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Exploring views on Swedish district nurses' prescribing: a focus group study in primary health care
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
2003 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 12, no 5, 643-650 p.Article in journal (Refereed) Published
Abstract [en]

• Since 1994 district nurses (DNs) in Sweden have been permitted to prescribe drugs from a limited list. This reform has met severe resistance from doctors and the opinions of general practitioners (GPs) and DNs have differed in many aspects.

•  The aim of this study was to gain deeper understanding of the different opinions about DNs' prescribing and to explore the impact of the reform on primary care.

• Six focus group interviews were conducted, four with DNs and two with GPs.

•  Data analysis revealed six categories, which were condensed into two dimensions. The dimensions were individual prerequisites, with the categories responsibility and knowledge, and organizational prerequisites, with the categories distribution of work, climate of co-operation, resistance and economic considerations.

•  District nurses were very positive towards prescribing and had gained new knowledge through the compulsory training course and via discussions with pharmacists. Because of the responsibility required for prescribing, some nurses had introduced systems for self-monitoring. Prescribing was seen as a natural part of the nursing process. All interviewees could describe periods of resistance against the reform, and the head of the health centre was a key person for attitudes at the workplace.

• The DNs found the nurse prescribing reform very positive. They experienced a strengthening of professionalism and also thought that the reform was a natural development. Negative attitudes and opinions offset the positive feelings. The resistance that had appeared in the beginning had now turned into silent acceptance.

Place, publisher, year, edition, pages
2003. Vol. 12, no 5, 643-650 p.
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-28308DOI: 10.1046/j.1365-2702.2003.00716.xLocal ID: 13440OAI: oai:DiVA.org:liu-28308DiVA: diva2:249114
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Psychosocial working conditions among general practitioners and district nurses: Organisational, professional and gender aspects
Open this publication in new window or tab >>Psychosocial working conditions among general practitioners and district nurses: Organisational, professional and gender aspects
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on the psychosocial working conditions shared by general practitioners and district nurses in Sweden, in relation to the personal doctor reform and district nurses' right to prescribe drugs.

First, a questionnaire was compiled and developed through a stepwise development phase, including key informant interviews, literature review, and review of other models and questionnaires used with a similar purpose. The questionnaire developed was used in a pilot study with 42 general practitioners and 39 district nurses. The questionnaire with 78 items in different parts, was tested for construct validity through factor analysis, and for reliability through Cronbach's alpha. It was then used in the main study.

One aim was also to compare perceived changes in working conditions between general practitioners and district nurses during different degrees of implementation of a personal doctor system. A sample of 469 general practitioners and 466 district nurses participated. The cross-sectional design makes it difficult to distinguish the possible direct effects of a personal doctor from other regional differences. However, is it important to note that the personnel in a more far-reaching personal doctor system perceived less favourable psychosocial working conditions than personnel in a more traditional primary care system.

Another aim was to investigate gender and professional differences in the shared psychosocial working conditions. Both general practitioners and district nurses were satisfied with the professional content of their work and experienced rather low or moderate levels of strains -and symptoms. However, female general practitioners perceived the most unfavourable working conditions compared with both male colleagues and female district nurses.

The opinions among general practitioners and district nurses, to district nurses' right to prescribe drugs differed in all aspects studied. District nurses were positive and general practitioners negative. To gain a deeper understanding of the different opinions, six focus group interviews was carried out. The resistance to the refonn had turned into silence. General practitioners and district nurses hardly speak to each other about prescribing. The district nurses were uncertain whether the general practitioners trusted them and made up systems for self-control.

The personnel within a more far-reaching personal doctor system perceived less-favourable psychosocial working conditions compared with personnel in more traditional primary care system. Female general practitioners seem to experience the most unfavourable working conditions. compared with both their male counterparts, and female district nurses. District nurses prescribing highlights professional differences. Quantitative and qualitative data complement each other and give more diverse information.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 669
Keyword
psychosocial working conditions, primary care, general practitioners, district nurses, profession, gender aspects, personal doctor reform, district nurses prescribing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27556 (URN)12218 (Local ID)91-7219-962-8 (ISBN)12218 (Archive number)12218 (OAI)
Public defence
2001-05-04, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved

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Wilhelmsson, SusanFoldevi, Mats

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