Samtal som stöd för patienters livsstilsförändringar
-en viktig del av sjuksköterskans hälsofrämjande arbeteav
Elisabeth Brobeck
Akademisk avhandling
Avhandling för medicine doktorsexamen i
Medicinsk vetenskap med inriktning hälso- och vårdvetenskap, som kommer att försvaras offentligt
Fredag den 23 maj 2014 kl. 13.00, Hörsal P2, Örebro universitet Opponent: Docent Ann Bengtson
Göteborgs universitet Göteborg, Sverige
Örebro universitet
Institutionen för hälsovetenskap och medicin 701 82 ÖREBRO
Abstract
Elisabeth Brobeck (2014): Dialouge as support for patients’ lifestyle change – an important part of nurses’ health promotion practice. Örebro Studies in Care Sciences 54
Non-communicable diseases, such as cardiovascular diseases and diabetes, can largely be prevented. The WHO therefore urges healthcare professionals to concentrate more on promoting health in order to increase disease prevention and enabling people to take responsibility for their health. The overall aim was to explore and describe health promotion with focus on lifestyle discus-sions from a patient and nursing perspective, and to examine the relationship between health professionals lifestyle advice and lifestyle changes in the popu-lation. Design: Studies I-III have a qualitative descriptive design. Data were collected by individual interviews (I,II) and focus group interviews (III) and analysed using qualitative content analysis. In study I, 20 registered nurses (RNs) were interviewed about their experiences of employing MI in health promotion practice (HPP). In study II, 16 patients were interviewed about their experience of lifestyle discussions based on MI. In study III, three focus group interviews were performed focusing on how the RNs view HPP and its implementation in clinical practice. Study IV has a descriptive, comparative design and is based on a Swedish population survey. Data collection method was telephone interviews from a random selection of people aged 18 and over, based on those how has attended health care as a patient in the last 12 month (n=52 595). The questions concerned lifestyle advice and lifestyle change as well as the background: age, sex and educational level. Data were processed by using descriptive and analytical statistics. Results: The RNs described MI as a demanding but enriching and useful method. MI clarified their health pro-motion role as well as strategies to enable and promote change for the pa-tients. The method was also described as a way to guide the care relationship (I). The patients reported that lifestyle discussions based on MI highlighted the importance of their own will to change. They also expressed the need for RNs to be truly engaged in their problems (II). The RNs described time constraints in their everyday work that limited HPP. They also experienced that the goals of HPP were not integrated into clinical practice (III). At health care visits lifestyle issues were raised with one third of the patients (n=16 940) and al-most half of these patients (n=6 655) stated that this had actually contributed to their lifestyle change. Male, younger patients and those with a high educa-tional level were those who to the highest degree reported that lifestyle issues had been raised with them. The advice from healthcare professionals contrib-uted to lifestyle changes most in men, elderly patients and those with a low educational level.Conclusions: Healthcare professionals’ lifestyle advice is important for patient lifestyle change. Lifestyle discussions are an essential part of nurses’ HPP, as they enable patients’ self-determination in the lifestyle change process. RNs reported that the visions for HPP were not sufficiently integrated into clinical practice.
Keywords: empowerment, experience, health promotion practice, lifestyle change, lifestyle discussion, nurse, nursing, patient
Elisabeth Brobeck, School of Health and Medical Sciences Örebro University, SE-701 82 Örebro, elisabeth.brobeck@regionhalland.se
