Abstract
BackgroundThe definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. The meaning of holism in international literature differs between medicine and nursing. The question is, if the difference is due to different educational traditions. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. Thus, the aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs).MethodsSeven focus group interviews with a purposive sample of 22 GPs and 20 nurses working in primary care in two Swedish county councils were conducted. The interviews were transcribed verbatim and analysed using qualitative content analysis.ResultsThe analysis resulted in three categories, attitude, knowledge, and circumstances, with two, two and four subcategories respectively. A professional attitude involves recognising the whole person; not only fragments of a person with a disease. Factual knowledge is acquired through special training and long professional experience. Tacit knowledge is about feelings and social competence. Circumstances can either be barriers or facilitators. A holistic view is a strong motivator and as such it is a facilitator. The way primary care is organised can be either a barrier or a facilitator and could influence the use of a holistic approach. Defined geographical districts and care teams facilitate a holistic view with house calls being essential, particularly for nurses. In preventive work and palliative care, a holistic view was stated to be specifically important. Consultations and communication with the patient were seen as important tools.Conclusion'Holistic view' is multidimensional, well implemented and very much alive among both GPs and DNs. The word holistic should really be spelt 'wholistic' to avoid confusion with complementary and alternative medicine. It was obvious that our participants were able to verbalise the meaning of a 'wholistic' view through narratives about their clinical, every day work. The possibility to implement a 'wholistic' perspective in their work with patients offers a strong motivation for GPs and DNs.
Highlights
The definition of primary care varies between countries
Members of a focus group are selected from persons who may be expected to share their experiences of the phenomenon that would be of interest to the researcher
The concept of a holistic view is not applied to Swedish primary health care other than in different policies and political documents, but was said to permeate general practitioners (GPs) and nurses' practical work
Summary
The definition of primary care varies between countries. Swedish primary care has developed from a philosophic viewpoint based on quality, accessibility, continuity, co-operation and a holistic view. Due to the uncertainties in defining holism and a holistic view we wished to study, in depth, how holism is perceived by doctors and nurses in their clinical work. The aim was to explore the perceived meaning of a holistic view among general practitioners (GPs) and district nurses (DNs). The definition of primary care varies between countries. In a WHO report primary care was considered to be more difficult to define in comparison with specialist care, which is described as services delivered by specialists in hospitals [1]. Primary care can, according to the same report, be described in terms of concept, level, content of services, process and team membership. Starfield describes primary care by level and function [2]. Starfield defines primary care as a set of functions that, in combination, are unique to primary care and characterised by four attributes; first contact, longitudinality, comprehensiveness and coordination [2]
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