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dc.contributor.authorGullbrå, Frøydis
dc.date.accessioned2017-06-07T09:08:22Z
dc.date.available2017-06-07T09:08:22Z
dc.date.issued2017-05-30
dc.identifier.isbn978-82-308-3064-2
dc.identifier.urihttp://hdl.handle.net/1956/15936
dc.description.abstract<p>Background and aims: Children whose parents suffer from mental illness, substance abuse, or severe somatic disease are at risk of developing psychosocial problems and a variety of health complaints. These children often remain invisible in the healthcare system. Most parents will first visit their general practitioner (GP) if they are in need of healthcare, and the GP often meets the entire family and provides continuity of care. This doctor is therefore in a unique position to also help the patient&rsquo;s children. This thesis focusses on the GP&#39;s role with regard to children as next of kin. Specifically, the research aimed to identify the types of help that GPs can provide, as viewed from the perspective of three groups: children with parents who are ill or are substance abusers, ill parents, and lastly, GPs.</p> <p>Materials and Methods: After deciding on a qualitative approach, we invited GPs, adolescents, and ill parents to interviews regarding the ways in which a GP could provide help for children as next of kin. We performed focus group interviews with the GPs and adolescents, and semi-structured interviews with the ill and substanceabusing parents. The data were analyzed using thematic content analysis or systematic text condensation.</p> <p>Results: Children living in families with an ill or substance-abusing parent experienced unpredictability in their daily life, and often had own health problems. Despite good intentions, the parents did not always manage to create a good and predictable everyday life for their children. Both parents and adolescents stated that they wanted their GP to acknowledge the fact that they are striving to lead a normal everyday life. However, they would simultaneously find it helpful if the GP recognized that their situation carried extra burdens due to parental illness. The children or adolescents did not visit their GP frequently, and if they did, it was mostly for somatic complaints. They welcomed a discussion of their home situation with the GP in these consultations. They found it difficult to raise the issue of their home situation by themselves, even if they were in need of support and required information about the parent&rsquo;s situation. Several expressed a need to be prompted by a helper they trusted. The parents expressed the same need for help in order to gain support and assistance in informing their children, but were also sometimes reluctant to address the home situation with their GP. The GPs stated that they were in a position to identify children in need of support and to advise their parents. This research found that the structural frameworks of general practice, with short consultations and the focus on the presenting patient, were significant barriers, as was the GPs&rsquo; fear of placing extra burdens on struggling patients.</p> <p>Conclusions: GPs are in a good position to support children as next of kin, but often miss the opportunities to act. A good starting point may be to recognize a parent&rsquo;s honest intentions to make a good life for their children, and to consider the children and adolescents as ordinary youths in a challenging life situation. Within a trusting patient-doctor relationship, the sensitive topic of how a parental illness might affect the children in a family can be discussed, and a GP can provide support and advice, to adolescents or parents, based on the needs identified. It is usually important for the GP to participate in a multidisciplinary collaboration to ensure appropriate support and care for the families with the greatest burdens.</p>eng
dc.description.abstract<p>Bakgrunn og m&aring;l: Barn som har foreldre med psykisk sjukdom, rusmisbruk eller alvorleg somatisk sjukdom, har ein auka risiko for &aring; utvikle psykososiale problem og ulike typar helseplager. Desse barna blir ofte usynlege i helsevesenet . N&aring;r helseplager oppst&aring;r, er det ofte fastlegen foreldre f&oslash;rst opps&oslash;kjer om dei har trong for helsehjelp. Fastlegen kjenner ofte heile familien og f&oslash;lgjer familien over tid, og skulle difor vere i ein god posisjon til &aring; sj&aring; barna, og s&oslash;rge for at dei ogs&aring; f&aring;r n&oslash;dvendig oppf&oslash;lging. Denne avhandlinga fokuserer p&aring; fastlegen si rolle i h&oslash;ve barn som p&aring;r&oslash;rande. Konkret vil prosjektet pr&oslash;ve &aring; identifisere korleis ein fastlege kan hjelpe, sett fr&aring; perspektivet til tre grupper: barn som har sjuke eller rusmisbrukande foreldre, sjuke foreldre og fastlegar.</p> <p>Materiale og metode: Vi valte ei kvalitativ tiln&aelig;rming og inviterte fastlegar, ungdom med sjuke foreldre og sjuke foreldre til intervju. Tema var korleis ein fastlege kan hjelpe barn som p&aring;r&oslash;rande. Vi utf&oslash;rte fokusgruppeintervju med fastlegar og ungdom, og semi-strukturerte individuelle intervju med sjuke og rusmisbrukande foreldre. Data blei analysert ved &laquo;thematic content analysis&raquo; eller systematisk tekstkondensering .</p> <p>Resultat: Barn som har vakse opp i familiar med ein sjuk eller rusbrukande forelder, opplevde ofte ein uforutsigbar kvardag, og dei hadde ofte eigne helseplager. P&aring; trass av gode intensjonar, klarte ikkje alltid foreldra &aring; skape ein trygg og god kvardag for barna sine. B&aring;de foreldra og ungdommane uttrykte at dei ynskte at fastlegen skulle anerkjenne deira fors&oslash;k p&aring; &aring; skape ein normal kvardag, og p&aring; same tid forst&aring; at dei var i ein situasjon med ekstra byrder p&aring; grunn av sjukdom/rus hj&aring; ein forelder. Desse ungdommane var ikkje ofte innom fastlegen, og d&aring; helst med fysiske plager. Dei ynskte gjerne at fastlegen i konsultasjonen tok opp heimesituasjon med sjuk forelder. Dei fann det sj&oslash;lv vanskeleg &aring; ta opp dette temaet, ogs&aring; om dei kunne ha behov for st&oslash;tte og informasjon om den sjuke forelderen sin situasjon. For &aring; snakke om dette trengte dei &aring; bli invitert til det av ein hjelpar dei hadde tillit til. Foreldra uttrykte same behov for r&aring;d i h&oslash;ve det &aring; st&oslash;tte og informere barna, men var ogs&aring; nokon gonger reservert i h&oslash;ve til &aring; ta dette opp med fastlegen. Fastlegane uttrykte at dei var i ein god posisjon for &aring; identifisere barn i risiko og for &aring; r&aring;dgi foreldre. Rammene i allmennpraksis med korte konsultasjonar og hovudfokus p&aring; pasient tilstades, var viktige hindringar i dette arbeidet. Det same var fastlegen si frykt for &aring; gi ekstra byrder til foreldre som streva.</p> <p>Konklusjon: Fastlegen er i ein god posisjon for &aring; hjelpe barn som p&aring;r&oslash;rande, men g&aring;r ofte glipp av moglegheitene til &aring; handle. Eit godt utgangspunkt kan vere &aring; anerkjenne foreldra sine gode intensjonar om &aring; skape ein god kvardag for ungane sine, og &aring; forst&aring; at ungdommane har behov for &aring; bli m&oslash;tt som vanlege ungdommar med ein utfordrande livssituasjon. I ein tillitsfull relasjon kan sensitive tema som korleis foreldre sin sjukdom p&aring;verkar barna, bli tatt opp. Fastlegen kan gi st&oslash;tte og r&aring;d, b&aring;de til foreldre og ungdom, basert p&aring; dei behov som er avdekka. For dei tyngst ramma familiane kan det vere viktig at fastlegen deltek i tverrfagleg samarbeid for &aring; sikre n&oslash;dvendig hjelp.</p>eng
dc.language.isoengeng
dc.publisherThe University of Bergeneng
dc.relation.haspartPaper I: Gullbrå F, Smith-Sivertsen T, Rortveit G, Anderssen N, Hafting M. To give the invisible child priority. Children as next of kin in general practice. A qualitative study among general practitioners. Scand J Prim Health Care 2014; 32 (1): 17-23. The article is available at: <a href="http://hdl.handle.net/1956/15933" target="blank">http://hdl.handle.net/1956/15933</a>eng
dc.relation.haspartPaper II: Gullbrå F, Smith-Sivertsen T, Graungaard AH, Rortveit G, Hafting M. How can the general practitioner support adolescent children of ill or substance-abusing parents? A qualitative study among adolescents. Scand J Prim Health Care. 2016; 34 (4): 360-367. The article is available at: <a href="http://hdl.handle.net/1956/15934" target="blank">http://hdl.handle.net/1956/15934</a>eng
dc.relation.haspartPaper III: Gullbrå F, Smith-Sivertsen T, Rortveit G, Anderssen N, Hafting M. Ill and substance-abusing parents: how can the general practitioner help their children? A qualitative study. BMC Fam Pract. 2016; 17: 154. The article is available at: <a href="http://hdl.handle.net/1956/15935" target="blank">http://hdl.handle.net/1956/15935</a>eng
dc.titleChildren as next of kin and the general practitioner. A qualitative study about the general practitioner’s opportunities to helpeng
dc.typeDoctoral thesiseng
dc.rights.holderCopyright the Author. All rights reservedeng
bora.peerreviewedPeer reviewedeng
dc.identifier.cristinID1470943
dcterms.hasParthttp://hdl.handle.net/1956/15935eng
dcterms.hasParthttp://hdl.handle.net/1956/15933eng
dcterms.hasParthttp://hdl.handle.net/1956/15934eng


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