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Gaining Professional Competence for Patient Encounters by Means of a New Understanding
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Swedish health care is currently facing problems, such as lack of financial resources, staff shortage and dissatisfaction among patients and professionals. Patients’ dissatisfaction was the point of departure for the present study, and one approach dealing with this problem was investigated. It was hypothesised that a patient-centred perspective could offer a possible solution. The aim of the study was to explore health care professionals’ and medical students’ understanding of their professional role and the patient encounter. A further goal was to determine whether these understandings could be developed by educational interventions. Students and professionals have been either interviewed or responded to a survey about their professional role and the patient encounter. Qualitative analysis was used. One group- and one individualised intervention were carried out. The participants’ understandings of their professional role were taken as the starting point for learning. The results showed that a minority of medical students and professionals in diabetes care had incorporated a patient-centred perspective. Nurses in telephone advisory services recognised the patients’ needs, but experienced conflicting demands of being both carer and gatekeeper. A non-optimal match between patients’ needs and what professionals understand as their role could cause some of the problems. Competence development could be achieved by taking the participants understanding of the professionals’ role and of the patient encounter as a starting point for reflection. The results have implications for changes in organisation and education in health care, to optimise outcomes of care. Time for reflection, mentoring and professional development is needed.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis , 2002. , p. 91
Series
Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 0282-7476 ; 1145
Keywords [en]
Medical sciences, competence development, diabetes care, educational interventions, medical students, patient encounters, phenomenography, phenomenology, professional role, telephone advisory services
Keywords [sv]
MEDICIN OCH VÅRD
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
URN: urn:nbn:se:uu:diva-1975ISBN: 91-554-5297-3 (print)OAI: oai:DiVA.org:uu-1975DiVA, id: diva2:161577
Public defence
2002-05-14, Rudbecksalen, Uppsala, 13:15
Opponent
Available from: 2002-04-22 Created: 2002-04-22 Last updated: 2010-06-16Bibliographically approved
List of papers
1. Swedish medical students' views of the changing professional role of medical doctors and the organisation of health care
Open this publication in new window or tab >>Swedish medical students' views of the changing professional role of medical doctors and the organisation of health care
2004 (English)In: Advances in Health Sciences Education, ISSN 1382-4996, E-ISSN 1573-1677, Vol. 9, no 1, p. 5-14Article in journal (Refereed) Published
Abstract [en]

Medical students will influence future health care considerably. Their professional orientation while at medical school will be related to their future professional development. Therefore, it is important to study this group's view of the role of medical doctors, especially because Swedish health care is currently undergoing major changes and financial cut backs. Here, the theoretical framework was contemporary theories of competence development, which has shown that people's understanding of their work influences their actions. The aim of this study was to describe medical students' views of their future professional role in health care. In total, 57 fourth-year medical students at a Swedish university were asked to write a short essay about how they conceptualised their professional role in future health care. Fifty-three students (93%) replied. The essays were analysed qualitatively in three steps and four themes were subsequently identified: the professional role in change, organisation of health care, working conditions and the possibilities of having a balanced life. Some factors mentioned that would strongly influence the professional role were being team leader, increased specialisation, supporting the patient and computer science and technology. The students expressed ambiguous feelings about power and leadership. The results indicate that the students share a rather dark view of both the medical profession and health care, which seems to be related to stress and financial cutbacks. Mentoring, time for reflection and changes in the curricula might be needed.

Keywords
future care, medical students, organisation of health care, professional role, qualitative analysis
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-65235 (URN)10.1023/B:AHSE.0000012207.88241.8b (DOI)000188119000002 ()
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-11-30Bibliographically approved
2. 'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services
Open this publication in new window or tab >>'Carer and gatekeeper' - conflicting demands in nurses' experiences of telephone advisory services
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 2, p. 142-148Article in journal (Refereed) Published
Abstract [en]

Millions of calls are made to the telephone advisory services in primary health care in Sweden. The patients seem happy with the advice and counselling they receive, but little has been written about nurses' experiences of performing telephone advisory services. Yet, the nurses are expected to be patient, sensitive and have a broad knowledge of medicine, nursing and pedagogy. The aim of this study was to describe how nurses experience the patient encounter when performing telephone advisory services. A strategic sample of five nurses were interviewed and asked to describe how they experienced the central aspects of the patient encounter by telephone. The transcribed interviews were analysed by the Empirical Phenomenological Psychological method. The nurses' experience of the patient encounter when performing telephone advisory services can be characterized in terms of the conflicting demands of being both carer and gatekeeper. The constituents of these conflicting demands were: reading between the lines while pressed for time; educating patients for self-care while fearful of misinterpreting the situation; encountering patients' satisfaction and dissatisfaction. The conflicting demands of being both professional carer and gatekeeper caused stress among the nurses. The organization of the telephone advisory services seems to hinder high-quality care.

Keywords
telephone advisory service, patient encounter, conflicting demands, nurses' experiences, phenomenology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-63235 (URN)10.1046/j.1471-6712.2002.00075.x (DOI)000176748700006 ()
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-11-30Bibliographically approved
3. Swedish health care professionals' diverse understandings of diabetes care
Open this publication in new window or tab >>Swedish health care professionals' diverse understandings of diabetes care
2003 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 51, no 1, p. 53-58Article in journal (Refereed) Published
Abstract [en]

Knowledge of health care professionals’ different understandings of diabetes care is important when preparing such professionals in patient education. For patients to manage illness effectively, the actions of health care professionals are crucial. Patients’ understanding of their condition should be taken as the point of departure when creating a learning situation. The professionals’ understandings of diabetes care were mapped using a survey including 169 primary care doctors, nurses, assistant nurses and chiropodists in Stockholm, Sweden. The responses were analysed using a phenomenographic approach. Five understandings were identified: the professionals treat the patients, the professionals give information, the professionals focus relation and organisation, the professionals seek the patient’s agreement, and the professionals focus the patient’s understanding of the situation. Only 20 (12%) of the 169 professional caregivers focused the patient’s understanding. Professionals need to develop their understandings of health care and the professional–patient interaction in order to support the patients’ learning.

Keywords
Sweden, Diabetes, Patients’ learning, Patient encounter, Phenomenography
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-64459 (URN)10.1016/S0738-3991(02)00212-4 (DOI)000185030900007 ()
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-11-30Bibliographically approved
4. Understanding the job in a new way - a basis for development of competence in diabetes care
Open this publication in new window or tab >>Understanding the job in a new way - a basis for development of competence in diabetes care
2000 (English)In: Upsala Journal of Medical Sciences, Supplement, ISSN 0300-9726, Vol. 105, no 2, p. 161-169Article in journal (Refereed) Published
Abstract [en]

Patients complain that doctors and nurses do not listen, and therefore a need to develop the patient encounter is at hand. Phenomenological theory has opened new ways to develop professional competence. If the idea holds that we express our understanding about our work through our actions, a change in understanding might further develop professional competence. This idea offers a new way to develop competence in diabetes health care service. The aim of this study was to map health care professionals' understanding of the patient encounter before and after an educational intervention that focused the way the health care professional experienced the encounter, and to describe how their understanding changed. Two general practitioners and two diabetes nurses participated. They were interviewed before and after the intervention. The intervention comprised 4-5 sessions during which they together with a tutor reviewed their videotaped consultations with different persons with diabetes. The tutors' role was to make interventions that could alter the persons understanding of the diabetes consultation through questioning. The interviews were analysed using phenomenographic method. The results show that the professionals changed their ways of experiencing the encounter after the intervention. They started to question their way of working, focused the patient's learning process and became interested in how to stimulate it.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-53443 (URN)000168299700013 ()11095112 (PubMedID)
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-04Bibliographically approved
5. A change of the physicians' understanding of the encounter parallels competence development
Open this publication in new window or tab >>A change of the physicians' understanding of the encounter parallels competence development
2001 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 42, no 3, p. 271-278Article in journal (Refereed) Published
Abstract [en]

Patients today complain that physicians do not listen. There is a need to improve the professional competence in the patient encounter. According to theory, competence is a result of how people perceive their work. Observation and reflection can improve the competence. The aim of this study was to investigate if physicians can develop a more patient-centred consultation style by an experienced-based specialist course and how such a development is related to the physicians understanding of the task. The physicians video recorded consultations and reflected on these. The video consultations were analysed with a time study and Pendleton et al.’s consultation schedule [Pendleton D, Schoefield T, Tate P, Havelock P. The consultation: an approach to learning and teaching. Oxford: Oxford University Press, 1984.]. Before–after questions were answered. The study indicates that seven out of 10 physicians participating in the course had developed a patient-centred attitude and acted according to it. The time study gave ambiguous results. This study implicates that it is possible to initiate competence development by influencing the understanding of the encounter.

Keywords
Consultation, Pendleton, Competence development, Video-recordings, Patient-centred
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-53430 (URN)10.1016/S0738-3991(00)00132-4 (DOI)000166726900008 ()
Available from: 2008-10-17 Created: 2008-10-17 Last updated: 2017-12-04Bibliographically approved

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