Dissatisfaction with appearance is a common phenomenon, more frequent among women than men (Frisén & Holmqvist 2010, Neighbors & Sobal 2007) but so common that it can be considered a norm (Tantleff-Dunn, Barnes & Larose 2011). Health professionals are therefore in contact with the phenomenon on a regular basis in different health settings. Previous research have shown that health professionals experience time constraints and lack of confidence in relation to patients’ appearance issues (Persson et al 2009; Konradsen et al 2009). Little is however known about the resources needed from the professionals’ point of view. The aim of the study was therefore to explore the phenomenon from a nursing perspective in general and with particular emphasis on resources needed.
Five semi-structured focus group interviews were conducted with 24 health professionals in total (19 women and 5 men). Their age varied from approximately 20 to 45 years, with adherent variation in professional experience from a variety of health settings. The interviews were digitally recorded, transcribed verbatim and analyzed through thematic analysis (Braun & Clarke, 2006). The study was done in accordance with the Swedish Law of Research Ethics, SFS 2003:460.
The analysis resulted in the two themes knowledge development and operative support, representing different resources needed according to the respondents. The respondents own knowledge and professional competence was constantly referred to as the most important resource. The findings showed the importance of appearance being included in their education, the need for a continuous process of reflection and learning on an individual level but also on group level in terms of collegial learning. In order for the knowledge and competence to be put into practice there was also need for operative support. Sufficient time for communicating with the patients and the need for appropriate technical support in some nursing situations were emphasized by the participants.
The findings clearly shows the central role that health professionals have in relation to patients’ appearance issues and their need for resources. The findings adds to existing body of knowledge and can be used as a framework for health promotion strategies in health settings, with regards to patients’ appearance issues and distress. More research as well as action is needed from a nursing as well as public health perspective.
BACKGROUND: Health care professionals frequently interact with unknown patients in a process involving appearance-based judgements and priority-setting, all of which has an effect on health care equality. The healthcare provider-patient interaction is also highly relevant for the awareness and support of patients' appearance concerns, with an associated possibility for improving patients' satisfaction with their appearance and health. The aim was therefore to explore nursing staff's experience of patients' appearance issues in various nursing situations, with the purpose to facilitate awareness raising and knowledge development.
METHOD: A qualitative research approach with focus group interviews was chosen due to the exploratory aim of the study. Five semi-structured focus group interviews were conducted with 24 nursing staff in total (19 women and five men). The participants' ages varied (20 to 45 years) as did their professional nursing experience. The interviews lasted approximately one hour, were digitally recorded, transcribed verbatim and analysed through thematic analysis.
RESULTS: The thematic analysis resulted in the two themes Patient perspective and Professional nursing role, with associated subthemes. The findings showed the importance and impact of appearance issues in nursing situations and how these are linked to the health of the patients. Some groups of patients were identified as more vulnerable than others, which was associated with health care inequalities and health disparities. Value-based strategies along with knowledge, and skills for holistic person-centred care were identified as important resources for the development of appearance-related awareness and support in various nursing situations.
CONCLUSION: Strategies for improvement can be realised through the educational system for nursing staff, but mainly by using collective reflective learning forums in different workplaces. An empowerment approach is considered a useful framework for the implementation of holistic person-centred care, functioning as a resource for appearance-related awareness and support in various nursing situations. However, more research is needed on the complex and challenging phenomenon of appearance issues in nursing situations. Knowledge development related to successful person-centred strategies for appearance-related awareness and support is important, especially strategies with a salutogenic perspective.
År 2011 startade Stöd- och serviceenheten i Kristianstads kommun projektet Medarbetare i fokus (MIF) för att arbeta med värdegrund och kompetensutveckling. Projektet utvärderades av extern utvärderare från Högskolan Kristianstad. Utvärderingens syfte var att följa projektet genom lärande utvärdering med fokus på process och resultat samt att ge återkoppling för lärande, anpassning och utveckling. Såväl kvantitativa som kvalitativa metoder användes för att utvärdera projektet. Resultatet visade att medarbetare hade under hela projektets gång hade positiva upplevelser av hälsa, arbete, balans i vardagen och kundrelationen. Projektet drevs av en engagerad ledningsgrupp vars arbete präglades av långsiktigt tänkande och fokus på hållbarhet. För att genomföra projektet utbildades processtöd och internutbildare. Medarbetarna upplevde kompetensutvecklingen som positiv, men en del hade svårt att se koppling mellan kompetensutveckling och dagligt arbete. Värdegrundsarbetet präglades av samarbete mellan processtöd och enhetschefer som skapade diskussioner gällande värdegrund på enhetens arbetsplatser. De upplevde ofta sitt arbete som positivt men också svårt på grund av kontextuella faktorer. Slutsatserna blev att en engagerad projektledning var en förutsättning för projektets framgång och för att på sikt kunna främja en hälsoskapande arbetsplats. Utbildningarnas innehåll utgick från medarbetarnas önskemål och upplevda behov vilket främjade delaktighet och engagemang från medarbetarna. Vissa svårigheter att direkt omsätta innehållet i projektets utbildningar till praktik framkom vilket skapade svårigheter i att direkt nå implementering och förändring i det dagliga, praktiska arbetet med kunderna. Internutbildare skapade förutsättningar för en lärande organisation och hållbar utveckling då kunskap kan fortsätta utvecklas i organisationen även efter projekttiden. Stöd och långsiktighet behövdes för att nå längre på sikt och för att tankar skulle kunna omsättas till praktiska handlingar. Goda upplevelser av hälsa, arbete, balans i vardagen och kundrelation skapade förutsättningar för att på sikt nå en hälsoskapande och lärande organisation.