The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study

BACKGROUND: The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). METHODS: Seven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis. RESULTS: The analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools. CONCLUSION: 'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word holistic should really be spelt 'wholistic' to avoid confusion with complementary and alternative medicine. It was obvious that our participants were able to verbalise the meaning of a 'wholistic' view through narratives about their clinical, every day work. The possibility to implement a 'wholistic' perspective in their work with patients offers a strong motivation for GPs and DNs

Phosphorylation of GFAP is associated with injury in the neonatal pig hypoxic-ischemic brain

Glial fibrillary acidic protein (GFAP) is an intermediate filament protein expressed in the astrocyte cytoskeleton that plays an important role in the structure and function of the cell. GFAP can be phosphorylated at six serine (Ser) or threonine (Thr) residues but little is known about the role of GFAP phosphorylation in physiological and pathophysiological states. We have generated antibodies against two phosphorylated GFAP (pGFAP) proteins: p8GFAP, where GFAP is phosphorylated at Ser-8 and p13GFAP, where GFAP is phosphorylated at Ser-13. We examined p8GFAP and p13GFAP expression in the control neonatal pig brain and at 24 and 72 h after an hypoxic-ischemic (HI) insult. Immunohistochemistry demonstrated pGFAP expression in astrocytes with an atypical cytoskeletal morphology, even in control brains. Semi-quantitative western blotting revealed that p8GFAP expression was significantly increased at 24 h post-insult in HI animals with seizures in frontal, parietal, temporal and occipital cortices. At 72 h post-insult, p8GFAP and p13GFAP expression were significantly increased in HI animals with seizures in brain regions that are vulnerable to cellular damage (cortex and basal ganglia), but no changes were observed in brain regions that are relatively spared following an HI insult (brain stem and cerebellum). Increased pGFAP expression was associated with poor neurological outcomes such as abnormal encephalography and neurobehaviour, and increased histological brain damage. Phosphorylation of GFAP may play an important role in astrocyte remodelling during development and disease and could potentially contribute to the plasticity of the central nervous system

Condition-related knowledge among children and adolescents with spina bifida in a Swedish county Condition-related knowledge among children and adolescents with spina bifida in a Condition-related knowledge among children and adolescents with spina bifida

Abstract Spina bifida is a congenital birth defect, resulting in physical and cognitive dysfunctions. Condition-related knowledge among children and adolescents with spina bifida is essential to facilitate independent management of their condition. The aim was to describe the condition-related knowledge among children and adolescents with spina bifida in a Swedish county. Thirteen persons with spina bifida (10 to 17 years) participated. Condition-related knowledge was assessed (n=13) using a questionnaire (KOSB) and a semi-structured interview (n=8). Interview data were analyzed using qualitative content analysis. The participants had well-developed knowledge concerning proper bladder management, but was lacking knowledge of signs of shunt malfunctioning and etiology. Some participants were uninterested in learning about their condition, despite being aware that they lacked knowledge. The findings indicate potential areas that may be included in local educational initiatives. It should be considered that persons with spina bifida may not be motivated to learn more about their condition

Improvement of communication and interpersonal competence in telenursing - development of a self-assessment tool

Aims and objectivesThe aim of this study was to develop a self-assessment tool aiming to raise telenurses awareness of their communication and interpersonal competence, and highlight areas in need of improvement. BackgroundSeveral studies have revealed the need for development of communication competence in telenursing. Structured analyses of conversations with patients/callers, is one way to increase telenurses awareness of their unique communication and interpersonal competence. DesignInstrument development, Validation assessment using the method Content Validity Index. MethodThe process to determine content validity was done in two stages; the development stage and the assessment stage. The development stage started with a literature search. The assessment stage was separated into two phases, assessment by an expert group and assessment and test by telenurses. The telenurses also participated in consensus discussions. ResultsA telenursing self-assessment tool with 58 items was developed. The items were sorted into five sections according to the nursing process. ConclusionThis study describes the thorough development process of the telenursing self-assessment tool to be used by telenurses in order to become aware of their unique communication and interpersonal competence when analysing their own conversations with patients/callers. As a formative tool it is meant to provide self-direction, feedback and coaching, and create learning opportunities. Relevance to clinical practiceThe self-assessment tool helps the telenurse to follow the nursing process, to be patient-centred, and it is meant to provide self-direction, feedback, and coaching, as well as create learning opportunities. The tool can contribute to the development of communication and interpersonal competence in telephone advice nursing. Further development of the tool may provide an objective scoring instrument for evaluating communication training and education in the field.Funding Agencies|National Medical Advisory Service Ltd (in Swedish Sjukvardsradgivningen SVR AB); County Council of Ostergotland, Sweden</p

Экономика информации

Aims and objectivesThe aim of this study was to develop a self-assessment tool aiming to raise telenurses awareness of their communication and interpersonal competence, and highlight areas in need of improvement. BackgroundSeveral studies have revealed the need for development of communication competence in telenursing. Structured analyses of conversations with patients/callers, is one way to increase telenurses awareness of their unique communication and interpersonal competence. DesignInstrument development, Validation assessment using the method Content Validity Index. MethodThe process to determine content validity was done in two stages; the development stage and the assessment stage. The development stage started with a literature search. The assessment stage was separated into two phases, assessment by an expert group and assessment and test by telenurses. The telenurses also participated in consensus discussions. ResultsA telenursing self-assessment tool with 58 items was developed. The items were sorted into five sections according to the nursing process. ConclusionThis study describes the thorough development process of the telenursing self-assessment tool to be used by telenurses in order to become aware of their unique communication and interpersonal competence when analysing their own conversations with patients/callers. As a formative tool it is meant to provide self-direction, feedback and coaching, and create learning opportunities. Relevance to clinical practiceThe self-assessment tool helps the telenurse to follow the nursing process, to be patient-centred, and it is meant to provide self-direction, feedback, and coaching, as well as create learning opportunities. The tool can contribute to the development of communication and interpersonal competence in telephone advice nursing. Further development of the tool may provide an objective scoring instrument for evaluating communication training and education in the field.Funding Agencies|National Medical Advisory Service Ltd (in Swedish Sjukvardsradgivningen SVR AB); County Council of Ostergotland, Sweden</p

Experiences among children and adolescents of living with spina bifida and their visions of the future

Purpose: Transitioning to independence may be problematic for persons with spina bifida (SB). Experiences of young persons with SB may provide insights into this group's needs for support. Therefore, the aim of this study was to investigate children'\u80\u99s and adolescents' experiences of living with SB, their social and emotional adjustment, and their thoughts about becoming independent adults. Method: Semi-structured interviews were conducted with young persons with SB (N = 8, age range 10 - 17 years). Social and emotional problems were assessed using Beck Youth Inventories. The interview transcripts were analyzed using qualitative content analysis. Results: Three main themes were found: being a person with SB; everyday living as a person with SB; and preparing for life as an adult with SB. Indications of emotional and social problems were most prominent among participants with milder physical disability. Conclusions: The findings indicate that young persons with SB may overestimate their independence. Other potentially problematic areas were lack of motivation, planning and preparedness for becoming independent. Research on transition to independence in this group should consider assistance at an early age in planning and executing strategies for independence. In addition, the potentially difficult situation for young persons with mild SB should be investigated further.Funding agencies: Swedish Inheritance Fund, County Council of Ostergotland; Research Fund of the Linkoping University Hospital</p

Condition-related knowledge among children and adolescents with spina bifida in a Swedish county

Spina bifida is a congenital birth defect, resulting in physical and cognitive dysfunctions. Condition-related knowledge among children and adolescents with spina bifida is essential to facilitate independent management of their condition. The aim was to describe the condition-related knowledge among children and adolescents with spina bifida in a Swedish county. Thirteen persons with spina bifida (10 to 17 years) participated. Condition-related knowledge was assessed (n = 13) using a questionnaire (KOSB) and a semi-structured interview (n = 8). Interview data were analyzed using qualitative content analysis. The participants had well-developed knowledge concerning proper bladder management, but were lacking knowledge of signs of shunt malfunctioning and etiology. Some participants were uninterested in learning about their condition, despite being aware that they lacked knowledge. The findings indicate potential areas that may be included in local educational initiatives. It should be considered that persons with spina bifida may not be motivated to learn more about their condition