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Proximity and distance: challenges in person-centred care for diabetes specialist nurses in primary health care
Umeå University, Faculty of Medicine, Department of Nursing.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Närhet och distans : utmaningar i personcentrerad vård för diabetessjuksköterskor inom primärvården (Swedish)
Abstract [en]

Background Type 2 diabetes demands self-management over time, to maintain health and reduce the risk for diabetes complications. However, despite efforts, many persons with type 2 diabetes are not reaching the treatment targets. In diabetes, person-centred care and group education are recommended. Diabetes specialist nurses (DSNs) working in primary healthcare have an important role in supporting patients with type 2 diabetes in their self-management to adapt to the demands of the disease in everyday life. Therefore, it is important to explore the DSNs’ professional role and their experiences of practising person-centred care. The overall aim of the thesis was to explore the professional role of DSNs in primary healthcare, and to describe their experiences of person-centred diabetes care.

Methods The thesis includes three studies with qualitative, and one with a quantitative, approach. Data collection consisted of focus group interviews, individual interviews, observations, and questionnaires. Qualitative content analysis and statistics were used in the analysis. In studies I and II, 29 and 31 DSNs participated, respectively. In study III, 10 DSNs and 44 persons with type 2 diabetes participated. Lastly, in study IV, 10 DSNs participated.

Results The results in the thesis showed that DSNs have a complex and multifaceted professional role that entails striving to be an expert, a fosterer, a leader, an executive, and a role model, which they found challenging. The DSNs perceived high job demands, such as decision-making and learning. The thesis also showed that the interaction between DSNs and persons with type 2 diabetes shifted from empowerment to authority struggles during group support sessions based on person-centred care. The experience of person-centred care was described as enriching, but DSNs also expressed ambivalence, related to an altered professional role.

Conclusion There is a desire by DSNs to be close to persons with type 2 diabetes, although they have several challenges to fulfil, which makes it difficult to uphold a relation with proximity; thus, distance is also present. Even though person-centred care is recommended in healthcare, and despite DSNs’ efforts to practise PCC, the result of this thesis shows that it also implies an altered professional role for DSNs that has to be addressed.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2013. , 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1593
Keyword [en]
Diabetes specialist nurse, professional role, self-management support, type 2 diabetes, caring relation, power relation, person-centred care
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-80908ISBN: 978-91-7459-735-6 (print)OAI: oai:DiVA.org:umu-80908DiVA: diva2:651939
Public defence
2013-10-25, Vårdvetarhusets Aula, Vårdvetarhuset, Umeå Universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
Diabetes intervention in Västerbotten, DIVA 2
Available from: 2013-10-03 Created: 2013-09-27 Last updated: 2013-10-03Bibliographically approved
List of papers
1. Diabetes specialist nurses' perceptions of their multifaceted role
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2012 (English)In: European Diabetes Nursing, ISSN 1551-7853, E-ISSN 1551-7861, Vol. 9, no 2, 39-44 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to explore diabetes specialist nurses' (DSNs') perceptions of their professional role in diabetes care.

Exploratory interviews were used to elicit DSNs' perceptions of their professional role. Twenty-nine DSNs working in 23 primary health care centres in northern Sweden were interviewed in focus groups. Data were analysed using qualitative content analysis.

The DSNs described their profession as encompassing five major roles: ‘expert’, ‘fosterer’, ‘executive’, ‘leader’, and ‘role model’. Challenges interpreted as role ambiguities included feeling uninformed, fragmented, resigned, pressed for time, and self-reproachful.

The profession of DSN was interpreted as multifaceted, with various roles and role ambiguities. Patient-centred care and empowerment, which are recommended in diabetes care, can be difficult to achieve when DSNs experience role ambiguity.

Lack of clarity about role demands and difficulty in reconciling different roles may have a negative impact on DSNs' attitudes in clinical encounters and could inhibit patient-centred care. The development of the DSN profession requires improved awareness of the DSN's professional role in the clinical encounter, not only to improve the care of patients with diabetes, but also to retain these professionals.

Place, publisher, year, edition, pages
Maney Publishing, 2012
Keyword
Diabetes specialist nurse, patient-centred care, professional role, role ambiguity
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-61554 (URN)10.1002/edn.204 (DOI)
Available from: 2012-11-20 Created: 2012-11-20 Last updated: 2017-12-07Bibliographically approved
2. Role clarity and role conflict among Swedish diabetes specialist nurses
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2013 (English)In: Primary care diabetes, ISSN 1878-0210, Vol. 7, no 3, 207-212 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To explore diabetes specialist nurses (DSNs)' perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.

METHODS: A cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.

RESULTS: The DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.

CONCLUSIONS: The DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Diabetes specialist nurse, role clarity, role conflict, psychosocial work aspects
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-80709 (URN)10.1016/j.pcd.2013.04.013 (DOI)000324965700005 ()23768659 (PubMedID)
Available from: 2013-09-24 Created: 2013-09-24 Last updated: 2016-06-13Bibliographically approved
3. Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes
Open this publication in new window or tab >>Interaction between diabetes specialist nurses and patients during group sessions about self-management in type 2 diabetes
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(English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134Article in journal (Refereed) Submitted
Keyword
Diabetes specialist nurse, interaction, patient, self-management, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-80901 (URN)
Projects
Diabetes intervention in Västerbotten , DIVA 2
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved
4. Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses
Open this publication in new window or tab >>Patient-centred care in type 2 diabetes: an altered professional role for diabetes specialist nurses
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2014 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 28, no 4, 675-682 p.Article in journal (Refereed) Published
Abstract [en]

Little research has been done to try to understand how patient-centred care is understood and practised by healthcare professionals specialising in patients with diabetes. Experiences from patient-centred practices need to be highlighted as a way of motivating diabetes specialist nurses to take a patient-centred approach. The aim of this study was to describe diabetes specialist nurses' experiences of practising patient-centred care in the context of a type 2 diabetes intervention. The study design was descriptive and used qualitative methods. Focus group interviews complemented by individual semi-structured interviews were analysed by qualitative content analysis. The main theme of the diabetes specialist nurses' experiences of practising patient-centred care was an altered professional role. The main theme was based on two themes: ambivalence towards practising patient-centred care and enriched relationships with the patients. The ambivalence towards practising patient-centred care was based on the three subthemes: a position of withdrawn expertise, inconvenience of changing routines and insights that patient-centred care is difficult but possible. Their experiences of enriched relationships with patients were based on the two subthemes: courage to discuss the severity of diabetes and increased engagement in patients' daily lives. The diabetes specialist nurses' experiences with practising patient-centred care included doubts about their ability to practise in such a way and about the feasibility of such care. At the same time, their enriched relationships with patients were seen as an opportunity to engage in patients' lives. Training and support for practising patient-centred care may improve diabetes specialist nurses skills in patient-centred care and self-management support in type 2 diabetes.

Keyword
Diabetes specialist nurse, intervention, pateint-centred care, pateint education, qualitative content analysis, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-80905 (URN)10.1111/scs.12092 (DOI)000345314000006 ()24164307 (PubMedID)
Projects
Diabetes intervention in Västerbotten DIVA 2
Available from: 2013-09-27 Created: 2013-09-27 Last updated: 2017-12-06Bibliographically approved

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