Du kan se listen med alle mine udgivelser herunder. Hvis du er fagligt eller personligt interesseret i nogle af mine udgivelser, er du velkommen til at kontakte mig, for at få afgang til det. De fleste af mine udgivelser er det der hedder Open Access, så de kan findes og downloades af alle fx fra Google Scholar. Hvis du har en særlig interesse i min ph.d. afhandling, og gerne vil læse den, er du også velkommen til at tage kontakt til mig. Nederst på siden kan du finde et resume af min afhandlingen på dansk og engelsk.
Mine udgivelser fra ph.d.-en:
Schultz, R., Brostrøm Kousgaard, M., & Davidsen, A. S. (2021). “We have two different agendas”: the views of general practitioners, social workers and hospital staff on interprofessional coordination for patients with chronic widespread pain. Journal of Interprofessional Care, 35(2), 284-292. Læs denne af mine udgivelser her
Schultz, R., la Cour, P., Kousgaard, M. B., & Davidsen, A. S. (2021). “My private theory is that it’s all in the head”: Understandings of chronic widespread pain among social workers from municipality job centers in Denmark. Health Psychology Open, 8(1).
Schultz R., Perspectives on Patient Trajectories on Chronic Widespread Pain – Patients’ and professionals’ experience of intersectoral trajectories, and municipality social workers’ understandings of chronic widespread pain. PhD-afhandling (2020).
Schultz R., Brostrøm Kousgaard M., la Cour P. & Davidsen A. Between three chairs: Experiences of being a patient with chronic widespread pain in an intersectoral setting in Denmark. Health Psychology Open (2019). Læs denne af mine udgivelser her
Mine udgivelser fra fagbøger:
Schultz R. Kognitiv adfærdsterapi, kap. 6 in Glintborg, C. (red.) (2018) Rehabiliteringspsykologi – en introduktion i teori og praksis. Aarhus Universitetsforlag.
Andre af mine udgivelser:
Schultz R. Copingstrategier ved fibromyalgi og kroniske neuropatiske smerter. Best Practice,Reumatologi, maj 2017.
Baastrup, S. Schultz R., Brødsgaard I., Moore R., Jensen T.S., Vase L., Bach F.W., Rosenberg R. & Gormsen L. A Comparison of Coping Strategies in Patients with Fibromyalgia, Chronic Neuropathic Pain, and Pain-Free Controls. Scandinavian Journal of Psychology (2016), 57(6), 516-522.
La Cour P., Schmidt A.A. & Schultz R. Validation of the Danish-Language Injustice Experience Questionnaire. Journal of Health Psychology (2015).
Hansen K.E., Kesmodel U., Baldursson E., Schultz R. & Forman A. The influence of endometriosis related symptoms on work life and work ability: a study of Danish endometriosis patients in employment. European Journal of Obstetrics and Gynecology (2013).
Schultz R., Baastrup S. & Hansen T. Psykoedukation som intervention mod kroniske smerter ved fibromyalgi. Akademisk Kvarter (2012).
Hvis du er interesseret i nogle af mine udgivelser, så kan du kontakte mig her.
Patienter med generaliserede smerter i bevægeapparatet (GSB) oplever ofte langvarige forløb, der involverer den praktiserende læge, det kommunale jobcenter og en eller flere hospitalsafdelinger. Tidligere forskning har vist, at læger synes det er en vanskelig patientgruppe at arbejde med. Patienterne føler sig ofte stigmatiserede i deres møde med læger.
Der er dog ikke tilstrækkelig viden om, hvordan patienter med GSB oplever deres forløb, når dette både involverer det kommunale jobcenter, hospitaler og almen praksis, ligesom der mangler viden om, hvordan fagfolk fra disse tre sektorer oplever deres samarbejde om patienter med GSB.
De kommunale jobcentre spiller endvidere en stadig større rolle i patienternes forløb, men der er begrænset viden om, hvordan sagsbehandlerne forstår GSB. Formålet med ph.d.-studiet var at undersøge hvordan patienter med GSB oplever deres tværsektorielle behandlingsforløb; hvordan fagfolk fra jobcentre, hospitaler og almen praksis oplever samarbejdet om patienter med GSB; og hvordan kommunale sagsbehandlere forstår og forklarer GSB.
Spørgsmålene blev belyst via semistrukturerede interviews med 12 sagsbehandlere, 7 praktiserende læger, 10 hospitalsansatte og 10 patienter med GSB (i alt 39 interviews). Alle deltagere blev rekrutteret i Region Hovedstaden fra januar 2016 til februar 2017. Interviewmaterialet blev analyseret med Interpretative Phenomenological Analysis.
Studiet viste, at patienter med GSB generelt oplevede at blive mødt med forståelse fra de professionelle i alle tre sektorer. Alle patienter havde dog også oplevelser af at blive mødt med en påtaget forståelse eller respektløs attitude fra de professionelle. Oplevelsen af manglende forståelse fik dem til at bruge undvigelsesstrategier, hvor de trak sig fra relationen til den professionelle og fortalte så lidt som muligt. Dette var særlig tydeligt i relationen mellem patienter og sagsbehandlere, og kan delvist relateres til sagsbehandlernes forståelse og håndtering af patienter med GSB.
Sagsbehandlerne forklarede GSB-tilstande ud fra psykosociale årsager som ’ondt i livet’, kriser, traumer, personlighedstræk som perfektionisme eller psykiatrisk lidelse. Sagsbehandlerne delte dog ikke dette ’private’ syn med patienterne, men udtrykte i stedet en mere neutral, kortfattet ’professionel’ forståelse i mødet med patienter.
Studiet indikerer, at fagfolk bør være særligt bevidste om, hvordan de møder patienter med GSB, hvis de skal opbygge en samarbejdsalliance.
Træning af mentalisering vil kunne styrke denne proces. Undervisning af sagsbehandlere i aktuelle smerteteorier kan samtidig overvejes for at klæde dem bedre på til at forstå patienterne og tale med dem om mulige forståelser af deres symptomer og vanskeligheder, selvom der endnu ikke findes nogen tilstrækkelige forklaringer på symptomerne.
Bedre arbejdsmiljø for sagsbehandlerne med et lavere stressniveau vil endvidere kunne støtte bedre evne til mentalisering, og hermed også bedre interpersonel forståelse af patienterne.
Resultaterne viste endvidere, at patienterne oplevede en fragmentering af deres forløb internt mellem hospitalsafdelinger samt i kommunale jobcentre, og imellem hospital, kommune og almen praksis. Dette svarede til de professionelles oplevelse af, at der manglede koordinering med andre professionelle.
Koordinering og samarbejde mellem professionelle blev udfordret af, at kommunikationen hovedsalig foregik via standardiserede skriftlige attester, samt af forskellige syn på hensigtsmæssige tidsforløb, forskellige målsætninger og indtagelse af forskellige positioner i forhold til arbejdet med patienter med GSB. For at styrke samarbejdet mellem almen praksis, kommuner og hospitaler bør der formuleres fælles mål for patienternes forløb og skabes bedre mulighed for at afholde ansigt-til-ansigt møder.
Patients with chronic widespread pain (CWP) often experience long-term trajectories involving general practice, municipality job centers, and one or more hospital units. Research has shown that physicians find it challenging to work with this group of patients, and that patients with CWP often feel stigmatized in their encounters with physicians.
As yet there is insufficient knowledge on how patients with CWP experience their trajectory when it involves their municipality job center, general practice and hospitals. Further, there is little knowledge on how professionals from these three sectors experience the coordination of work for patients with CWP. The municipality job centers also play an increasingly large role in patients’ trajectories, as they administer financial support and (re-)engagement with the labor market. But we do not know enough about how social workers understand CWP conditions.
The objective of my PhD-study was to investigate how patients with CWP experience intersectoral treatment trajectories; how professionals from municipality job centers, hospitals and general practice experience interprofessional coordination for patients with CWP; and how social workers from municipality job centers understand and explain CWP conditions.
The objectives were investigated via semi-structured interviews with 12 social workers, 7 GPs, 10 hospital staff, and 10 patients with CWP (a total of 39 interviews). All participants were recruited in the Capital Region of Denmark from January 2016 to February 2017. Data were analysed with interpretative phenomenological analysis.
The study showed that patients with CWP were generally met with an understanding attitude in all three sectors. However, all patients had negative experiences of being met with a not-understanding or a disrespectful attitude by professionals. The experience of not being understood made the patients resort to withdrawal strategies, where they disengaged from the relationship with professionals and said as little as possible during encounters. This was mainly seen in the relations between patients and social workers, and it may be due, in part, to how social workers understood and approached patients with CWP conditions.
The social workers mainly explained that CWP had psychosocial causes, such as ‘life’s troubles’, crises, trauma, personality traits such as perfectionism, or psychiatric illness. They called this a ‘personal’ understanding which they did not share, but revealed a brief and more neutral ‘professional’ understanding in encounters with patients.
The findings indicate that professionals should be aware of how they interact with patients with CWP if they are to create a positive working alliance. Training in mentalizing abilities could strengthen this process.
Teaching current theories of chronic pain to social workers should also be considered to prepare them for a more nuanced understanding and discussion of possible explanations for CWP with patients, even though there is still no fully sufficient explanation of symptoms. Moreover, better working environment with lower levels of stress for social workers could support better mentalizing capacities and, thereby, better interpersonal understandings of patients.
Furthermore, the study showed that patients with CWP experienced fragmentation in their trajectories between hospital departments, within municipality sections, and between hospitals, municipality job centers and general practice. This finding was echoed by the professionals, who experienced a lack of interprofessional coordination, which was challenged by communication based mainly on standard, written forms, divergent views on appropriate timescales for treatment, different intersectoral goals, and opposing positions regarding their work with patients with CWP.
To strengthen coordination between general practice, municipalities, and hospitals, shared goals for patient trajectories should be negotiated, and opportunities for more face-to-face contacts should be improved.