health care systems in transition: Equality, access and health literacy in three Scandinavian welfare states.: “The Emperor’s new clothes”: discourse analysis on how the patient is constructed in the new Swedish Patient Act2017Conference paper (Refereed)
    Abstract [en]

    The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig’s analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient’s entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act’s provisions in daily healthcare work.

  • 14.
    Dahlborg Lyckhage, Elisabeth
    et al.
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Pennbrant, Sandra
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    Boman, Åse
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level.
    "The Emperor's new clothes": discourse analysis on how the patient is constructed in the new Swedish Patient Act.2017In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 24, no 2, article id e12162Article in journal (Refereed)
    Abstract [en]

    The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work.

  • 15.
    Johnsson, Anette
    et al.
    University West, Department of Health Sciences, Section for nursing - undergraduate level. Jönköping University, School of Health and Welfare, Sweden.
    Boman, Åse
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Wagman, Petra
    Jönköping University, School of Health and Welfare, Sweden.
    Pennbrant, Sandra
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    Voices used by nurses when communicating with patients and relatives in a department of medicine for older people: An ethnographic study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. E1640-E1650Article in journal (Refereed)
    Abstract [en]

    AIM: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

    BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

    DESIGN: An ethnographic design informed by the sociocultural perspective was applied.

    METHOD: Forty participatory observations were conducted and analyzed during the period October 2015 to September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semi-structured follow-up interviews were conducted with five nurses.

    RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualized, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices this indicates a shift in the orientation or situation.

    CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

    RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes. This article is protected by copyright. All rights reserved.

  • 16.
    Johnsson, Anette
    et al.
    University West, Department of Health Sciences, Section for nursing - undergraduate level. Jönköping University, School of Health and Welfare, Jönköping University, Sweden.
    Wagman, Petra
    Jönköping University, School of Health and Welfare, Jönköping University, Sweden.
    Boman, Åse
    University West, Department of Health Sciences, Section for nursing - graduate level.
    Pennbrant, Sandra
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    What are they talking about? Content of the communication exchanges between nurses, patients and relatives in a department of medicine for older people: An ethnographic study2018In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. E1651-E1659Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: To explore and describe the content of the communication exchanges between nurses, patients and their relatives in a department of medicine for older people in western Sweden.

    BACKGROUND: Information, messages and knowledge are constantly being communicated between nurses, older patients and relatives in the healthcare sector. The quality of communication between them has a major influence on patient outcomes. A prerequisite for good care to be given and received is that there is mutual understanding between the parties involved.

    DESIGN: An ethnographic study was informed by a sociocultural perspective.

    METHOD: Data were collected through 40 participatory observations of meetings between nurses and older patients and/or relatives which covered 135 hours of nurse-patient-relative interaction, field notes, 40 field conversations with 24 nurses and 40 field conversations with patients (n=40) and relatives (n=26). Five semi-structured interviews were conducted with nurses. An ethnographic analysis was performed.

    RESULTS: The analysis identified three categories of content of the communication exchanges: medical content focusing on the patient's medical condition, personal content focusing on the patient's life story, and explanatory content focusing on the patient's health and nursing needs. The content is influenced by the situation and context.

    CONCLUSIONS: Nurses would benefit from more awareness and understanding of the importance of the communication content and of the value of asking the didactic questions (how, when, what and why) in order to improve the patients' and relatives' understanding of the information exchanges and to increase patient safety.

    RELEVANCE TO CLINICAL PRACTICE: Nurses can use the communication content to create conditions enabling them to obtain a holistic view of the patient's life history and to develop an appropriate person-centered care plan. This article is protected by copyright. All rights reserved.

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  • rtf