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In Denmark, 12,000 people live with Parkinson's disease. Parkinson's disease is a chronic neurodegenerative disease that requires specialized interventions based on a coordinated interdisciplinary and intersectoral approach. This study aims to illuminate challenges experienced by professionals related to creating coordinated pathways for people with Parkinson's disease and their relatives in a Danish context. The study is based on ten qualitative interviews with healthcare professionals from different professional backgrounds; the interviews were analyzed using qualitative content analysis. The analysis revealed four themes: Collaboration happens by coincidence; Geography dictates treatment offers; Professionals have no influence over treatment offers; and, Achieving new knowledge can be a challenge.These barriers challenge health care professionals to create a coordinated individualized pathway. Consequently, people living with Parkinson's disease and their relatives must seek and coordinate activities themselves, and ultimately interventions may not target individual needs, risking inequality in treatment and care. [ABSTRACT FROM AUTHOR]

Purpose: To explore how the nurses experienced using video in their work at emergency primary health care centres. Method: Individual interviews with seven nurses at three different outpatient centres. The findings were analysed on the basis of Braun and Clark's thematic analysis method. Results: The nurses experienced a sense of security in using video in the decision. They experienced that the patient became more confident that a healthcare professional had seen the problem. The nurses faced stress in the emergency room but believed that the video tool itself was easy to use. They noticed increased collaboration between colleagues. Conclusion: Mostly, the nurses experienced benefits from using video in the emergency room. Emergency services can -- to their advantage -- work to provide better formal training of the video system, and thus avoid techno stress. In addition, nurses should be offered regular meetings where they can share episodes they encountered in facing the challenges of everyday work. [ABSTRACT FROM AUTHOR]

In Denmark, patient-centred care and treatment is an independent goal and an expression of high quality in healthcare practices. Core principles such as equal partnership, joint decision-making, and a holistic effort are an expression of the fact that person-centred treatment is being delivered. Patient-centredness was initiated by the World Health Organization in 1977, and since 1997 person-centredness has increasingly been used to promote the humanistic approach. The idea of providing person-centred care originates from client-related psychotherapy and person-centred counselling. At Lillebælt Hospital, excellence in nursing, treatment and care is a special focus area for managers and employees to prevent the suffering that can arise in people who feel treated as an object, lack specific knowledge, or do not understand a given rationale or guidance. This article presents a theoretical practice model for an equal partnership and a person-oriented collaboration between professional and patient. [ABSTRACT FROM AUTHOR]

Copyright of Klinisk Sygepleje is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Developing skills in professional relationships is a central theme in the education of public health nurses. According to the National Curriculum, students shall deepen their knowledge in communication, with especially focus on parental guidance and dialogue with children, youth and parents. Health clinics and school health services should promote health and development, and it is important that the nurse has the ability to fine-tune and adjust, be open, committed and willing to listen to offer a good relationship. The aim of this article is to present the theoretical background and research in developing relationship skills and discuss experiences and challenges in developing such skills among students at Master of Clinical Nursing, specialization public health nurse. The dialogue is the basis for developing relationship skills. The interaction is critical in the collaboration and the professional has a particular responsibility to ensure that «the other» are taken care of and understood in their own terms. Instruction in relation to developing relationship skills are inspired by an overriding constructivist and socio-cultural perspective where people construct their understanding through learning and cognition, and interaction between people is very important for learning. Developing relational skills is a process and it is important that education facilitates sufficient training and exercises in which the student's knowledge and reflections is requested and challenged. [ABSTRACT FROM AUTHOR]

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Nordic Nursing Research / Nordisk Sygeplejeforskning is the property of H. Aschehoug & Co. (W. Nygaard) AS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Systematic reviews (SR) are a recognised standard for synthesising clinical data in order to support evidence-based clinical decisions. A robust search strategy is the core of an SR, requiring theoretical and methodological considerations in the pre-, intra- and post-search stage. This review discusses the competencies necessary to design a search including the necessary symbiosis between medical knowledge and detailed knowledge of database architecture and corresponding semantics. Information specialists play an important role in high-quality SR.

An evaluation of the effect of using an interpreter in psychotherapy is quite complex. In the few existing studies on the use of interpreters in psychotherapy no significant difference was found in treatment outcome related to whether an interpreter was used or not. On the other hand, the inclusion of an interpreter affects the therapeutic alliance and the relationships between the parties. The role of the interpreter in psychotherapy is characterized by diversity, and the included studies indicate the need for training to improve the cooperation between the interpreter and the therapist.

A group coaching course for doctors under specialist training was evaluated. The course consisted of group coaching, theoretical presentations and practical exercises over a three-month period. The confidential forum of colleagues was of utmost importance, creating recognition and social support in contrast to the collegiate competitiveness of the workplace. The doctors found new ways of dealing with professional problems and acquired new communication skills. Further investigations are needed to decide whether group coaching should be offered to all trainees.

For more than twenty years a dynamic group of doctors has on a voluntary basis been on call for their colleagues experiencing crisis reactions related to work and personal life. Consultancies are anonymous; only a few data are registered in order to gather insight into the reasons for seeking assistance. The majority of contacts now seem to be work-related stress, conflicts with colleagues, family problems, illness and abuse. Patient claims and a bad press are not as frequent as they used to be.

The study developed and tested collaboration models for home medication reviews (HMR) between community pharmacies and general practitioner (GP)s. Three pairs (each comprising one pharmacist and one GP) developed a collaboration agreement on the patient group, content and place for HMR, responsibilities, continuation etc. The collaboration models were evaluated by the pairs and by a project group. The models were very different - adjusted to the GP's and the pharmacist's individual wishes. The entering of collaboration agreements is a good platform for effective cooperation between the pharmacist and the GP and leads to successful HMRs. We recommend that others develop collaboration models too.

Effective palliative care requires continuous contact, exchange of information, and mutual professional respect between all the relevant health-care professionals. At least one of the professionals should coordinate care. Many patients with advanced cancer report uncovered palliative care needs. In order to assure that all cancer patients receive optimal palliative care, earlier initiation and better integration of basic palliative care (at hospitals and in primary care) and specialist palliative care teams are needed.

Good clinical skills and dexterity alone do not make a good surgeon. Skills in leadership, decision-making, communication and teamwork, so-called non-technical skills, are also needed. Research on the effect of training non-technical skills is sparse but improvement in communication and teamwork has been achieved due to team training. Implementation of a preoperative briefing also improves communication and reduces the number of postoperative complications. Focus should be directed towards the training of surgeons in non-technical skills in order to improve outcome after surgery.

Introduction: In Denmark, grommet insertion in the tympanic membrane is the most frequent type of surgery carried out on children. Denmark has a higher registered incidence of grommet treatment than the countries with which we normally compare ourselves. It is therefore relevant to study whether ear, nose and throat (ENT) specialists follow grommet treatment guidelines, and which children are treated with grommets., Material and Methods: The study was planned as an observational survey with the individual child as observational unit for patient data. The ENT specialist was the observational unit for doctor behaviour. Data were collected in a double questionnaire study in which two questionnaires were completed by the ENT specialist and another two by the parents of each individual child., Results: A total of 24 ENT specialists participated, and they included 426 children in the study. The majority of the children were observed between three and six months prior to surgery. In 32% (28-37%) of the cases, the specialist had no information describing how long the GP had observed the child. A total of 95% (92-97%) of the parents were satisfied with the grommet treatment and estimated that it had considerably improved the child's and the family's daily lives., Conclusion: The specialists followed the grommet treatment guidelines. Communication between specialists and GPs could be improved. Parents were satisfied with the treatment.

Introduction: Assessment of physicians' performance focuses on the quality of their work. The aim of this study was to develop a valid, usable and acceptable multisource feedback assessment tool (MFAT) for hospital consultants., Material and Methods: Statements were produced on consultant competencies within non-medical areas like collaboration, professionalism, communication, health promotion, academics and administration. The statements were validated by physicians and later by non-physician professionals after adjustments had been made. In a pilot test, a group of consultants was assessed using the final collection of statements of the MFAT. They received a report with their personal results and subsequently evaluated the assessment method., Results: In total, 66 statements were developed and after validation they were reduced and reformulated to 35. Mean scores for relevance and "easy to understand" of the statements were in the range between "very high degree" and "high degree". In the pilot test, 18 consultants were assessed by themselves, by 141 other physicians and by 125 other professionals in the hospital. About two thirds greatly benefited of the assessment report and half identified areas for personal development. About a third did not want the head of their department to know the assessment results directly; however, two thirds found a potential value in discussing the results with the head., Conclusion: We developed an MFAT for consultants with relevant and understandable statements. A pilot test confirmed that most of the consultants gained from the assessment, but some did not like to share their results with their heads. For these specialists other methods should be used.

Introduction: On 1 January 2004, a new medical specialist reform was implemented. The Danish School of Education, University of Aarhus, conducted research from 2002-2006 in the form of two studies to study educational practice within medical specialist training programmes. This article, based on selected data from the second study, sheds light on the reception of the reform's seven competence roles. The roles represented a pedagogical paradigm shift which calls for a new interpretation of the spectrum of medical expertise. However, the reform's reception has not previously been subject to qualitative analysis., Material and Methods: The qualitative data consists of two semi-structured focus group interviews comprising 13 doctors and six rounds of observation of three junior hospital doctors with individual follow-up interviews., Results: The study shows that, almost two years after the reform's introduction, the roles were not ascribed equal value by the doctors, even if this was intended by the reform. The description of competence objectives does not sufficiently reflect everyday practice where competences are often socially situated and constructed. Furthermore, the study indicates a need for training of supervisors in the evaluation of the competence objectives., Conclusion: The doctors' perception of the roles indicate a discrepancy between their official formulation and everyday practice. This discrepancy can partly be attributed to the profession's focus on the role as medical expert, inexhaustive descriptions of objectives, and a surfeit of pedagogical qualifications among instructors.

Feedback has been identified as an essential component of motor learning. However, feedback principles derived from motor learning theories cannot uncritically be applied to clinical skills training because this knowledge is based primarily on the study of very simple motor skills. Research into feedback in relation to clinical skills training is currently limited. Theories on motor learning can serve as the basis for designing research in this domain, especially the importance of including retention tests when measuring permanent learning outcomes.

Interprofessional training wards have now been established in Denmark. Nurses, occupational therapists, physiotherapist and medical students train interprofessional collaboration while holding the responsibility for orthopaedic patients in the training ward and being supervised by clinical tutors. The result is a strengthening of the students' own professional identity and ability to understand other professions' role in patient care and rehabilitation. Patient satisfaction and complications are similar to those of conventional wards. Clinical tutoring and economy in the training wards can be a challenge.

Feedback may be described as a process comprising communication of information and reactions to such communication. It has been defined as specific information about the difference between a trainee's observed performance and a given standard with the intent of achieving performance improvement. Feedback is essential in medical education and has great implications for the educational climate. It has been shown that a common language regarding the principles of feedback has a sustained effect on quality and frequency of feedback. Further research is needed on feedback and educational climate, and on how to motivate trainees to improve future learning through feedback.

Introduction: The purpose of this pilot study was to examine how group supervision may help junior doctors recognize the learning potential in difficult on-the-job situations., Material and Methods: Eight junior doctors from an internal medicine department participated in a group supervision project during three months in the spring of 2007. Two supervisors from the hospital's Human Resource Department facilitated the process. The main themes and cases were related to the profession and not to private problems or aspects of biomedical knowledge. At the end of the project, all participants filled out an evaluation questionnaire consisting of qualitative as well as quantitative questions., Results: After the group supervision sessions, the doctors felt better equipped to meet the challenges of everyday work and had discovered the value of using each other as colleagues. Furthermore, they stated that the method had helped them improve their professional and managerial competencies as well as their ability to cooperate. Seven of the eight participants would participate in group-supervision again if possible. Participants' absence was mostly due to overtime work, being on call or being out of town., Conclusion: The results indicate that group supervision can be beneficial for junior doctors as it illustrates to them the learning potential of the difficult professional situations that inevitably occur on the job. When working with personal reflection in a supervision group, junior doctors realise how many doubts and thoughts they have in common, and how they can benefit from each other in addressing these issues. Success is dependent on high motivation and good planning.

In an 850-bed Danish University hospital, "3-hour meetings" provide junior doctors with three hours within normal working hours for discussing training with an innovative purpose. The meetings are followed-up by dialogue and action throughout the organisation. The junior doctors get many of their training initiatives implemented. The Head of Department obtains information, which is used for prioritisation of educational initiatives. At hospital level, an overview of education as well as sharing of knowledge and educational vision is achieved.

Introduction: Many foreign doctors work in Danish hospitals. This study concerns the opportunities available to and difficulties encountered by these doctors., Materials and Methods: A questionnaire concerning guidance available to foreign doctors, their linguistic and professional competence and their cultural backgrounds was sent to foreign doctors, to Danish doctors, to Danish nurses, and to patients in Greater Copenhagen. A total of 1539 questionnaires were sent., Results: 49-57% in each group replied. The majority of both foreign doctors and Danish doctors found that introductory guidance was adequate, but nurses thought otherwise. A large majority of Danish personnel (78-89%) had experienced that they themselves or patients could not understand a foreign doctor. A lesser number of foreign doctors (27-33%) had the same experience with Danish personnel or patients. Foreign doctors' language difficulties gave rise to feelings of insecurity and doubts about professional competence in both Danish personnel and patients (53-69%). Danish personnel estimate that European Union (EU) doctors' professional competence is equal to Danish doctors' professional competence, while non-EU foreign doctors are not so highly esteemed. 90% of patients are of the opinion that foreign doctors are professionally competent. Cultural background can influence clinical practice in the opinion of 50% of Danish personnel and 42% of foreign doctors., Conclusion: Insufficient communication is the biggest challenge for foreign doctors, and can influence the evaluation of their professional competence. Cultural differences may influence foreign doctors' cooperation with Danish personnel. Patients are satisfied with treatment given by foreign doctors.

Introduction: Facilitator programmes or outreach visits have proven effective in changing physician behaviour, and there is increased focus on facilitator programmes as effective strategies in continuing GP education. This article presents GP motivation and barriers to receiving a facilitator visit in connection with a newly-established facilitator programme on dementia in Vejle County., Materials and Methods: The article is based on data collected in a qualitative evaluation of the programme, and includes focus group discussions with participating GPs (three groups, 19 participants) and facilitators (four), telephone interviews with GPs who declined to participate in the programme (15), and observational studies., Results: Primary motivational factors for participation were: 1) the programme was associated with the acquisition of neutral knowledge, 2) the opportunity for dialogue with colleagues about everyday practice, 3) the facilitator as a person, 4) the time and place of the visits, and 5) the topic. Initially, many GPs were critical of the programme. The barriers were primarily due to 1) a lack of understanding of the relevance (including topic), 2) insecurity about the aims of the programme, and 3) the facilitator as a person., Conclusion: The main barriers towards the programme may be overcome through better introduction of the programme. However, the content of the visits should also be brought into focus--specifically the topic of facilitation and its relevance to practice, as well as the form of the visits, especially the possibility of giving the GPs the opportunity to choose among different facilitators.

Introduction: The aim of the study was to assess the level of job satisfaction among Danish general practitioners (GPs)., Materials and Methods: A questionnaire on job satisfaction and sociodemography was sent to all 458 registered GPs in the County of Aarhus, Denmark., Results: A total of 379 (83.5%) GPs participated. Danish GPs have a high level of job satisfaction. They were most satisfied with colleagues and fellow workers, amount of responsibility and freedom to choose their own method of working, and they were least satisfied with remuneration and hours of work. Longer working hours were associated with lower job satisfaction. Furthermore, GPs with low job satisfaction wanted to retire earlier. There was no association between job satisfaction and the number of practice staff. One in every twenty (6%) GPs would not repeat the same career choice again. Apart from their remuneration, Danish GPs' job satisfaction was higher than that of their Norwegian and British colleagues., Conclusion: Overall job satisfaction among Danish GPs was high, also compared with foreign countries. Low job satisfaction was associated with wanting to retire early, implying that a high level of job satisfaction is important for GP retention. Shorter working hour was associated with higher job satisfaction.

There is an increasing percentage of women in the medical profession. The impact which this will have on the medical field is an issue for continuing debate. The reasons for the increase in the number of women who choose the medical profession are complex, as are the possible consequences. There is much prejudice in the debate concerning these issues and this seems to be part of the reason why women encounter more difficulties than men in the journey from medical student to respected member of the profession. Studies in the field caution us to avoid seeing gender as a causal factor and instead to study the importance of gender in the actual interaction of individuals in a specific context.

Introduction: The purpose of this project was to introduce a newly developed educational program consisting of a new concept with metacompetences. Our aim was to evaluate the need for new educational methods and to clarify the educational capacity of our clinic., Materials and Methods: The duration of the project was two years; it was allocated to pre-registration house officers. Part one of the project was a systematic evaluation of the functions of each department, with a focus on educational capacity. The next stage was to introduce new methods into the departments. The project focused on the metacompetences for communication and collaboration evaluated, using a system of supervised rounds. A newly developed questionnaire using a visual analogue scale was used for feedback to the officers in training., Results: The new educational methods scored high in the evaluation, and the pre-registration house officers were able to achieve all the competences in the education program., Conclusion: The implementation of the system took place without major difficulties, and the extra workload allocated to the department was minimal.

In their work, doctors are exposed to strong emotions on the part of their patients. They need to learn to listen and not interrupt them; in general, after each consultation they focus on whatever was not accomplished. Therefore doctors need a secure environment in which they can examine common work conditions, as well as their own strengths and weaknesses, with colleagures in order to discover new ways of doing things. Based on this observation, it is a very positive development that supervision has become a part of the new specialist training for general practice.