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Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure - A grounded theory study.
Göteborgs Universitet.ORCID iD: 0000-0002-7633-482x
Göteborgs Universitet.
Göteborgs Universitet.
2015 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 10, no 1, article id 27775Article in journal (Refereed) Published
Abstract [en]

Living with chronic heart failure (CHF) often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: "Experiencing a subordinate approach," "Objectifying during the encounter" and "Expected to be compliant." This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: "Experiencing an empowering approach," "Person-centredness during the encounter" and "Expected to be capable." It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals' attitudes and communication in encounters with patients. Health care must be designed to support and promote patients' own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore strongly suggest a paradigm shift in the health-care organisation and culture in order to support the patients in their efforts to live a meaningful, rich life, in spite of the chronic illness CHF.

Place, publisher, year, edition, pages
2015. Vol. 10, no 1, article id 27775
Keywords [en]
Chronic disease, continuity, grounded theory method, heart failure, illness, patient perspective, person-centred care
National Category
Nursing
Identifiers
URN: urn:nbn:se:hb:diva-12751DOI: 10.3402/qhw.v10.27775ISI: 000357477900001PubMedID: 28229746Scopus ID: 2-s2.0-84936768117OAI: oai:DiVA.org:hb-12751DiVA, id: diva2:1144937
Available from: 2017-09-27 Created: 2017-09-27 Last updated: 2020-12-03Bibliographically approved
In thesis
1.
The record could not be found. The reason may be that the record is no longer available or you may have typed in a wrong id in the address field.
2. Kontinuitet som grund för vårdande och hälsa vid hjärtsvikt: patienters, närståendes och sjuksköterskors perspektiv
Open this publication in new window or tab >>Kontinuitet som grund för vårdande och hälsa vid hjärtsvikt: patienters, närståendes och sjuksköterskors perspektiv
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim was to examine continuity of care for persons with heart failure from the patients’, next of kin’s and nurses’ perspectives.

Methods: This thesis has a caring science approach and consists of four qualitative studies conducted in a health care context. Studies I and II are based on patients’ experiences of continuity in heart failure. The data were collected through individual interviews and a group interview that was analysed using the grounded theory method. Study III is based on next of kin’s perceptions of continuity of care in heart failure. The data were collected with individual interviews and analysed using a phenomenographic method. Study IV is based on nurses’ perceptions of continuity of care for patients with heart failure. The data were collected with focus group interviews and analysed using a phenomenographic method.

Results: Continuity of care supports caring and health. To patients, continuity is what connects care and life. Continuity of care creates conditions that support the patient’s health processes and vitality; it contributes to the patient being able to maintain continuity in life. To the next of kin, continuity of care contributes to a feeling of being in “good hands”. Continuity can be the support that next of kin need to integrate care into their daily life with the patient and to find a balance between responsibility and commitment in the patient’s care. Nurses have a unique opportunity to create continuity of care in a way that meets the needs and conditions of both patients and next of kin. When continuity is created based on patients’ needs, in a way that is meaningful and relevant to patients’ health, continuity contributes to well-being, safety and autonomy for patients and next of kin. Continuity of care also makes it easier for nurses to collaborate with the patients, next of kin and other professionals.

Conclusion: Continuity makes care caring. Continuity of care supports patients and next of kin to manage life adaptation that accompanies the disease and preserve their well-being and health as much as possible. Continuity of care supports nurses’ professional practice.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2020
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 108
Keywords
Caring, Continuity, Continuity of care, Focus groups, Grounded theory, Heart failure, Next of kin, Nurses, Patients, Phenomenography, Qualitative interviews
National Category
Nursing
Research subject
The Human Perspective in Care
Identifiers
urn:nbn:se:hb:diva-23394 (URN)978-91-88838-78-0 (ISBN)978-91-88838-79-7 (ISBN)
Public defence
2020-10-09, M404, Allégatan 1, Borås, 11:00 (Swedish)
Opponent
Available from: 2020-12-03 Created: 2020-06-24 Last updated: 2020-12-03Bibliographically approved

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Östman, Malin

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