Under senare år har primärvården utsatts för en högre belastning i form av ökande utgifter och större efterfrågan efter medicinsk vård. En växande kunskap om negativa farmakologiska biverkningar och det globala problemet med antibiotikaresistens har resulterat i att egenvård och aktiv exspektans har fått en starkare position inom primärvården.
Behandlingsrekommendationer vid lindrig sjukdom är en viktig fråga eftersom vårdsökande tenderar att upprepa strategier som fungerat vid tidigare sjukdomstillfällen, och erfarenhet av egenvård ökar framtida utövande av egenvård. Det finns dock begränsat med forskning som beskriver hur människor agerar för att lindra sina symtom vid lindrig sjukdom och hur vårdpersonal kan stödja människor i att känna trygghet i utövandet av symtomlindrande egenvård. För att kunna erbjuda en egenvårdsrådgivning där personers behov blir mött finns ett behov av att veta mer om vilka faktorer som stärker människors tilltro till den egna förmågan
att vårda sig själv.
Det övergripande syftet med denna avhandling var att studera människors erfarenheter och behov vid egenvård och egenvårdsrådgivning vid lindrig sjukdom. Detta har åstadkommits genom att studera personers erfarenheter av och kunskaper om lindrig sjukdom, samt användandet av egenvårdsåtgärder och informationskanaler vid egenvård av lindrig sjukdom. Personers behov av trygghet i egenvård studerades också, tillsammans med upplevelser av stödjande och hindrande faktorer i utövandet av egenvård. Nöjdhet med telefonrådgivning studerades, och sist utfördes en kvalitativ studie av hur upplevelsen av trygghet påverkar beslutsprocessen vid egenvård av lindrig sjukdom.
Resultaten visade att personer med erfarenhet av lindrig sjukdom skattade sin kunskap om sjukdomarna högre, och att kunskap ökade personernas tilltro till sin egen förmåga att utöva egenvård. Sjukvården kontaktades oftast vid mindre vanliga sjukdomstillstånd, och följsamhet till egenvårdsråd varierade beroende på informationskälla. För att känna sig trygg med att utöva egenvård behövdes goda kunskaper om att uppnå symtomlindring, och yngre personer uppgav oftare att de behövde ha familj och vänner att prata med för att känna sig trygg. Tillgänglighet till vården var den faktor som oftast sågs som ett stöd i egenvård, medan brist på kunskap oftast angavs som ett hinder. Personer som fick enbart egenvårdsrådgivning var mindre nöjd med telefonrådgivningen än personer som hänvisades till läkare, och det att känna sig trygg efter samtalet med sjuksköterskan var den faktor som inverkade mest på den totala nöjdheten med
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telefonrådgivningen. Råd att utöva egenvård hade en bromsande effekt på
sjukvårdsanvändandet, och resulterade i 66.1 % av fallen i en lägre vårdnivå än personerna hade tänkt sig innan de ringde. Osäkerhet och bedömning av risk påverkade vilka åtgärder som vidtogs vid lindrig sjukdom, beroende på om symtomen bedömdes som ofarliga eller livshotande. När människor känner trygghet påverkas både egenvården och
rådgivningssituationen positivt.
Sammanfattningsvis visar denna avhandling att lindrig sjukdom kan orsaka stress och rädsla, och att personer arbetar aktivt för att hantera sina symtom. Trygghet är en viktig faktor som påverkar hur människor agerar vid lindrig sjukdom, och som inverkar på upplevelsen av rådgivningssituationen. Sjuksköterskan kan utgöra en lugnande kraft, och i samtalet med sjuksköterskan uppstår en unik möjlighet att skapa trygghet och tilltro till att lindrig sjukdom läker ut av sig själv, och att det finns effektiva åtgärder att ta till för att lindra sina symtom och skapa välbefinnande. Råd om egenvård behöver vara handlingsorienterade och utrusta människor med effektiva handlingsalternativ för att återfå kontroll över situationen. Precis som hälsa är mer än frånvaro av sjukdom, är egenvård mer än frånvaro av medicinsk vård.
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ACKNOWLEDGEMENTS
This thesis was carried out at the Division of Nursing, Department of Health Sciences, Luleå University of Technology. Many people have contributed with support, encouragement and reassurance (!) as I worked with my thesis, and to all of you I express my sincere gratitude. First of all I would like to thank all persons who generously contributed to these studies with their time, views and experiences. The thesis could not have been written without you.
My special thanks:
To my main supervisor, Stefan Sävenstedt, for giving me this opportunity, and for the freedom and trust that you have granted me. Thank you for believing so strongly in me, and for providing me with calm and reassurance whenever I have doubted myself.
To my co-supervisor, Britt-Marie Wälivaara, for careful and constructive advice and for generously sharing your insights and perspectives with me.
To my co-supervisor, Irene Vikman, for the support and for sharing with me your knowledge and experience.
To my co-supervisor, Jesper Martinsson, for sharp and educative supervision. What is the probability that this thesis would have been this great without your help, given that you are the most amazing statistician in the world?!
My alma mater, the Department of Health Sciences at Luleå University of Technology for providing me with an excellent education, a passion for nursing and science, and this fantastic
opportunity.
To my colleagues and fellow Ph.D. students at the Department of Health Sciences for the dedicated and creative research discussions, for enlightening me with different perspectives and for all the good times. A special thanks also to the CardioCross-sisters (Linda Sandström, Åsa Engström, Ulrica Strömbäck, and Irene Vikman) for all the blood, sweat and tears, but mostly for the laughs.
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To all researchers at the Centre of Academic Primary Care at the University of Aberdeen, especially Alison Elliott, Chris Burton, Catriona Mallia, Alison Thornton, Mags Watson and Terry Porteous for interesting and inspiring discussions during my study visit.
My sincere gratitude to the amazing nurses that work at the SHD – thank you for your efforts and your time! Special thanks to Gunilla Lindgren for all the kind help and to Solveig Kronlund for the encouragement to take the step into research.
To my father and my best friend, Ørnulf Rysst Andersen, for all your love and support, and for encouraging me to be the best that I can be. For all the hours and adventures that we’ve had together, and still have to come.
To my awesome aunts Gunhild Skatteboe, Ingrid Hallan and Karen Andersen for inspiration and for making me feel so proud to be a nurse!
To my sister-in-law Ann Gustafsson, for your love and support, and for your ability to spread happiness wherever you go, just by being you. To Alma and Samuel because I love you, and to my parents-in-law, Inger and Bengt Gustafsson, for the excellent child-care, gardening and maintenance help during all of these years. Always caring and always just a phone call away. You are amazing!
To Linnea Rauer, my daughter, sister and best friend. For your love and support and for your calm and caring way.
To my neighbors and friends Anna, Hanna and Johanna for all the late nights and the wine, and to my darling Caroline. If I could choose a sister, it would be you!
To my wonderful children, Sol, Emil and My, for all your joy and enthusiasm, and for forcing me to be here and now and leave the dissertation at work. You fill my heart with pride and love, and no textbook has ever taught me as much about life and the world as you have. I love you.
Last by not least, I would like to thank the love of my life Johan. I respect your wish to include man-flu as a chapter in the dissertation, and I know you say that being married to a nurse means you only get sympathy when you’re dying. But it’s not true. You are always in my heart. Thank you for making me so happy.
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