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Life Versus Disease in Difficult Diabetes Care: Conflicting Perspectives Disempower Patients and Professionals in Problem Solving

Department of Nursing Science, University of Aarhus, Denmark

Marit Kirkevold

University of Aarhus, Denmark, and University of Oslo, Norway

Conflicts in problem solving are known from diabetes research on patients with good glycemic control but have rarely been studied in the care of patients with poor glycemic control. Equally, the different perspectives of health care providers and patients have not been a focus in previous studies. The authors studied the interactions between health care providers and 11 diabetes patients with poor glycemic control in a grounded theory study at a Danish university hospital. Keeping Life and Disease Apart was identified as a core category. It involved a pattern of conflicts both between and within patients and health professionals, which disempowered them in problem solving. Three approaches to problem solving were identified: A compliance-expecting approach kept the pattern unchanged, a failure-expecting approach deadlocked the pattern, and a mutuality-expecting approach appeared to neutralize the conflict.

Key Words: diabetes • chronic care • conflict • grounded theory • problem solving • knowledge

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