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Content and distribution of discursive space in consultations between patients with atrial fibrillation and healthcare professionals.
2013 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 12, no 1, 47-55 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To describe (i) the topics participants talk about, (ii) the use of discursive space in consultations between patients with atrial fibrillation (AF) and their nurses and physicians, and (iii) the frequencies of the ways the patients, nurses and physicians introduce the topics.

METHODS: Data were collected from 23 videotaped consultations concerning patients with AF as well as physicians and nurses, respectively. To obtain a description of topics discussed, the transcripts were analysed using content analysis. The patterns of dominance for the respective topic and participant were explored from the framework of analysis that treats dominance.

RESULTS: Four topics were used by both nurses and physicians in the consultations. These were 'pathophysiology', 'diagnostic procedures', 'treatment' and 'activity'. In the nurse-patient consultation an additional topic, 'routines related to the physician's responsibilities', emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between the nurses and patients and unequal between the physicians and patients. The healthcare professionals initiated the topics more frequently compared to the patients, whereby the medical approach recommended in the guidelines for AF could be recognized. The patients were the dominating initiators in the topic 'activity', which refers to the adaptation of activities in daily life in relation to the AF.

CONCLUSIONS: The medical-driven agenda dominates over the patient-driven agenda in consultations between healthcare professional and patients with AF. The patients initiated the conversations when discussing living with AF and were more talkative during conversations in nurse consultations.

Place, publisher, year, edition, pages
2013. Vol. 12, no 1, 47-55 p.
Keyword [en]
Atrial fibrillation, Referral and consultation, Human, Videorecording, Content analysis, Physicians, Registered nurses, cardiovascular nursing, Communication, Descriptive research
National Category
Nursing
Identifiers
URN: urn:nbn:se:shh:diva-2163DOI: 10.1177/1474515111430894PubMedID: 22357787OAI: oai:DiVA.org:shh-2163DiVA: diva2:916203
Available from: 2016-04-01 Created: 2016-04-01 Last updated: 2016-06-15Bibliographically approved
In thesis
1. Communication in Patient Involvement in Decision making: Examples from consultations on atrial fibrillation
Open this publication in new window or tab >>Communication in Patient Involvement in Decision making: Examples from consultations on atrial fibrillation
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Abstract

Background: Further knowledge is needed regarding communication that occurs in practice between patients with atrial fibrillation (AF) and health professionals in consultations to understand the issue of patient involvement in treatment decisions.

Overall aim: The overall aim of this thesis is to contribute knowledge on communication between patients and health professionals (cardiology nurses and cardiologists), focussing on how they create involvement in decision making in consultations.

Specific aims: (1) To describe (i) the topics that patients with AF discuss with cardiology nurses and cardiologists; (ii) the use of discursive space in consultations between these participants; and (iii) the frequency at which patients, cardiology nurses, and cardiologists introduce identified topics. (2) To describe the different types of resistance by patients to treatment with warfarin and how cardiologists respond to such resistance. (3) To examine how patients describe involvement and communication in decision making regarding treatment in consultations with cardiology nurses and cardiologists. (4) To examine how cardiologists describe their views on patient involvement in AF treatment decisions, their perceptions regarding efforts to involve patients, and how they handle decisions.

Methods: A qualitative design was used. In study I, the sample consisted of 23 videotaped consultations between patients with AF and cardiology nurses and cardiologists at six nurse-led cardiology outpatient clinics. Content analysis was used to obtain a description of topics that were discussed. The patterns of dominance for the various topics and participants were examined. In study II, the sample consisted of 11 videotaped consultations between patients with AF and cardiologists. Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin. In study III, 22 patients with AF were interviewed directly after their consultations with cardiology nurses and cardiologists. Content analysis was used for the resulting data. In study IV, 10 cardiologists were interviewed in cardiology clinics at four Swedish hospitals and qualitative content analysis was used.

Findings: In study I, a medically driven agenda dominated the patient-driven agenda. However, when the patients initiated conversations about their life with AF (the topic that received the least amount of space on the agenda), involvement was created. In study II, the patients’ resistance could be viewed as a source of knowledge about patients’ real-life situations and what motivates them. In study III, despite not being actively involved in the decision-making process, the patients experienced a sense of involvement when they felt understood and were listened to. In study IV, by taking into account the patients’ feelings in the consultations, and by actively encouraging the patients to be involved, the cardiologists contributed to patient involvement.Conclusions: Patients, cardiology nurses, and cardiologists create involvement in decision making in consultations as communicative projects. Patients strive for space and create involvement by showing resistance to the decisions suggested by health professionals. However, involvement is not only an issue about obtaining space in the consultations, but is also associated with obtaining clarification, building confidence, feeling understood, trusting cardiology nurses and cardiologists, and having confidence in receiving consistent care within an established relationship. On a theoretical level, this thesis sheds light on the interaction between the concepts of communication, involvement, and decision making.

Place, publisher, year, edition, pages
Stockholm: Karolinska Institutet, 2016. 81 p.
Keyword
Communication, Patient involvement, Shared decision making, Atrial fibrillation, Interaction, Patient participation, Person-centered care, Resistance, Discursive space, Consultation
National Category
Nursing
Identifiers
urn:nbn:se:shh:diva-2171 (URN)978-91-7676-042-0 (ISBN)
Public defence
2016-01-22, Weitnersalen, Sophiahemmet University, Valhallavägen 91, Hus R, Stockholm, 09:30 (English)
Opponent
Supervisors
Available from: 2016-06-15 Created: 2016-04-01 Last updated: 2016-06-15Bibliographically approved

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Citation style
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