Effects of COPD self-care management education at a nurse-led primary health care clinic.

Chronic obstructive pulmonary disease (COPD) is disabling, with symptoms such as chronic cough, phlegm, wheezing, shortness of breath and increased infections of the respiratory passage. The aim was to examine the effects of a structured educational intervention programme at a nurse-led primary health care clinic (PHCC) on quality of life (QoL), knowledge about COPD and smoking cessation in patients with COPD. This study had an experimental design in which 52 patients with COPD from a Swedish primary care setting were randomized into two groups (intervention or control). Both groups received standard care but patients in the intervention group were also offered two visits to a nurse specialized in COPD care. The purpose of the visits was to increase the patients' self-care ability and their knowledge about COPD. The study was approved by the local Research Ethics Committee. Data were collected using two questionnaires, one pertaining to knowledge about COPD and smoking habits and St. George's Respiratory Questionnaire, addressing how QoL was affected by the patients' respiratory symptoms. The intervention and control groups answered both questionnaires on their first and last visits to the PHCC. A statistically significant increase was noted in the intervention group on QoL, the number of patients who stopped smoking and patients' knowledge about COPD at the follow-up, 3-5 months after intervention. However, a confounding factor may have been that one of the researchers (Eva Osterlund Efraimsson), as a nurse in the PHCC, performed the intervention. This implies that patients were in a dependent relationship which may have affected the responses in a favourable direction. Our findings show that conventional care alone did not have an effect on patients' QoL and smoking habits. Instead, the evidence suggests that a structured programme with self-care education is needed to motivate patients for life-style changes.

Experiences of Swedish community health nurses working with health promotion and a patient-held health record.

Community health nurses have a tradition of preventive care, and might therefore be a key group in the introduction of new health-promotion methods. The aim of this study was to describe Swedish community health nurses' experiences in working with health promotion and a patient-held record as an integrated tool in their health-promotion work. Interviews were performed with 12 nurses at primary healthcare centres in the county of Dalarna, Sweden. A qualitative content analysis applying aspects of the grounded theory approach was performed. Central to the analysis was the nurses' struggle for balance, in being both a doer of practical disease-oriented tasks and a health-promotion communicator. Descriptions of the nurses' struggles to balance their work were grouped into three themes: (i) working alone and as a part of a team; (ii) nurse-related and patient-related interests; and (iii) patient's responsibility and shared responsibility between patient and nurse. The findings indicated that the structural organization in the primary healthcare centres was important for the community health nurses' means to work with health promotion and the patient-held record. In addition, the community health nurses' cognitive and emotional needs also affected this balance. In conclusion, the struggle of community health nurses to find a balance between being doers and health-promotion communicators is valuable in understanding health promotion in primary health care. The study indicates that it is not enough to develop health-promotion methods acceptable to community health nurses. A comprehensive examination of working conditions and the content of daily work is needed to ensure an emphasis on health promotion, including long-term usage of patient-held records.