Aspects of Health Promotion Practice in Swedish primary healthcare : Perspectives from staff and patients related to working conditions of district nurses and lifestyle habit management in patients with risk factors for cardiovascular disease

Sammanfattning: The overall aim of present thesis was to generate knowledge about aspects of Health Promotion Practice (HPP) related to district nurses’ working conditions and their professional patient-related work. Further, the aim was to study lifestyle habit management and experiences of caring encounters in patients with risk factors of developing CVD. Various approaches of both a qualitative and quantitative nature were used. In Study I, data were collected by interviews to describe district nurses ׳ experiences of working with health promotion actions among patients with risk factors for cardiovascular disease (CVD). Study II was performed as a pilot using an intervention consisting of Motivational Interviewing (MI) and Physical Activity on Prescription (PAP), aiming to investigate exercise levels in patients. Study III was a feasibility study using an intervention of the “Attending Nurse Caring Model” (ANCM) among district nurses, to describe working life and working health. In Study IV, interviews were performed to describe patients’ experiences of the caring encounter between district nurses and patients. From the district nurses’ perspective, HPP was viewed as the essence of their work but organizational structures in primary healthcare were regarded as obstacles that complicated the prioritization of HPP, and their reports of dissatisfaction and stress due to not being able to complete their HPP were also a distinguishing feature (Study I). MI and PAP were piloted and studied concerning the impact on patients suffering from risk factors for CVD. This resulted in improvements in various health variables, both physical and psychosocial, among the patients studied (Study II). The feasibility of the ANCM was studied concerning district nurses’ own experiences of stress, burnout, empathy, and self-care in connection with work. Improvements were observed in all variables and indicated increased awareness of their patterns of action in their work (Study III). Moreover, the ANCM feasibility study also showed a strengthening in the caring encounter between patients and district nurses (Study IV). A theory-guided nursing practice consisting of elements that strengthened reflection activities of self-care and self-awareness in the district nurses was regarded as a valuable addition to a health-promoting working life as well as beneficial to their patients.