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  • 1.
    Lundberg, Kristina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Aspects of Health Promotion Practice in Swedish primary healthcare: Perspectives from staff and patients related to working conditions of district nurses and lifestyle habit management in patients with risk factors for cardiovascular disease2021Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The overall aim of present thesis was to generate knowledge about aspects of Health Promotion Practice (HPP) related to district nurses’ working conditions and their professional patient-related work. Further, the aim was to study lifestyle habit management and experiences of caring encounters in patients with risk factors of developing CVD. Various approaches of both a qualitative and quantitative nature were used. In Study I, data were collected by interviews to describe district nurses ׳ experiences of working with health promotion actions among patients with risk factors for cardiovascular disease (CVD). Study II was performed as a pilot using an intervention consisting of Motivational Interviewing (MI) and Physical Activity on Prescription (PAP), aiming to investigate exercise levels in patients. Study III was a feasibility study using an intervention of the “Attending Nurse Caring Model” (ANCM) among district nurses, to describe working life and working health. In Study IV, interviews were performed to describe patients’ experiences of the caring encounter between district nurses and patients. From the district nurses’ perspective, HPP was viewed as the essence of their work but organizational structures in primary healthcare were regarded as obstacles that complicated the prioritization of HPP, and their reports of dissatisfaction and stress due to not being able to complete their HPP were also a distinguishing feature (Study I). MI and PAP were piloted and studied concerning the impact on patients suffering from risk factors for CVD. This resulted in improvements in various health variables, both physical and psychosocial, among the patients studied (Study II). The feasibility of the ANCM was studied concerning district nurses’ own experiences of stress, burnout, empathy, and self-care in connection with work. Improvements were observed in all variables and indicated increased awareness of their patterns of action in their work (Study III). Moreover, the ANCM feasibility study also showed a strengthening in the caring encounter between patients and district nurses (Study IV). A theory-guided nursing practice consisting of elements that strengthened reflection activities of self-care and self-awareness in the district nurses was regarded as a valuable addition to a health-promoting working life as well as beneficial to their patients.   

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  • 2.
    Lundberg, Kristina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Introducing the Attending Nurse Caring Model of Jean Watson into primary health care in Sweden. A feasibility studyManuscript (preprint) (Other academic)
  • 3.
    Lundberg, Kristina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Jong, Mats
    Mid Sweden University, Sundsvall.
    Jong, Miek C
    UiT The Arctic University of Norway.
    Kristiansen, Lisbeth
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.
    Patients’ experiences of the caring encounter in health promotion practice: a qualitative study in Swedish primary health care2020In: BMC Family Practice, E-ISSN 1471-2296, Vol. 21, article id 232Article in journal (Refereed)
    Abstract [en]

    Background: Previous studies have reported that organizational structures and cultures in primary health care are obstacles to district nurses doing successful work in health promotion practice (HPP). Because organizational structures are not easily changed, Jean Watson’s Attending Nurse Caring Model (ANCM) was introduced and piloted at a primary health care center in Sweden, aiming to transform HPP so as to empower district nurses and increase their work satisfaction. Aim: To investigate patients’ experiences of the caring encounter in HPP after introduction of the ANCM in Swedish primary health care, the aim being to explore the essential components of the caring encounter between patients and district nurses. Methods: A descriptive and qualitative research design was used. Data collection was performed using individual face-to-face interviews with twelve patients at risk for developing CVD. Data analysis consisted of both deductive content analysis, using a categorization matrix based on the ANCM and, subsequently, inductive latent content analysis. Results: The findings were abstracted into three themes: 1.‘Feeling the deepest essence of being cared for’: to be respected and being put at the center of the encounter; 2. ‘Feeling acceptance and worth’: being treated with openness and permissive attitudes, 3. ‘Being in a supportive atmosphere that promotes hope’: to feel trust and being trusted in the encounter, and being empowered by hope. The unifying main theme of the caring encounter was abstracted as ‘Experiencing human dignity’. Conclusion: The present study revealed that the essence of the caring encounter between patients and district nurses in HPP is to be unconditionally accepted in an environment that inspires hope and encouragement. The ANCM seems to be a promising model to use for strengthening the caring encounter and supporting CVD patients in making healthy lifestyle choices. However, further studies of qualitative and quantitative designs are needed to investigate what the ANCM can contribute to HPP in Swedish primary health care. 

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  • 4.
    Lundberg, Kristina
    et al.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Husum Health Center, Västernorrland County Council, Husum, Sweden.
    Jong, Miek C.
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Louis Bolk Institute, Driebergen, The Netherlands; National Information and Knowledge Center for Integrative Medicine, Amsterdam, The Netherlands.
    Kristiansen, Lisbeth Porskrog
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Jong, Mats
    Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
    Health Promotion in Practice - District Nurses Experiences of Working with Health Promotion and Lifestyle Interventions among Patients at Risk of Developing Cardiovascular Disease2017In: Explore: The Journal of Science and Healing, ISSN 1550-8307, E-ISSN 1878-7541, Vol. 13, no 2, p. 108-115Article in journal (Refereed)
    Abstract [en]

    Objective

    Health Promotion Practice (HPP) has the objective to promote a healthier lifestyle and reduce the risk of disease. The aim of this study was to examine district nurses׳ experiences of working with health preventive actions among patients with risk factors for cardiovascular disease (CVD), and to identify facilitators and obstacles in HPP.

    Design/Setting

    The study was carried out with a qualitative approach where individual semistructured interviews were performed with a total of 12 district nurses in primary care. Data transcripts were analyzed with a manifest content analysis.

    Findings

    Five categories were identified. Firstly, informants regarded HPP as the core essence of their work. Secondly, counseling and coaching were reported as crucial elements in working with HPP. Thirdly, informants identified tools such as motivational interviewing (MI) to facilitate HPP. In the fourth category facilitators and barriers of HPP appeared, consisting of both positive and negative attitudes and presence as well as lack of organizational culture and structure. Finally, some informants were dissatisfied with HPP and viewed it as compulsory or as a burden, while others were satisfied and experienced it as a stimulating challenge.

    Conclusion

    This study identified that HPP is the core of the district nurses׳ work to promote a healthier lifestyle in individuals with CVD. Organizational structures and culture need to be improved in order to support district nurses to successfully work with HPP. To optimize health promotion and strengthen patients׳ self-care, it is recommended that HPP include holistic elements of care.

  • 5.
    Lundberg, Kristina
    et al.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Kristiansen, Lisbeth
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Jong, Miek C.
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    Jong, Mats
    Avdelningen för omvårdnad, Mittuniversitetet, Sundsvall.
    District Nurses Experiences of Working with Health Promotion and Lifestyle Interventions Among Patients at Risk of Developing Cardiovascular Disease2014In: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 20, no 5, p. A118-, article id P04.32Article in journal (Refereed)
    Abstract [en]

    Purpose: In preventive health work it is possible to map risk factors at healthy individuals which include information and advice aiming to decrease the risk of developing cardiovascular disease. This preventive health care is in Sweden carried out primarily by the district nurses and they have a key role in promoting health and prevent cardiovascular disease. The aim of the study was to examine district nurses' experiences of working with health promotion among patients with risk factors of cardiovascular disease, and to identify possibilities and obstacles for prevention work in the practical reality.

    Methods: The study has been carried out with a qualitative approach where narrative interviews were performed with a total of 12 district nurses working at health centers in north Sweden. Data transcripts were analyzed with qualitative content analysis.

    Results: The participants express that their work in health promotion is an essence of the job as district nurse. It gives an opportunity to promote healthier lifestyle on an individual level with direct effects on patients' health. Participants are clear about what should be included in the preventive work and mention the topics of diet, exercise, tobacco, alcohol habits and obesity. The district nurses state that education in Motivational Interviewing, (MI), in Physical Activity on Prescription, (PAP) and the colleagues attitudes are important facilitators for making the health promotive work to function in the practical reality. Lack of knowledge (own and among colleagues) and inadequate organizational structures constitute obstacles.

    Conclusion: District nurses are unanimous about what should be included preventive health care. It is experienced as an important part of their duties but has sometimes difficulties to prioritize it. Furthermore, the district nurses consider that knowledge within MI, PAP and the employees' attitudes constitute possibilities while one sees lack of time, negative attitudes and inadequate structures that obstacles for the preventive work.

  • 6.
    Sjöling, Mats
    et al.
    Department of Health Sciences, Mid Sweden University, Sundsvall.
    Lundberg, Kristina
    Department of Health Sciences, Mid Sweden University, Sundsvall; Husum Family Health Centre, County Council of Västernorrland, Örnsköldsvik.
    Englund, Erling
    Research and Development Centre, County Council of Västernorrland, Sundsvall.
    Westman, Anton
    Department of Surgical and Perioperative Sciences, Section of Anesthesiology and Intensive Care, Umeå University, Umeå; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Jong, Miek C.
    Department of Health Sciences, Mid Sweden University, Sundsvall; Department of Nutrition and Healthcare, Louis Bolk Institute, Driebergen, The Netherlands.
    Effectiveness of motivational interviewing and physical activity on prescription on leisure exercise time in subjects suffering from mild to moderate hypertension2011In: BMC Research Notes, E-ISSN 1756-0500, Vol. 4, article id 352Article in journal (Refereed)
    Abstract [en]

    Background

    Physical inactivity is considered to be the strongest individual risk factor for poor health in Sweden. It has been shown that increased physical activity can reduce hypertension and the risk of developing cardiovascular diseases. The objective of the present pilot study was to investigate whether a combination of Motivational Interviewing (MI) and Physical Activity on Prescription (PAP) would increase leisure exercise time and subsequently improve health-related variables.

    Methods

    This pilot study was of a repeated measures design, with a 15 months intervention in 31 patients with mild to moderate hypertension. Primary outcome parameter was leisure exercise time and secondary outcome parameters were changes in blood pressure, Body Mass Index (BMI), waist circumference, lipid status, glycosylated haemoglobin (HbA1c) and maximal oxygen uptake (VO2 max). Assessments of the outcome parameters were made at baseline and after 3, 9 and 15 months.

    Results

    Leisure exercise time improved significantly from < 60 min/week at baseline to a mean activity level of 300 (± 165) minutes/week at 15 months follow up. Furthermore, statistically significant improvements (p < 0.05) were observed in systolic (-14,5 ± 8.3 mmHg) and diastolic blood pressure (-5,1 ± 5.8 mmHg), heart rate (-4.9 ± 8.7 beats/min, weight (-1.2 ± 3.4 kg) BMI -0.6 ± 1.2 kg/m2), waist circumference (-3.5 ± 4.1 cm) as well as in VO2 max (2.94 ± 3.8 ml/kg and 0.23, ± 0.34 lit/min) upon intervention as compared to baseline.

    Conclusions

    A 15 month intervention period with MI, in combination with PAP, significantly increased leisure exercise time and improved health-related variables in hypertensive patients. This outcome warrants further research to investigate the efficacy of MI and PAP in the treatment of mild to moderate hypertension.

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