"Everyone who wants to can practice on me"- a qualitative study of patients' view on health profession students' learning in an interprofessional clinical placement.

INTRODUCTION: Healthcare services face significant challenges due to the aging population, increasing complexity of health issues, and a global shortage of health professionals. Health professions education needs to adapt and develop with healthcare services' needs. Interprofessional education and patient partnership are two trends that are increasingly being reinforced. Health professions students worldwide are expected to acquire competencies in interprofessional collaboration through undergraduate and postgraduate studies. Developing interprofessional collaborative skills in clinical placements is crucial. This study aims to explore two patients' meetings with an interprofessional student team and better understand how the patient can participate actively in the students´ learning processes. METHODS: This is a small single-case study. Two patients participated. Data was generated through participant observation and qualitative interviews. A practical iterative framework for qualitative data analysis inspired the analysis. RESULTS: The patients observed and reflected on the interprofessional students' learning process and felt responsible for contributing to their learning. The patients contributed to students' learning by making themselves available for practicing and sometimes giving feedback. They considered it a win-win situation to be involved in the interprofessional learning activity as they perceived being taken seriously by the students when addressing their problems and experienced positive outcomes for their situation, such as better physical functioning and adjustments to assistive devices. Patients emphasized the importance of learning collaboration between health professionals and how this could contribute to them feeling safer as patients. DISCUSSION: This study highlights the importance of including patients in interprofessional students' learning processes. Patients' active participation in interprofessional clinical placements can empower them, improve their self-efficacy, and potentially shift the power dynamic between patients and healthcare professionals. The study emphasizes the importance of the patient perspective in future research on interprofessional education in clinical settings. The study also highlights the need for clinical supervisors to facilitate patient involvement in interprofessional clinical placements and reinforce patients' feedback for the student team. CONCLUDING COMMENTS: Overall, this study contributes to the growing body of research on interprofessional education and patient partnership and emphasizes the importance of including patients in health professions education.

Student-led clinic cervical cancer screening-medical students' views on progression of learning, quality of Pap smears and women´s experiences of the visit - a mixed methods study.

BACKGROUND: Student-led clinics (SLC) have been described, but not in gynecology. Gynecology is a subject typically covered in the last terms of medical training, however it includes few opportunities for students to tackle all phases of a consultation and a shortage of opportunities to perform gynecological examinations. Therefore, we started a student-led clinic for cervical cancer screening (SLC-CCS) in Linköping, Sweden and aimed to evaluate students' views on the progression of learning, the quality of the Papanicolaou (Pap) smear, and women´s experiences of the visit, using mixed methodology. METHODS: The implementation of the SLC-CCS is described in detail. Students (n = 61) taking part in the SLC-CCS between January and May 2021 were invited to participate in a follow-up discussion (n = 24) focused around four themes: attitudes and expectations prior to participation, experiences of the patient encounter, organization of the placement, and reflections on and suggestions for further development of the placements. The group meetings were conducted in Swedish, recorded, transcribed verbatim and subjected to a qualitative, descriptive thematic analysis. Thematic analysis is considered an appropriate method of analysis for seeking to understand experiences, thoughts, or behaviors across a data set. The proportion of Pap smears lacking cells from the squamous epithelium during the study period was compared with data from the same clinic before the SLC-CCS started. A validated questionnaire on women's experience of the Pap smear visit was provided. Answers were compared between women who had the Pap smear taken by a student or a healthcare provider. RESULTS: Three different themes were generated: growing confidence in the clinical situation, embodied awareness of variation in anatomy, doubting accuracy of one's own performance. The percentage of Pap smears lacking cells from the squamous epithelium were equal (2%) during the study period compared to the period before the SLC-CCS started (p = 0.28). No difference was found in the satisfaction index between the women examined by a student, those examined by a healthcare provider, or women who did not know who the examiner was (p = 0.112). CONCLUSIONS: The students expressed a growing confidence in the clinical situation and there was high satisfaction from the women. The quality of the Pap smears taken by the students was equal to the quality of those taken by the health care staff. All these findings indicate that high patient safety was maintained during this activity support the recommendation to include SLC-CCS as part of the medical training.

Getting real in interprofessional clinical placements: patient-centeredness in student teams' collaborative learning.

Collaboration between healthcare providers helps tackle the increasing complexity of healthcare. When learning teamwork, interprofessional students are expected to work patient-centered; recognizing the patient's expertise and partnering with them. Research on interprofessional education (IPE) for undergraduates has illuminated learning outcomes, organization of learning activities, change in attitudes, etc. But, we know little about the interaction between patients and interprofessional student teams. This study aimed to explore how interprofessional student teams and patients interact in interprofessional clinical placements. With a focused ethnographic approach, participant observation and qualitative interviews were conducted in two contexts; a physical and an online arrangement. Central ideas in Goffman's dramaturgy constituted a theoretical lens. A reflexive thematic analysis generated three themes: (1) Preparing safe and comfortable encounters with patients, (2) Including and excluding the patient in the encounter, and (3) Adjusting to the patient's situation. We identified students' intentions of patient-centeredness when preparing encounters, but patients did not always feel included and listened to in encounters. After encountering patients, student teams adjusted their teamwork, by changing the team composition or the planned clinical interventions to better meet the patients' needs. Notably, team-based patient encounters led to a different view of the patient, their health issues, and how to collaborate. Our findings can inform educators of the importance of addressing patient-centered care in interprofessional learning arrangements. Today, clinical interprofessional placements may not exploit the potential for learning about patient-centeredness. A thematization of this, e.g., in supervision in future clinical placements can ensure an enhanced focus on this in interprofessional teamwork.

Interprofessional student groups using patient documentation to facilitate interprofessional collaboration in clinical practice - A field study.

BACKGROUND: This article explores and provides insights into how students learn interprofessional collaboration in a clinical placement. This topic is of interest for stakeholders in health services and education and for the research field of interprofessional education. OBJECTIVES: How patient documentation facilitates collaboration in interprofessional student groups is explored. DESIGN: This study uses qualitative research with an ethnographic design. SETTINGS: This research studies interprofessional education at a Norwegian university. PARTICIPANTS: Three student groups that participated in a two-week interprofessional clinical placement in a geriatric rehabilitation ward were studied, which comprised students of medicine, nursing, occupational therapy and physiotherapy. METHODS: Data were generated through observational studies and informal conversations with the students in interprofessional placement and consists of written field notes and transcribed audio-recorded conversations. The analysis drew on concepts from practice theory related to the social practices of learning. RESULTS: The students creatively and dynamically used a narrative note in the electronic patient record system in the ward to create an overview of care and ensure continuity of care for the patients for whom they were responsible. By using the narrative note in the record, the students aimed to develop a comprehensive understanding of their patients' clinical situations and care needs. When new information was entered in the note, information already written by individual students and student pairs was reviewed by all students, revised and mutually refined. As a result, multidimensional representations of the patients' health statuses and care needs emerged, including how the patients responded to the students' suggested interventions. CONCLUSIONS: Patient documentation can be a tool for stimulating interprofessional collaboration when students are allowed to organize patient care independently. We suggest that students' natural meaning-seeking capability is a hidden resource that can be exploited in interprofessional education.

Ten years of simulation-based shoulder dystocia training- impact on obstetric outcome, clinical management, staff confidence, and the pedagogical practice - a time series study.

BACKGROUND: To assess the impact of 10 years of simulation-based shoulder dystocia training on clinical outcomes, staff confidence, management, and to scrutinize the characteristics of the pedagogical practice of the simulation training. METHODS: In 2008, a simulation-based team-training program (PROBE) was introduced at a medium sized delivery unit in Linköping, Sweden. Data concerning maternal characteristics, management, and obstetric outcomes was compared between three groups; prePROBE (before PROBE was introduced, 2004-2007), early postPROBE (2008-2011) and late postPROBE (2012-2015). Staff responded to an electronic questionnaire, which included questions about self-confidence and perceived sense of security in acute obstetrical situations. Empirical data from the pedagogical practice was gathered through observational field notes of video-recordings of maternity care teams participating in simulation exercises and was further analyzed using collaborative video analysis. RESULTS: The number of diagnosed shoulder dystocia increased from 0.9/1000 prePROBE to 1.8 and 2.5/1000 postPROBE. There were no differences in maternal characteristics between the groups. The rate of brachial plexus injuries in deliveries complicated with shoulder dystocia was 73% prePROBE compared to 17% in the late postPROBE group (p > 0.05). The dominant maneuver to solve the shoulder dystocia changed from posterior arm extraction to internal rotation of the anterior shoulder between the pre and postPROBE groups. The staff questionnaire showed how the majority of the staff (48-62%) felt more confident when handling a shoulder dystocia after PROBE training. A model of facilitating relational reflection adopted seems to provide ways of keeping the collaboration and learning in the interprofessional team clearly focused. CONCLUSIONS: To introduce and sustain a shoulder dystocia training program for delivery staff improved clinical outcome. The impaired management and outcome of this rare, emergent and unexpectedly event might be explained by the learning effect in the debriefing model, clearly focused on the team and related to daily clinical practice.

Characteristics of two questionnaires used to assess interprofessional learning: psychometrics and expert panel evaluations.

BACKGROUND: Interprofessional learning activities are included in many curricula but are difficult to assess. For languages that are not widely spoken such as Swedish, few validated questionnaires exist that relate to interprofessional outcomes. Therefore, the aim was to examine two such questionnaires in relation to interprofessional competence domains. METHODS: Psychometric characteristics, such as homogeneity of items and internal consistency, were assessed for the Swedish versions of the Jefferson Scale of Attitudes Towards Physician-Nurse Collaboration (JSAPNC) and the Readiness for Interprofessional Learning Scale (RIPLS). The questionnaires were distributed directly following IPL activities. Mokken scale analysis based on Loevinger's coefficient for homogeneity and Cronbach's alpha were used to evaluate the scales. Two expert panels performed a qualitative analysis of items in relation to four internationally defined interprofessional competences. RESULTS: In total, 88 and 84 responded to the JSAPNC and RIPLS questionnaires, respectively. Estimates of homogeneity were low for both the JSAPNC (H = 0.16) and the RIPLS (H = 0.21). Reliabilities were weak (0.62 and 0.66, respectively) for the total scales. The expert panels categorised 68% of items into similar competence domains. However, their discussion revealed ambiguous wordings and imbalances in the two questionnaires in relation to domains. CONCLUSION: Interprofessional competence domains are defined but few validated tools exist to assess them. Examined tools relating to interprofessional learning in Swedish do not qualify for assessing overarching IPL outcomes, and summed scores from these tools should be used with caution.

Introducing the nurse practitioner into the surgical ward: an ethnographic study of interprofessional teamwork practice.

AIM: The first nurse practitioners in surgical care were introduced into Swedish surgical wards in 2014. Internationally, organisations that have adopted nurse practitioners into care teams are reported to have maintained or improved the quality of care. However, close qualitative descriptions of teamwork practice may add to existing knowledge of interprofessional collaboration when introducing nurse practitioners into new clinical areas. The aim was to report on an empirical study describing how interprofessional teamwork practice was enacted by nurse practitioners when introduced into surgical ward teams. METHODS AND RESULTS: The study had a qualitative, ethnographic research design, drawing on a sociomaterial conceptual framework. The study was based on 170 hours of ward-based participant observations of interprofessional teamwork practice that included nurse practitioners. Data were gathered from 2014 to 2015 across four surgical sites in Sweden, including 60 interprofessional rounds. The data were analysed with an iterative reflexive procedure involving inductive and theory-led approaches. The study was approved by a Swedish regional ethics committee (Ref. No.: 2014/229-31). The interprofessional teamwork practice enacted by the nurse practitioners that emerged from the analysis comprised a combination of the following characteristic role components: clinical leader, bridging team colleague and ever-present tutor. These role components were enacted at all the sites and were prominent during interprofessional teamwork practice. CONCLUSION: The participant nurse practitioners utilised the interprofessional teamwork practice arrangements to enact a role that may be described in terms of a quality guarantee, thereby contributing to the overall quality and care flow offered by the entire surgical ward team.

Emergent is Authentic: A Sociomaterial Perspective on Simulation-Enhanced Interprofessional Education.

This Conversations Starter article presents a selected research abstract from the 2017 Association of American Medical Colleges Western Region Group on Educational Affairs annual spring meeting. The abstract is paired with the integrative commentary of three experts who shared their thoughts stimulated by the study. The commentary explores the implications of sociomaterial perspectives for conceptualizing authenticity in the design and evaluation of simulation-enhanced interprofessional education.

Debriefing practices in interprofessional simulation with students: a sociomaterial perspective.

BACKGROUND: The debriefing phase is an important feature of simulation activities for learning. This study applies a sociomaterial perspective on debriefing in interprofessional simulation with medical and nursing students. Sociomaterial perspectives are increasingly being used in order to understand professional practice and learning in new ways, conceptualising professional practice as being embodied, relational and situated in sociomaterial relations. The aim of the study is to explore how debriefing is carried out as a practice supporting students' interprofessional learning. METHODS: Eighteen debriefing sessions following interprofessional full-scale manikin-based simulation with nursing and medical students from two different universities were video-recorded and analysed collaboratively by a team of researchers, applying a structured scheme for constant comparative analysis. RESULTS: The findings show how debriefing is intertwined with, and shaped by social and material relationships. Two patterns of enacting debriefing emerged. Debriefing as algorithm was enacted as a protocol-based, closed inquiry approach. Debriefing as laissez-faire was enacted as a loosely structured collegial conversation with an open inquiry approach. CONCLUSION: The findings indicate that neither an imposed structure of the debriefing, nor the lack of structure assured interprofessional collaboration to emerge as a salient topic for reflection, even though that was an explicit learning objective for the simulation.

Enacting simulation: A sociomaterial perspective on students' interprofessional collaboration.

Full-scale simulation exercises are becoming more common as an educational feature of the undergraduate training of health professionals. This study explores how interprofessional collaboration is enacted by the participating students. Practice theory is used as the theoretical framework for a field study of two naturalistic educational settings, when medical and nursing students come together to practice in a simulated emergency situation, where a manikin is replacing the patient. Eighteen sessions of simulations were observed, and data were collected through standardised video recordings that were analysed collaboratively. To ensure transparency and scientific rigour, a stepwise constant comparative analysis was conducted, in which individual observations within and across single video recordings were compared, negotiated and eventually merged. The findings show that the student teams relate to the manikin as a technical, medical, and human body, and that interprofessional knowings and enactments emerge as a fluid movement between bodily positioning in synchrony and bodily positioning out of synchrony in relation to the sociomaterial arrangements. The findings are related to contemporary theorisations of practice comprising an integrated view of body and mind, and it is discussed how the findings can be used in simulation exercises to support participants' learning in new ways.

Towards socio-material approaches in simulation-based education: lessons from complexity theory.

CONTEXT: Review studies of simulation-based education (SBE) consistently point out that theory-driven research is lacking. The literature to date is dominated by discourses of fidelity and authenticity - creating the 'real' - with a strong focus on the developing of clinical procedural skills. Little of this writing incorporates the theory and research proliferating in professional studies more broadly, which show how professional learning is embodied, relational and situated in social - material relations. A key concern for medical educators concerns how to better prepare students for the unpredictable and dynamic ambiguity of professional practice; this has stimulated the movement towards socio-material theories in education that address precisely this question. OBJECTIVES AND METHODS: Among the various socio-material theories that are informing new developments in professional education, complexity theory has been of particular importance for medical educators interested in updating current practices. This paper outlines key elements of complexity theory, illustrated with examples from empirical study, to argue its particular relevance for improving SBE. RESULTS: Complexity theory can make visible important material dynamics, and their problematic consequences, that are not often noticed in simulated experiences in medical training. It also offers conceptual tools that can be put to practical use. This paper focuses on concepts of emergence, attunement, disturbance and experimentation. These suggest useful new approaches for designing simulated settings and scenarios, and for effective pedagogies before, during and following simulation sessions. CONCLUSIONS: Socio-material approaches such as complexity theory are spreading through research and practice in many aspects of professional education across disciplines. Here, we argue for the transformative potential of complexity theory in medical education using simulation as our focus. Complexity tools open questions about the socio-material contradictions inherent in SBE, draw attention to important material dynamics of emergence, and suggest practical educative ways to expand and deepen student learning.

Fixing the wounded or keeping lead in the air-tactical officers' views of emergency care on the battlefield.

The aim of this study was to identify tactical officers' views of prehospital emergency care in the field before an international mission. A qualitative study with a phenomenographic approach based on interviews was used. The result of this study is a set of descriptive categories on a collective level, showing the variation in how the tactical officers perceived the phenomenon of emergency care in the battlefield. The result can be viewed as (1) noncombat-oriented including being able to do one's specialist task, being able to talk with local people, and being able to give first aid, and (2) combat-oriented including soldiers' skills and roles in the unit, being able to act in the unit, and being able to lead the care of injured. These findings are important for officers' preparation for international missions. The interaction between military and medical knowledge on-site care should be developed between the tactical officer and the medical personnel in order to minimize suffering and to enhance the possibility for survival of the casualty.

Interaction, action, and reflection: how medics learn medical care in the Swedish Armed Forces.

The objective of this study is to examine how medics within the Swedish Armed Forces perceive their learning outcome following military prehospital training. A qualitative study with a phenomenographic approach was used to investigate how learning is perceived among military medics. At meta level, the results can be viewed as an interaction, i.e., being able to collaborate in the medical platoon, including the ability to interact within the group and being able to lead; an action, i.e., being able to assess and treat casualties, including the ability to communicate with the casualty, to prioritize, and to be able to act; and a reflection, i.e., having confidence in one's own ability in first aid, including being prepared and feeling confident. Interaction during the period of education is important for learning. Action, being able to act in the field, is based on a drill in which the subject progresses from simple to complex procedures. Reflection, learning to help others, is important for confidence, which in turn creates preparedness, thereby making the knowledge meaningful.

One site fits all? A student ward as a learning practice for interprofessional development.

Interprofessional training wards (IPTWs), aiming to enhance interprofessional collaboration, have been implemented in medical education and evaluated over the last decade. The Faculty of Health Sciences, Linköping University has, in collaboration with the local health provider, arranged such training wards since 1996, involving students from the medical, nursing, physiotherapy, and occupational therapy programs. Working together across professional boundaries is seen as a necessity in the future to achieve sustainable and safe healthcare. Therefore, educators need to arrange learning contexts which enhance students' interprofessional learning. This article shows aspects of how the arrangement of an IPTW can influence the students' collaboration and learning. Data from open-ended questions from a questionnaire survey, during autumn term 2010 and spring term 2011 at an IPTW, was analyzed qualitatively using a theoretical framework of practice theory. The theoretical lens gave a picture of how architectures of the IPTW create a clash between the "expected" professional responsibilities and the "unexpected" responsibilities of caring work. Also revealed was how the proximity between students opens up contexts for negotiations and boundary work. The value of using a theoretical framework of professional learning in practice within the frames of healthcare education is discussed.

Ways of experiencing participation and factors affecting the activity level after nonreconstructed anterior cruciate ligament injury: a qualitative study.

STUDY DESIGN: Phenomenographic, cross-sectional. OBJECTIVES: To describe ways of experiencing participation in activities of individuals with a nonreconstructed anterior cruciate ligament injury and to describe the emotional aspects related to participation. Further, the objective was to explore factors affecting the activity level. BACKGROUND: The importance of assessing different factors (knee status, muscle performance, psychological factors, performance-based tests, and subjective rating of knee function) after an anterior cruciate ligament injury has been emphasized. However, the results of these assessments do not answer the question of how the individuals themselves experience their participation in activities. METHODS: Semi-structured interviews were conducted with 19 strategically selected informants (age range, 18-43 years) who had sustained an anterior cruciate ligament injury 18 to 67 months previously. A phenomenographic approach, which describes individuals' ways of experiencing a phenomenon, was used. RESULTS: Five qualitatively different categories were identified: (A) unconditioned participation, (B) participation as conditioned by risk appraisal, (C) participation as conditioned by experienced control of the knee, (D) participation as conditioned by experienced knee impairment, and (E) participation as conditioned by neglecting the knee injury. Within each category, 5 interrelated aspects were discerned: focus, level of performance, activities, strategies, and feelings. Categories A, C, and E reflected experiences of full participation, whereas categories B and D reflected experiences of modified participation. There were mostly positive feelings regarding participation. Negative feelings were expressed in category D. Factors affecting the activity level were grouped according to the framework of the International Classification of Functioning, Disability and Health and described as facilitating or hindering the activity level. Facilitating factors included regaining and maintaining physical function, regaining confidence in knee function, and learning/relearning movement patterns. Hindering factors included fear of injury/reinjury, uncontrollable giving way, and loss of motivation. CONCLUSION: With different strategies, most of the informants achieved a satisfactory activity level, despite impairments and decreased activity level. Both physical and psychological factors were described to affect the activity level, as well as time since injury.

How community-dwelling seniors with multimorbidity conceive the concept of mental health and factors that may influence it: a phenomenographic study.

Multimorbidity, that is, the coexistence of chronic diseases, is associated with mental health issues among elderly people. In Sweden, seniors with multimorbidity often live at home and receive care from nursing aides and district nurses. The aim of this study was to describe the variation in how community-dwelling seniors with multimorbidity perceive the concept of mental health and what may influence it. Thirteen semi-structured interviews were analysed using a phenomenographic approach. Six qualitatively different ways of understanding the concept of mental health and factors that may influence it, reflecting key variations of meaning, were identified. The discerned categories were: mental health is dependent on desirable feelings and social contacts, mental health is dependent on undesirable feelings and social isolation, mental health is dependent on power of the mind and ability to control thoughts, mental health is dependent on powerlessness of the mind and inability to control thoughts, mental health is dependent on active behaviour and a healthy lifestyle, and mental health is dependent on passive behaviour and physical inactivity. According to the respondents' view, the concept of mental health can be defined as how an individual feels, thinks, and acts and also includes a positive as well as a negative aspect. Social contacts, physical activity, and optimism may improve mental health while social isolation, ageing, and chronic pain may worsen it. Findings highlight the importance of individually definitions of mental health and that community-dwelling seniors with multimorbidity may describe how multiple chronic conditions can affect their life situation. It is essential to organize the health care system to provide individual health promotion dialogues, and future research should address the prerequisites for conducting mental health promotion dialogues.

Rehabilitation after coronary heart disease: spouses' views of support.

BACKGROUND: Family presence decreases mortality and improves psychosocial recovery after a coronary heart disease event. In this situation, spousal support seems important for the recovering partner's self-esteem and mastery. There is inadequate knowledge of how spouses view their supportive roles. AIM: The aim of this paper is to report a study investigating spouses' experiences of the rehabilitation phase of their partners' coronary heart disease and to gain their views about supporting them in lifestyle changes. METHOD: Eight male (mean age 61) and 17 female spouses (mean age 53), were interviewed 1 year after their partner's cardiac event. Of the partners, 18 had experienced myocardial infarction and 19 were revascularized. Interview transcripts were analysed qualitatively using a phenomenographic framework. FINDINGS: The analysis yielded five different views of the spouse's role. The participative role involved taking a practical part in lifestyle changes, communicating empathetically, and being positive about changes. The regulative role was characterized by being either positive or negative about changes, giving practical or cognitive support in order to control the partner's behaviour, and communicating authoritatively. In the observational role the spouse was passive, complied with suggestions, and communicated empathetically. The incapacitated role involved a positive attitude to changes, communicating without making demands, but being unable to provide support because of personal problems. Assuming a dissociative role entailed being negative about changes and authoritatively declaring a reluctance to be involved in the partner's change of lifestyle. Spouses adopted different roles depending on the support situation. CONCLUSION: Spouses' views of their roles in support varied considerably in terms of awareness of the benefits of behavioural changes, style of communication, pattern of co-operation and support situation. The findings favour the view that a family perspective is important in planning rehabilitation of patients following coronary heart disease.

Coronary heart disease: causes and drug treatment--spouses' conceptions.

BACKGROUND: Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event. AIMS AND OBJECTIVES: To explore spouses' conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event. DESIGN: Qualitative with an empirical and inductive approach. METHODS: Semi-structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework. RESULTS: Spouses' conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease. CONCLUSION: A variation of spouses' conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co-operative behaviour. RELEVANCE TO CLINICAL PRACTICE: Spouses' pre-existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.

Living with chronic renal failure: patients' experiences of their physical and functional capacity.

BACKGROUND AND PURPOSE: Several studies have shown that patients with chronic renal failure have reduced physical exercise capacity compared with the expected norm. There are, however, few qualitative studies showing ways in which patients experience their condition in terms of physical and functional capacity, and the limitations this imposes on their daily lives. The aim of the present study was to describe and analyse ways in which patients with chronic renal failure, in the pre-dialysis phase and patients undergoing haemodialysis or peritoneal dialysis, experienced their physical and functional capacity in their daily lives. METHOD: Semi-structured interviews were used to collect data, which were then analysed according to a contextual analysis within a phenomenographic approach. RESULTS: Analysis yielded a system of categories describing patients' experiences of mental and physical fatigue, physical and functional capacity, in terms of effect on performance and endurance, and their experience of temporal stress, in terms of lack of time as well as lack of peace in their daily lives. CONCLUSIONS: The results of the study will contribute to our understanding of how these patients experience their daily lives, and will help when meeting patients with chronic renal failure. This knowledge enables physiotherapists to focus rehabilitation training on problem areas that are important to patients themselves.