Abstract The original intention for the Partnership Community Worker (PCW) project in 2006 was for it to be an extension of the Pegasus Health General Practice and furthermore to be a bridge between the community and primary healthcare. It was believed that a close working relationship between the Practice Nurse and the PCW would help the target population of Māori, Pacifica and low income people to address and overcome their perceived barriers to healthcare which included: finance, transport, anxiety, cultural issues, communication, or lack of knowledge. Seven years later although the PCW project has been deemed a success in the Canterbury District Health Board annual reports (2013-14) and community and government agencies, including the Christchurch Resettlement Service (2012), many of the Pegasus Health General Practices have not utilised the project to its full extent, hence the need for this research. I was interested in finding out in the first instance if the model had changed and, if so why, and in the second instance if the promotional material currently distributed by Pegasus Health Primary Health Organisation reflected the daily practice of the PCW. A combination of methods were used including: surveys to the Pegasus Health General Practices, interviews with PCWs, interviews with managers of both the PCW host organisations and referring agencies to the PCW project. All the questions asked of all the participants in this research were focussed on their own perception of the role of the PCW. Results showed that the model has changed and although the publications were not reflecting the original intention of the project they did reflect the daily practice of the PCWs who are now struggling to meet much wider community expectations and needs. Key Results: Partnership Community Worker (PCW) interviews: Seventeen PCWs of the 19 employed were interviewed face to face. A number expressed interest in more culturally specific training and some are pursuing qualifications in social work; for many pay parity is an issue. In addition, many felt overwhelmed by the expectations around clients with mental health issues and housing issues now, post-earthquakes. Medical Practice surveys: Surveys were sent to eighty-two Pegasus Health medical practices and of these twenty five were completed. Results showed the full capacity of the PCW role was not clearly understood by all with many believing it was mostly a transport service. Those who did understand the full complexity of the role were very satisfied with the outcomes. PCW Host Community Manager Interviews: Of the ten out of twelve managers interviewed, some wished for more communication with Pegasus Health management because they felt aspects of both the PCW role and their own role as managers had become blurred over time. Referring organisations: Fifteen of the fifty referring community or government organisations participated. The overall satisfaction of the service was high and some acknowledged the continuing need for PCWs to be placed in communities where they were well known and trusted. Moreover results also showed that both the Canterbury earthquakes 2010-2011 and the amalgamation of Partnership Health PHO and Pegasus Health Charitable Limited in 2013 have contributed to the change of the model. Further future research may also be needed to examine the long term effects on the people of Canterbury involved in community work during the 2011-2014 years.

Förmaksflimmer är den vanligast förekommande hjärtrytmsrubbningen och är associerat med en ökad risk för morbiditet och mortalitet, samt en negativ påverkan på livskvaliteten. Förmaksflimmer är en kronisk sjukdom och står för en stor del av sjukdomsbördan både för patienterna och för hälso- och sjukvården. Inom vården för patienter med förmaksflimmer fungerar verksamheter för omhändertagandet olika. För att hjälpa dessa patienter behövs specifik och avancerad patientutbildning och råd av multidisciplinära team med kunskap som är evidensbaserad. Där är sjuksköterskan en del av det multidisciplinära teamet. I riktlinjer från ESC (European Society of Cardiology) gällande förmaksflimmer, har patienten den centrala rollen och ska tillsammans med vårdpersonal ta beslut om sin vård. Ett personcentrerat förhållningssätt kan hjälpa till att stärka patientens tilltro till sin egna förmåga, förbättra livskvalitet och symtomlindring, samt leda till kortare vårdtider. Syftet var att belysa sjuksköterskeledda mottagningar och dess effekt för patienter med förmaksflimmer. Litteraturöversikt med strukturerad sökning användes som design. Detta självständiga arbete inkluderade 16 vetenskapliga artiklar från databaserna Pubmed och CINAHL Complete. De inkluderade artiklarna kvalitetsgranskades och analyserades med integrerad analys för att syntetisera resultaten i relation till varandra. Vid analysen framkom kategorier och underkategorier som beskrev artiklarnas resultat. Resultatet visade att sjuksköterskeledd mottagning hade ett antal olika effekter för patienter med förmaksflimmer. Effekterna för sjuksköterskeledd mottagning var likvärdig eller bättre för patienter med förmaksflimmer jämfört med sedvanlig vård. Resultatet visade att de positiva effekterna för patienter med förmaksflimmer som fick vård på sjuksköterskeledd mottagning resulterade i färre sjukhusinläggningar, lägre mortalitet, bättre behandling med antikoagulantia, bättre följsamhet till fler rekommendationer, reducerat antal symtom och ökad kunskap om förmaksflimmer hos patienter. Slutsatsen var att sjuksköterskeledd mottagning är likvärdig eller bättre för patienter med förmaksflimmer vid jämförelse med sedvanlig vård. personcentrerat förhållningssätt kan hjälpa till att stärka patientens tilltro till sin egna förmåga, förbättra livskvalitet och symtomlindring, samt leda till kortare vårdtider / Atrial fibrillation is the most common cardiac arrhythmia and is associated with an increased risk of morbidity and mortality and negative impact on quality of life. Atrial fibrillation is a chronic disease and accounts for a large proportion of the disease burden both for patients and for health care. In the care of patients with atrial fibrillation, care activities work differently. To help these patients, specific and advanced patient education and advice from multidisciplinary teams with evidence-based knowledge is needed. There, the nurse is part of the multidisciplinary team. In guidelines from the ESC (European Society of Cardiology) regarding atrial fibrillation, the patient has the central role and must, together with care staff, make decisions about their care. A person-centered approach can help strengthen the patient's confidence in their own abilities, improve the quality of life and symptom relief, as well as shorten their care times. The aim was to illuminate nurse-led clinics and their effect for patients with atrial fibrillation. A literature review with structured search was used as a method. This master thesis included 16 scientific articles from the databases Pubmed and CINAHL Complete. The included result articles were quality reviewed and analyzed with integrated analysis to synthesize the results in relation to each other. The categories were then identified to describe the results of the articles. The results showed that nurse-led clinics had a number of different effects for patients with atrial fibrillation. The effects for nurse-led clinics were equivalent or slightly better for patients with atrial fibrillation compared with usual care. The results showed that the positive effects for patients with atrial fibrillation who received care at the nurse-led clinic to be: fewer hospital admissions, lower mortality, better treatment with anticoagulants, better adherence to more recommendations, reduced number of symptoms and increased knowledge of atrial fibrillation among patients. The conclusion is that nurse-led clinics are equivalent or better for patients with atrial fibrillation when compared with usual care.

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.