Patients' readiness for dietary change at the beginning of counselling: a transtheoretical model-based assessment.

BACKGROUND: The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient-specific stages of change. METHODS: The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. RESULTS: The patients were at different stages of change of diabetes-affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. CONCLUSIONS: Understanding patient-specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.

From nurse-centered health counseling to empowermental health counseling.

The main goals of this study were to examine aspects of the delivery and reception of advice and questions in interaction between nurses and patients and to describe linguistic features that constructed nurse-centered and empowermental health counseling. The research data, 38 health counseling sessions, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversational analysis. During nurse-centered discussions, the nurses' advice did not correspond to the patients' need for information. These counseling sessions began with check-up questions about the patients' condition and continued with factual questions about their illnesses and health care measures. During empowering health counseling, the nurses made use of the patients' knowledge of their circumstances and supported the patients' ability to reflect on their health behavior. Questioning and advising strategies were found to be crucial for building up empowermental conversation and enhancing the impact of health counseling.

The development of reflective learning in the context of health counselling and health promotion during nurse education.

AIMS AND BACKGROUND: The purpose of this follow-up study was to describe the development of reflective learning of 16 student nurses in the context of health counselling and promotion during clinical training of a 3-year nursing education programme in two Finnish polytechnics. The first aim was to analyse the levels of reflectivity in the student nurses' reflections on their videotaped counselling situations. The second aim was to explore the qualitative features of the reflective health counselling learning process in the context of health promotion. The theoretical background of the study was based on a transformative learning theory. METHODS: The data consisted of stimulated recall interviews with 16 student nurses conducted once a year between 1998 and 2000. The data were analysed using categorization and thematic analysis. FINDINGS: The findings of the study showed that half of the students in the research group reached the level of critical consciousness during their nursing education. The others remained at the level of consciousness. Two students who represented thoughtful action without reflection in the first study year were able to reach reflection and even critical reflection later during their education. The meaning schemas of counselling developed and were enriched when the students moved into the higher stages of reflection. There were features of an empowerment approach to health promotion only in the meaning schemas and perspectives of critical reflectors. CONCLUSIONS: These results may indicate that the empowerment approach to health promotion within the modern health promoting role of nurses requires critical reflection. Therefore, effective methods and evaluation tools of reflective learning are needed to support learning from practice via critical reflection.

Taciturn patients in health counseling at a hospital: passive recipients or active participators?

This study explored patients' taciturnity as observed on videotape during hospital health counseling situations with a nurse. Health counseling sessions, 38 in number, were videotaped, transcribed verbatim, and analyzed by using an adaptation of conversation analysis. The data analysis included information on 18 selected patients who spoke little and did not introduce new topics, but rather supported the discussion on the theme chosen by the nurse. When we examined nurses' and patients' speech word by word, we discovered four participation frames that produced taciturnity: in the hands of professionals, compliant, guilty, and polite. These could fluctuate during interaction. The findings indicate that there is a need for a more extensive description of taciturn, or silent, patients. What has been interpreted as passivity in the literature can be interpreted more constructively. This insight can be useful for developing health counseling practice in hospitals.

Investigating student nurses' constructions of health promotion in nursing education.

This article describes student nurses' constructions of health promotion and the change of these constructions during their nursing education in two Finnish polytechnics. The data consisted of essays written by the 19 student nurses before they began their nursing education in 1997 and of stimulated recall interviews with the same students during the second year of their education in 1998. The data were analyzed by using thematic analysis. During the first study year, 13 students' constructions of health promotion changed. Six students had initially broad constructions of health promotion and their constructions remained unchanged. Four basic changes were found in the students' constructions: (1) the emphasis shifted from physical to multidimensional health promotion, (2) health promotion became more concrete and contextual, (3) the conception of perfect health became more permissive and relative, and (4) the interpretation of health promotion shifted from performing towards being there for the patient. These results may indicate that student nurses in Finnish polytechnics were attempting to adopt the empowerment approach to health promotion for their constructions. Moreover, the results represent a major challenge concerning nursing education and health promotion learning from the constructivistic approach to knowledge building.