27 research outputs found

    Experts' Encounters in Antenatal Diabetes Care: A Descriptive Study of Verbal Communication in Midwife-Led Consultations

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    Aim. We regard consultations as cocreated communicatively by the parties involved. In this paper on verbal communication in midwife-led consultations, we consequently focus on the actual conversation taking place between the midwife and the pregnant woman with diabetes, especially on those sequences where the pregnant woman initiated a topic of concern in the conversation. Methods. This paper was undertaken in four hospital outpatient clinics in Norway. Ten antenatal consultations between midwives and pregnant women were audiotaped, transcribed to text, and analyzed using theme-oriented discourse analysis. Two communicative patterns were revealed: an expert's frame and a shared experts' frame. Within each frame, different communicative variations are presented. The topics women initiated in the conversations were (i) delivery, time and mode; (ii) previous birth experience; (iii) labor pain; and (iv) breast feeding, diabetes management, and fetal weight. Conclusion. Different ways of communicating seem to create different opportunities for the parties to share each other's perspectives. Adequate responses and a listening attitude as well as an ambiguous way of talking seem to open up for the pregnant women's perspectives. Further studies are needed to investigate the obstacles to, and premises for, providing midwifery care in a specialist outpatient setting

    The genetic history of Scandinavia from the Roman Iron Age to the present

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    The authors acknowledge support from the National Genomics Infrastructure in Stockholm funded by Science for Life Laboratory, the Knut and Alice Wallenberg Foundation and the Swedish Research Council, and SNIC/Uppsala Multidisciplinary Center for Advanced Computational Science for assistance with massively parallel sequencing and access to the UPPMAX computational infrastructure. We used resources from projects SNIC 2022/23-132, SNIC 2022/22-117, SNIC 2022/23-163, SNIC 2022/22-299, and SNIC 2021-2-17. This research was supported by the Swedish Research Council project ID 2019-00849_VR and ATLAS (Riksbankens Jubileumsfond). Part of the modern dataset was supported by a research grant from Science Foundation Ireland (SFI), grant number 16/RC/3948, and co-funded under the European Regional Development Fund and by FutureNeuro industry partners.Peer reviewedPublisher PD

    Experiences of being exposed to intimate partner violence during pregnancy

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    In this study a phenomenological approach was used in order to enter deeply into the experience of living with violence during pregnancy. The aim of the study was to gain a deeper understanding of women's experiences of being exposed to intimate partner violence (IPV) during pregnancy. The data were collected through in-depth interviews with five Norwegian women; two during pregnancy and three after the birth. The women were between the age of 20 and 38 years. All women had received support from a professional research and treatment centre. The essential structure shows that IPV during pregnancy is characterized by difficult existential choices related to ambivalence. Existential choices mean questioning one's existence, the meaning of life as well as one's responsibility for oneself and others. Five constituents further explain the essential structure: Living in unpredictability, the violence is living in the body, losing oneself, feeling lonely and being pregnant leads to change. Future life with the child is experienced as a possibility for existential change. It is important for health professionals to recognize and support pregnant women who are exposed to violence as well as treating their bodies with care and respect

    Monoskop Exhibition Library

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    The Exhibition Library reimagines the medium of art exhibition as well as that of art catalogue. Catalogues carry exhibitions through time and space, figuring as tropes for imagining arrangements and the course of works and settings they describe. However, they rarely give us a clue about what really happened, since they are often made before the show opens. Rather than documenting it, they often stand on their own, almost as if another work on display, truly as an artistic medium on its own. For this work, artists, designers, curators, poets and collectives created thirty catalogues of imaginary exhibitions. Exploring both the potential and impossible in art, the resulting exhibition library also serves as a “library of exhibitions.

    Being in an oasis: a restorative and reassuring place - women’s experiences of a valuable antenatal diabetes midwifery consultation

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    The prevalence of diabetes in the childbearing population is increasing globally. Pregnant diabetic women are considered to be at high risk, and thus require specialized, multidisciplinary prenatal care in which midwives play an integral part. These women’s views and experiences of encounters with midwives during diabetes care have not yet been investigated. Our aim was to use an exploratory interpretive approach to investigate the experiences of pregnant women and their perceptions towards the meaning of prenatal consultation provided by midwives in the prenatal care team. A purposive sample was recruited from four hospital-based prenatal diabetes outpatient clinics in the urban areas of Norway: 10 pregnant women (5 primiparous, 5 multiparous) aged 28-45 and diagnosed with different types of diabetes. Data from semi-structured interviews were transcribed and subjected to thematic analysis. Three main themes emerged: being in an open atmosphere, being seen as a person, and being reassured. Together, these themes created a construct that we labeled being in an oasis-a restorative and reassuring place. The counterpoint of this view was a more negative perspective described as having insufficient time, feelings of being objectified and rushed, and diseaseoriented care. The women valued the focus on surveillance in the consultations, although at their best, the midwife-woman encounters complemented and counteracted the iatrogenic effect of the biomedical focus in specialist prenatal care. However, the organization of care may have contributed to and created feelings of suffering, as these women had limited scope for addressing their concerns in the consultation. We conclude that these consultations are complex co-created activities in which interpersonal aspects of the midwifewoman encounters, such as the midwives’ openness and responsiveness to the women, seem to be significant in developing a personal approach. Introduction The prevalence of diabetes is increasing within both the general and the childbearing population, in Norway and worldwide.1 Women with pre-existing diabetes as well as those with pregnancy-induced diabetes (gestational diabetes, GDM) are regarded as a high-risk group with concerns for maternal, fetal, and neonate outcomes.2 In order to optimize their pregnancy outcome, these women are provided with centralized specialist care organized as diabetes teams within the prenatal outpatient clinics at obstetrics and gynecology departments. Midwives are routinely included in these teams, because they can provide the usual prenatal education and care in addition to diabetes management.3 Nurse-midwives are supposed to focus on more than the illness; they also attend to the patient as a unique individual with specific personal health concerns and questions. In this study, we therefore asked how these women perceive the care provided by the midwives in the prenatal team

    Kommunikativa processer och upplevelser av delaktighet i vÄrd- och omsorgsplaneringsmöten

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    Äldre personer med flera ohĂ€lsoproblem och komplexa vĂ„rd- och omsorgsbehov Ă€r en ökande grupp i samhĂ€llet. För att Ă„stadkomma en vĂ„rd och omsorg som svarar mot den enskilda personens behov Ă€r samverkanmellan olika vĂ„rdgivare och professioner en viktig utgĂ„ngspunkt vid vĂ„rd- och omsorgsplanering. I denna studie har vi undersökt hur delaktighet för patienter skapas vid vĂ„rd- och omsorgsplaneringsmöten (VOP-möten) samt hur deltagarna upplever detta. Datamaterialet bestĂ„r av bandinspelade VOP-möten samt efterföljande intervjuer med mötesdeltagarna. I datamaterialet ingick dels möten som genomfördes av vĂ„rd- och omsorgspersonal vars huvudsakliga arbetsuppgift Ă€r att genomföra vĂ„rd- och omsorgsplaneringar (hĂ€r kallade specialiserade vĂ„rdplaneringsteam), dels möten som genomfördes av personal som inte specifikt arbetade enbart med VOP-möten.De inspelade VOP-mötena analyserades utifrĂ„n dimensionerna aktiv-passiv, subjekt-objekt. I analysen belystes hur sĂ„vĂ€l patienternas, nĂ€rstĂ„endes samt vĂ„rd- och omsorgspersonalens förhĂ„llningssĂ€tt bidrog till den bild av patienten som framstĂ€lldes under mötet. Resultatet presenteras utifrĂ„n följande kategorier: Att vara ett ”aktivt subjekt”, d v s att man Ă€r delaktig i sin vĂ„rd- och omsorgsplanering och förvĂ€ntas ta ansvar vid formulering av mĂ„lsĂ€ttningar; Att vara ett ”passivt subjekt” det vill sĂ€ga patienten framstĂ„r som en hel person som lever i ett livssammanhang men som pĂ„ grund av hĂ€lsoskĂ€l eller pĂ„verkan i omgivningen inte Ă€r sĂ„ delaktig vid VOP-mötet; Att vara ett ”aktivt objekt” vilket innebĂ€r att endast begrĂ€nsade aspekter av personen framtrĂ€der exempelvis genom att patienten bidrar till en beskrivning av sig sjĂ€lv som ett objekt; samt slutligen; Att vara ett ”passivt objekt” dĂ€r patienten frĂ„ntas möjligheten att delta i bedömning eller planering av vĂ„rd och omsorg. I resultatet beskrivs dessutom omstĂ€ndigheterna kring mötet, ”Samtalsramen”, samt deltagarnas upplevelser före, under och efter mötet.I resultatet framkom att patienterna i huvudsak var aktiva vid VOP-mötena och bemöttes som subjekt. Patienternas delaktighet underlĂ€ttades i den hĂ€r studien av att de var vĂ€l förberedda inför mötet, de visste vad mötet skulle handla om, flera hade tidigare erfarenheter av VOP-möten och de gavs möjlighet att berĂ€tta vem man var och hade varit. Patienterna beskrev i de efterföljande intervjuerna att de, inför VOP-mötet, kĂ€nde en oro att sjĂ€lvbilden skulle komma att förĂ€ndras frĂ„n sjĂ€lvstĂ€ndighet till beroende. Patienterna beskrev i de flesta fall att de kĂ€nde sig bekvĂ€ma under mötet. Vidare framkom att patienterna efter mötet upplevde bĂ„de att deras önskemĂ„l infriats, men ocksĂ„ en medvetenhet om att livsavgörande beslut hade aktualiserats, vilket kunde föranleda sĂ„vĂ€l besvikelse som anpassning till en ny livssituation.Resultatet kan inte sĂ€gas representera hur VOP-möten generellt sett genomförs och upplevs. BegrĂ€nsningari datamaterialet bestĂ„r av att inspelningarna av VOP-möten och intervjuer Ă€gde rum i ett omrĂ„de dĂ€r det fanns god tillgĂ„ng pĂ„ korttidsplatser. Majoriteten av datamaterialet utgjordes ocksĂ„ av möten med vĂ„rdpersonalsom var sĂ€rskilt erfarna och intresserade av arbetsuppgiften. Denna rapport kan dĂ€rför sĂ€gas beskriva i huvudsak ”goda exempel” pĂ„ vĂ„rd- och omsorgsplaneringsmöten, d v s nĂ€r det fungerar vĂ€l. Trots detta anser vi att den modell som beskriver hur patienterna positionerar sig och positioneras som aktiv/passiv, subjekt/objekt Ă€r giltig och möjlig att anvĂ€nda i alla typer av VOP-möten och kan tjĂ€na som stöd för att förstĂ„ vad som hĂ€nder och hur det hĂ€nder i kommunikationsprocessen

    TvÀrprofessionell samverkan för patienters/brukares delaktighet i vÄrd- och omsorgsplanering

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    Äldre personer med flera och komplexa sjukdomstillstĂ„nd Ă€r en ökandegrupp i samhĂ€llet. För att kunna erbjuda mĂ„lgruppen en god vĂ„rd stĂ€lls kravpĂ„ samverkan mellan professionsföretrĂ€dare och vĂ„rdverksamheter inomsĂ„vĂ€l öppen som sluten vĂ„rd och omsorg. Administrativa frĂ„gor har pĂ„ olikasĂ€tt dominerat utvecklingen. Nya rutiner för informationsöverföring harinförts i VĂ€stra Götaland och informationen mellan vĂ„rdgivarna skickas idatoriserad form. Det hĂ€r projektet belyser patienters/brukares perspektivkring deltagande vid vĂ„rdplanering liksom vad som hĂ€nder i sambandmed vĂ„rdplaneringsmöten ur de professionellas perspektiv med fokus pĂ„samverkan och patienters delaktighet. Studierna har genomförts underledning av Eva LidĂ©n, Med. Dr med inriktning mot omvĂ„rdnadsforskningoch leg. Distriktssköterska, i samarbete med projektmedarbetare ochreferensgrupp med företrĂ€dare för olika professioner och verksamheter.Projektet har bestĂ„tt av tre delstudier under Ă„ren 2009–2011. EnkartlĂ€ggning genomfördes 2008 inför starten av projektet. De tredelstudierna har haft som övergripande fokus att studera förutsĂ€ttningaroch hinder för samverkan mellan personal frĂ„n olika professioner ochorganisationer liksom patienters/brukares delaktighet. Personal frĂ„nhĂ€lso-/sjukvĂ„rden, primĂ€rvĂ„rd och kommunalt anstĂ€lld vĂ„rdpersonal avolika kategorier liksom patienter/brukare har i studierna bidragit medvĂ€rdefull information utifrĂ„n deras erfarenheter av att medverka i vĂ„rdochomsorgsplaneringsmöten (VOP-möten) inför patienters utskrivningfrĂ„n sjukhus.I föreliggande slutrapport sammanfattas i korthet de tvĂ„ förstadelstudierna, som belyser hur organisations- och verksamhetsföretrĂ€dare serpĂ„ samverkan och patienters/brukares delaktighet liksom förutsĂ€ttningaroch hinder för deras medverkan vid vĂ„rdplanering (LidĂ©n 2009; BĂ„ngsbo& LidĂ©n 2010). Det huvudsakliga innehĂ„llet utgörs av resultatet av dentredje och sista delstudien, samt en diskussion över det sammanvĂ€gdaresultatet av de tre delstudierna.Delstudie tre syftade till att belysa hur vĂ„rd- och omsorgspersonali reflektionsgrupper kommunicerar kring patienters behov och sittprofessionella ansvarsomrĂ„de vid VOP-möten.Syftet med studien var ocksĂ„ att beskriva om och vilka förĂ€ndringar i synsĂ€tt som deltagarna upplevdeföre och efter interventionen i form av handledda reflektionsgruppermed deltagare frĂ„n kommun, primĂ€rvĂ„rd samt slutenvĂ„rd. Avsikten medreflektionsgrupperna vara att öka medvetenheten om kommunikativaprocesser som förekommer vid VOP-möten. Resultatet av delstudie trevisade att VOP-möten i stort fungerar bĂ€ttre idag Ă€n tidigare och attvarierande professionsperspektiv diskuterades. Dock dominerar detorganisatoriska perspektivet, med stor betydelse för grĂ€nsöverskridandesamverkan. Diskussionerna bidrog enligt informanterna till en bĂ€ttreförstĂ„else för andra organisationers villkor samt en ökad medvetenhet ombetydelsen av patienter/brukares delaktighet vid VOP-möten.Det sammanvĂ€gda resultatet av de tre delstudierna visar att vĂ„rdplaneringĂ€r en komplex verksamhet och det har blivit tydligt i projektet att det blivit en alltmer specialiserad uppgift vilket inte med automatik innebĂ€rökad delaktighet för patienter/brukare. Dock underlĂ€ttas samverkandĂ„ de professionella kontakterna blir fĂ€rre. PersonkĂ€nnedom ochkommunikation liksom kunskap och förstĂ„else för andra organisationersverksamhet, bidrar till organisationsöverskridande samverkan enligtdatamaterialet. Det finns goda intentioner att samverka mellan professionsochverksamhetsföretrĂ€dare, bĂ„de inom den egna organisationen ochmed andra organisationer. NĂ€r personalen samverkar inför, under ochefter VOP-möten kan patienter/brukares delaktighet understödjas ochförbĂ€ttras. Men detta förutsĂ€tter en medvetenhet hos personalen och ettunderstödjande förhĂ„llningssĂ€tt, dĂ€r yrkesomrĂ„den och professionelltansvar kompletterar och överlappar oberoende av organisations- ellerprofessionstillhörighet. Det finns en stor medvetenhet i datamaterialetom hur det ska vara för att vĂ„rdplanering ska fungera sĂ„ bra som möjligtmen det finns olika försvĂ„rande faktorer frĂ€mst pĂ„ organisationsnivĂ„. Trots detta finns goda möjligheter för en stĂ€ndigt pĂ„gĂ„ende utveckling

    Patient participation in discharge planning conference

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    Introduction: There is a need for individualized discharge planning to support frail older persons at hospital discharge. In this context, active participation on their behalf cannot be taken for granted. The aim of this study was to elucidate patient participation in discharge planning conferences, with a focus on frail older persons, supported by the theory of positioning described by HarrĂ© & van Langenhove.Methods: The study was designed as a case study based on audio-recordings of multidisciplinary discharge planning conferences and interviews with health professionals elucidating their opinions on preconditions for patient participation in discharge planning. The analysis has been performed using qualitative content analysis and discourse analysis. Data collection took place during 2008–2009 and included 40 health professionals and 13 frail older persons in hospital or municipal settings.Results: Findings revealed four different positions of participation, characterized by the older person's level of activity during the conference and his/her appearance as being reduced (patient) or whole (person). The positions varied dynamically from being an active person, passive person, active patient, or passive patient and the health professionals, next-of-kin, and the older persons themselves contributed to the positioning.Conclusions: The findings showed how the institutional setting served as a purposeful structure or a confinement to patient participation

    The meaning of learning to live with medically unexplained symptoms as narrated by patients in primary care: A phenomenological–hermeneutic study

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    Background: Although research about medically unexplained symptoms (MUS) is extensive, problems still affect a large group of primary care patients. Most research seems to address the topic from a problem-oriented, medical perspective, and there is a lack of research addressing the topic from a perspective viewing the patient as a capable person with potential and resources to manage daily life. The aim of the present study is to describe and interpret the experiences of learning to live with MUS as narrated by patients in primary health-care settings. Methods: A phenomenological–hermeneutic method was used. Narrative interviews were performed with ten patients suffering from MUS aged 24–61 years. Data were analysed in three steps: naive reading, structural analysis, and comprehensive understanding. Findings: The findings revealed a learning process that is presented in two themes. The first, feeling that the symptoms overwhelm life, involved becoming restricted and dependent in daily life and losing the sense of self. The second, gaining insights and moving on, was based on subthemes describing the patients’ search for explanations, learning to take care of oneself, as well as learning to accept and becoming mindful. The findings were reflected against Antonovsky's theory of sense of coherence and Kelly's personal construct theory. Possibilities and obstacles, on an individual as well as a structural level, for promoting patients’ capacity and learning were illuminated. Conclusion: Patients suffering from MUS constantly engage in a reflective process involving reasoning about and interpretation of their symptoms. Their efforts to describe their symptoms to healthcare professionals are part of this reflection and search for meaning. The role of healthcare professionals in the interpretative process should be acknowledged as a conventional and necessary care activity
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