Anbefalinger til forandring af en ambulant hospitalsintervention målrettet kvinder med graviditetssukkersyge.

Abstract

Titel: Anbefalinger til forandring af en ambulant hospitalsintervention målrettet kvinder med graviditetssukkersyge. Formål: Formålet med projektet er at forbedre den nuværende indsats på et hospitalsambulatorium til kvinder med gestationel diabetes mellitus (GDM) under graviditeten, med henblik på at øge handlekompetencer og derigennem at øge kvindernes livskvalitet. Metode: Projektet er videnskabsteoretisk forankret i kritisk realisme og tager udgangspunkt i MRC-modellen, understøttet af INDEX-guidance med henblik på at videreudvikle og finde frem til forandringsforslag til praksis. Resultaterne er baseret på semistrukturerede inter-views af seks gravide kvinder med GDM. Interviewguiden er udarbejdet med inspiration fra realistiske interviews, for herudfra at kunne identificere hæmmende og fremmende mekanismer for at øge handlekompetencer blandt kvinder med GDM og derigennem fremme livskvaliteten. Praksis har hjulpet med rekruttering af informanter. Ydermere er der foreta-get en systematisk litteratursøgning i fire forskellige databaser, PubMed, Embase, Cinahl og PsycNet, med henblik på at undersøge hvilke hæmmende og fremmende mekanismer som forskningslitteraturen præsenterer, for at øge handlekompetencerne hos kvinderne. Herud-fra blev 6 artikler identificeret relevante og analyseret. Både artikler og interviews er analyseret med inspiration fra Braun og Clarkes tematiske analyse. Analyseresultaterne er lige-ledes anvendt til raffinering af projektets programteori. Resultater: Projektets analyse resulterede i fem mekanismer, der kan være fordelagtige for praksis at aktivere, herunder ‘individuel inddragelse’, ‘støtte’, ‘chok over diagnosen’, ‘plan-lægning og strukturering’ samt ‘engagement, vision, kritisk sans, handleerfaringer, indsigt’. 1. for at aktivere individuel inddragelse, rådes praksis at gøre brug af Vibis’ (Videnscenter for Brugerinddragelse i Sundhedsvæsenet) anbefalinger herfor. 2. ydermere anbefales prak-sis at anvende Fundamental of Care Frameworket, for derved på kort tid at danne en relati-on, støtte kvinden og reducere chok over diagnosen. Derudover anbefales praksis at inddrage partneren i samtalerne, da denne udgør en stor støtte for kvinden. 3. Desuden anbefales det, at sundhedspersonalet udarbejder en action plan og en coping plan, hvor adfærden konkretiseres og specificeres og hvor der tages højde for eventuelle barrierer. 4. Slutteligt anbefales det at have fokus på handling, deltagelse og viden og deraf integrere elementer af målgruppens egne handlinger og erfaringer i vejledningen og ydermere opdatere den nuværende pjece med viden herunder adfærdsændring og slutteligt anvende SMART-Modellen. Projektets analyse indikerer, at disse forandringsforslag kan medføre øget handlekompetencer og øget livskvalitet for kvinderne. Konklusion: Projektet bidrager således med fire forandringsforslag, der udmønter sig i ni anbefalinger til praksis, der kan bidrage til, at kvinder med GDM opnår øgede handlekompetencer og deraf øget livskvalitet, som samtidig kan reducere forekomsten af utilsigtede konsekvenser.

Title: Recommendations for improvement for an outpatient hospital intervention aimed at women with gestational diabetes. Purpose: The purpose of this project is to improve the current intervention at an outpatient hospital for women with gestational diabetes mellitus (GDM) during pregnancy, with the specific aim of enhancing action competences and thereby enhancing quality of life among the women. Methods: The project theory of science is embedded in critical realism and the develop-ment of the intervention is inspired by the MRC-model and assisted by the INDEX-Guidance with the intention of determining possible recommendations for improvement for the out-patient hospital. The results are based on semi structured interviews of six pregnant wom-en diagnosed with GDM, completed with inspiration from realistic interviews and hereby identifying barriers and facilitators for increasing action competences and quality of life. The outpatient hospital has assisted with recruitment of the participants. There is further-more carried out a systematic literature search in four databases, PubMed, Embase, Cinahl and PsycNet, with the intention of examining barriers and facilitators that according to the research literature can enhance action competences among women with GDM. The sys-tematic literature search resulted in identification of six relevant articles. The articles and the interviews are both analysed with inspiration from Braun and Clarkes thematic analysis. The results of the analysis is furthermore used to refine the program theory of the project. Results: The analysis found five mechanisms, that may benefit the outpatient hospital, in-cluding ‘individual involvement’, ‘support’, ‘shock over the diagnosis’, ‘planning and struc-ture’ and ‘involvement, vision, critical sense, insight, experience of actions’. 1. The advice to activate the mechanism ‘individual involvement’, is to use recommendations from Vibis for involvement (Danish center for user involvement). 2. It is furthermore recommended to use the Fundamental of Care Framework and thereby, being able to form a relationship, in a short time, which can lead to ‘support’ for the woman and reduce the ‘shock over the diag-nosis’. Additionally, it is recommended to involve the partner in the consultations, because the partner is a big support for the woman. 3. It is recommended that the health care per-sonnel compose an action plan and a coping plan, where behaviour is specified and where possible barriers is taken into account, to help the woman with ‘planning and structure’. 4. Finally, it is recommended that focusing on action, participation and knowledge and thereby incorporating elements of the target groups own actions and experiences in the counselling and furthermore updating the present pamphlet with knowledge, comprising behavioural change and finally using the SMART-model. The projects analysis indicates that the sugges-tions of change can lead to enhanced action competences and enhanced quality of life for the women. Conclusion: The project thereby contributes with 4 recommendations of improvement, that can lead to women enhancing their action competences and hereby their quality of life, which concomitant can reduce the occurrence of unanticipated consequences.

A master thesis from Aalborg University

Anbefalinger til forandring af en ambulant hospitalsintervention målrettet kvinder med graviditetssukkersyge.

[Recommendations for improvement for an outpatient hospital intervention aimed at women with gestational diabetes.]