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Objective: To explore the everyday dilemmas of parents living with a child with nocturnal enuresis and to describe their support needs in relation to healthcare professionals.

Subjects and methods: The study was conducted in 2011 in Uppsala County, Sweden. Parents of 13 children with enuresis, 10 mothers and three fathers, participated in qualitative semi-structured in-depth interviews, which were analysed using systematic text condensation.

Results: The analysis of the material resulted in six themes: enuresis is socially stigmatising and handicapping; all practices and home remedies are tested; it creates frustration in the family; protecting the child from gossip or teasing; support from healthcare providers would have helped; it's something we just have to live with. Two patterns of coping were identified: the Unworried wet-bed-fixers and the Anxious night-launderers.

Conclusion: Having a child with enuresis can be stressful for parents, although they tried hard not to blame their child. Because parents can feel reluctant to bring up enuresis themselves, they want child health nurses to routinely raise the issue of bedwetting at the yearly check-up. Parents' information needs included causes of and available treatment options for enuresis as well as access to aids and other support for affected families. .

Introduction: COPD exacerbations are associated with lung function decline,lower quality of life and increased mortality, and can be prevented by pharmacologicaltreatment and rehabilitation. The aim of this study was to explore if theorganization of the COPD care in primary health care centres influences the riskfor new exacerbations.Methods: A clinical population of 775 COPD patients was randomly selected from70 Swedish primary health care centres (PHCCs). Data on COPD exacerbationsand following preventive measures were obtained from medical record review.Cox regression analyses were used to estimate the risk of a new exacerbation withadjustment for age and sex.Results: During a study period of four years 458 patients had an exacerbation,and of these 278 patients (61%) had a second exacerbation during the follow-upperiod. Patients with a scheduled extra visit to an asthma/COPD nurse followingan exacerbation had a decreased risk of a new exacerbation compared to patientswith no extra follow-up besides regularly scheduled visits (adjusted hazard ratio(95% CI) 0.54 (0.32 to 0.93), p=0.026).Conclusion: Scheduling an extra visit to an asthma/COPD nurse following aCOPD exacerbation decreased the risk of reexacerbations in primary care patients.We conclude that a close cooperation between professional categories is importantin the prevention of COPD exacerbations in primary care.

Background: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation.

Aims: To examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk.

Methods: A clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex.

Results: During a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045).

Conclusions: Guidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients. (C) 2013 Primary Care Respiratory Society UK. All rights reserved.

ABSTRACT The general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD. Designs: Observational, prospective observational and experimental designs were used. Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker. Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

The general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD. Designs: Observational, prospective observational and experimental designs were used. Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker. Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Background: Smokers with chronic obstructive pulmonary disease (COPD) have high nicotine dependence making it difficult to quit smoking. Motivational interviewing (MI) is a method that is used in stimulating motivation and behavioral changes.

Objective: To describe smoking cessation communication between patients and registered nurses trained in MI in COPD nurse-led clinics in Swedish primary health care.

Methods: A prospective observational study with structured quantitative content analyses of the communication between six nurses with basic education in MI and 13 patients in non-smoking consultations.

Results: Only to a small extent did nurses’ evoke patients’ reasons for change, stimulate collaboration, and support patients’ autonomy. Nurses provided information, asked closed questions, and made simple reflections. Patients’ communicationwasmainly neutral and focusing on reasons for and against smoking. It was uncommon for patients to be committed and take steps toward smoking cessation.

Conclusion: The nurses did not adhere to the principles of MI in smoking cessation, and the patients focused to a limited extent on how to quit smoking.

Practice implications: To make patients more active, the nurses need more education and continuous training in motivational communication.

Aim: To examine smoking cessation communication between patients and registered nurses, with a few days of Motivational Interviewing (MI) based education, in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care (PHC). Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity (MITI) Scale and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did, but only to a small extent, evoke patients’ reasons forchange, foster collaboration and support patients’ autonomy. In the registration of specific utterances; they provided a lot of information (42%), asked closed (21%) rather than open questions (3%) and made more simple (14%) than complex (2%) reflections. Most of the registration of the patients’ utterances in the communication were either toward or away from smoking cessation coded in the category Follow/Neutral (59%), followed by utterances in the categories of Reason for change 40%, Taking steps 1% and Commitment 0%. No significant differences could be observed in the results of MITI and CLAMI between the first and third consultations. Conclusion: Smoking cessation communication at nurse-led COPD clinics neither focused on the patients’ reasons for or against smoking nor motivated patients to express commitment to, or take steps towards, smoking cessation

Objective: To explore smoking cessation communication between patients and registered nurses in consultations over time at nurse-led Chronic Obstructive Pulmonary Disease (COPD) clinics in primary health care. Method: The first and third of three consultations were videotaped, involving 13 smokers and six nurses with a few days of Motivational Interviewing (MI) based education. In these consultations smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity Scale (MITI) and Client Language Assessment in Motivational Interviewing (CLAMI). Results: The nurses did only to a small extent evoke patients’ reasons for change, foster collaboration and support patients’ autonomy. Nurses provided a lot of information (42%), asked closed (21%) rather than open (3%) questions and made more simple (14%) than complex (2%) reflections. Patients communication were mainly Follow/Neutral (59%), Reasons for and against smoking 40%, least common were Taking steps (1%) and Commitment (0%) toward smoking cessation. Conclusion: The nurses did not use professional smoking cessation communication and the patients did not talk about how to quit smoking. Practice Implications: To make the patients more active in their smoking cessation process at nurse-led COPD clinics in primary health care the nurses need continuous education and training in smoking cessation communication.

Aim: To describe to what extent registered nurses use Motivational Interviewing (MI) in smoking cessation communication over time at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care. Background: For smokers with COPD the most crucial and evidence-based intervention is smoking cessation. Method and Results: The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. The nurses’ smoking cessation communication was analyzed using the Motivational Interviewing Treatment Integrity scale, a behavioral coding system that assesses the practitioners’ use of motivational interviewing. Nurses and patients talked for equal amounts of time in one third of the 26 consultations, whilst nurses talked for longer in the remaining two thirds. To capture an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five as the top score. Evocation, collaboration, autonomy-support and empathy averaged between 1.31 and 2.23 whereas direction scored five in all consultations. Of communication behaviors, giving information was the most frequently used, followed by closed questions, MI non–adherent and simple reflections. MI Adherent, open questions and complex reflections occurred rarely. There were no significant individual or group-level differences in any of the ratings between the first and the third consultations. Conclusion: In smoking cessation communication the nurses had low scores on evocation, collaboration, autonomy-support, empathy and high scores on direction. They also supplied large amounts of information, posed closed questions and made simple reflections. Open questions and complex reflections occurred rarely.

Aim. This paper is a report of a study to describe to what extent Registered Nurses, with a few days of education in motivational interviewing based communication, used motivational interviewing in smoking cessation communication at nurse-led chronic obstructive pulmonary disease clinics in primary health care.

Background. For smokers with chronic obstructive pulmonary disease the most crucial and evidence-based intervention is smoking cessation. Motivational interviewing is often used in healthcare to support patients to quit smoking.

Method. The study included two videotaped consultations, the first and third of three at the clinic, with each of 13 smokers. Data were collected from March 2006 to April 2007. The nurses’ smoking cessation communication was analysed using the Motivational Interviewing Treatment Integrity scale. To get an impression of the consultation, five parameters were judged on a five-point Likert-scale, with five indicating best adherence to Motivational Interviewing.

Results. Evocation’, ‘collaboration’, ‘autonomy-support’ and ‘empathy’ averaged between 1·31 and 2·23 whereas ‘direction’ scored five in all consultations. Of communication behaviours, giving information was the most frequently used, followed by ‘closed questions’, ‘motivational interviewing non–adherent’ and ‘simple reflections’. ‘Motivational interviewing adherent’, ‘open questions’ and ‘complex reflections’ occurred rarely. There were no important individual or group-level differences in any of the ratings between the first and the third consultations.

Conclusion. In smoking cessation communication the nurses did not employ behaviours that are important in motivational interviewing.

Objective. The aim of the study was to explore the structure, content in communication and self-management education in patients’ first consultations at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary healthcare.

Method. Thirty consultations performed by seven registered nurses were videotaped; structure and content in the consultation was analyzed using Pendleton's Consultation Map. Nurses’ self-management education was assessed from the content of the conversation: whether important and relevant information and self-management education was given, and how investigations were performed.

Results. Each consultation lasted for a mean time of 37.53 min. Communication about reasons for consultations concerned mainly medical and physical problems and to a certain extent patients’ perceptions. Teaching about self-management and smoking cessation was of an informative nature. Two consultations ended with shared understanding, and none of the patients received an individual treatment-plan.

Background: There has been insufficient study of the care of persons with diagnosed dementia and the contemporary presence of asthma and/or Chronic Obstructive Pulmonary Disease (COPD). Inhalation treatment requires active patient participation, which is more difficult for a person who has dementia. A consequence of incorrect inhalation technique will be a lack of benefit of medicine affecting dyspnea, fatigue, sleeping problems, cognitive capability and respiratory infections such as pneumonia. Pneumonia is the most common symptom affecting health and well-being among elderly. Improved care and treatment for asthma and COPD may be of importance to these people’s health, quality of life and to community medical costs. The aim is to describe inhalation treatment among persons with dementia who also have asthma and/or COPD. The aim is also to examine the effects of training in inhalation technique and inhalation aids for nursing staff working in dementia care.

Research questions: 

• How is the presence of asthma and/or COPD among persons with dementia related to expected incidence? 
• What inhalation techniques and levels of inhalation strength occur among patients with asthma, COPD and dementia? 
• How is the quality of life for persons with dementia and asthma and/or COPD influenced by whether the nursing staff is given training in inhalation technique, inhalation aids and devices?

Method: The project will be planned in two parts: firstly, a descriptive epidemiological mapping, scrutinizing register and journal data of the diagnoses asthma and COPD among persons with dementia: secondly, an observation of inhalation techniques and a control of inhalation strength among patients in dementia care with asthma and/or COPD. This will be carried out before and after a randomized controlled training intervention in inhalation technique and inhalation aids given to nursing staff in dementia care.