Samverkan och lärande kring sårbehandling : erfarenheter från olika professionsperspektiv i primärvård och utbildning

Detta är en avhandling från Stockholm : Karolinska Institutet, Dept of Learning, Informatics, Management and Ethics

Sammanfattning: Aim: The overall aim of this thesis is to explore collaboration and knowledge development in wound management in practice and in education. One specific aim is to investigate district nurses’ (DNs’) wound management according to wound appearance, assignment of responsibilities for diagnosis and care, guidelines for wound treatment and DNs’ collaboration with other professional groups (I). Another is to describe DNs' experiences of nursing actions in wound management (II), and experiences of knowledge and knowledge development in wound care when treating patients with different types of wounds (III). Further aim is to explore General Practitioners’ (GPs’) experiences of their role in leg ulcer management with emphasis on perceptions of knowledge in wound management and collaboration with DNs (IV). The last specific aim is to explore attitudes and perceptions from nursing and medical students towards the other profession in relation to wound care (V). Methods: Data were collected by questionnaire (I). Descriptive statistical analysis and content analysis of the textual data were conducted. For study II-IV qualitative interviews were performed with eight DNs (II), 16 DNs (III) and 16 GPs (IV). Content of interviews were analyzed using qualitative content analysis (II-III) and thematic analysis (IV). One study applied both questionnaire and focus groups (V). Analyses of questionnaires were made by descriptive statistics and thematic analysis of focus groups (V). Results: DNs' wound management cases consisted in total of 310 wounds in 283 patients. The most common acute wounds were traumatic wounds while pressure ulcers and venous leg ulcers dominated of slow healing wounds. Collaboration between DNs and GPs was lacking. The area of responsibility of different professional groups was not defined and guidelines for wound treatment were often lacking. Interprofessional collaboration was regarded as important for wound healing (I). DNs strived to provide expert wound care while working independently. These aspirations were aggravated by organizational shortcomings, such as lack of authority and resources required to carry out their nursing actions optimally (II). DNs experienced wound management as knowledge-intensive and knowledge development as ongoing process based on learning alongside with clinical practice (III). GPs described their role in wound management as consultant and coordinator in charge of the diagnosis. They perceived their wound care knowledge as being depending on their education and clinical experience. Collaboration with DNs was governed by organizational factors (IV). Nursing and medical students showed a positive attitude towards interprofessional collaboration. They experienced the need for clarity of roles in wound care. Structures of authoritarian attitudes, care culture and old traditions were seen as obstacles to future collaboration. Interprofessional education (IPE) was seen as an opportunity to acquire wound care knowledge and jointly learn about each other’s professions and thus IPE was seen as a tool in to the profession (V). Conclusion: DNs and GPs work multiprofessionally in parallel activities and interact with each other only when problems occur in wound treatment. Collaboration is largely controlled by the organization. The wound care knowledge is mainly based on clinical experience which is extensive for DNs and sporadic for GPs. Nursing and medical students have positive attitudes towards interprofessional collaboration and see the IPE as a tool into the profession.

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