title: Health Promotion in Practice-District Nurses׳ Experiences of Working with Health Promotion and Lifestyle Interventions Among Patients at Risk of Developing Cardiovascular Disease.
abstract: OBJECTIVE
  Health Promotion Practice (HPP) has the objective to promote a healthier lifestyle and reduce the risk of disease. The aim of this study was to examine district nurses׳ experiences of working with health preventive actions among patients with risk factors for cardiovascular disease (CVD), and to identify facilitators and obstacles in HPP.
  
  
  METHODS
  The study was carried out with a qualitative approach where individual semistructured interviews were performed with a total of 12 district nurses in primary care. Data transcripts were analyzed with a manifest content analysis.
  
  
  RESULTS
  Five categories were identified. Firstly, informants regarded HPP as the core essence of their work. Secondly, counseling and coaching were reported as crucial elements in working with HPP. Thirdly, informants identified tools such as motivational interviewing (MI) to facilitate HPP. In the fourth category facilitators and barriers of HPP appeared, consisting of both positive and negative attitudes and presence as well as lack of organizational culture and structure. Finally, some informants were dissatisfied with HPP and viewed it as compulsory or as a burden, while others were satisfied and experienced it as a stimulating challenge.
  
  
  CONCLUSIONS
  This study identified that HPP is the core of the district nurses׳ work to promote a healthier lifestyle in individuals with CVD. Organizational structures and culture need to be improved in order to support district nurses to successfully work with HPP. To optimize health promotion and strengthen patients׳ self-care, it is recommended that HPP include holistic elements of care.
authors.affiliation: Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Husum Health Center, Västernorrland County Council, Husum, Sweden. Electronic address: Kristina.lundberg@miun.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Lundberg
authors.affiliation: Department of Nursing, Mid Sweden University, Sundsvall, Sweden; Louis Bolk Institute, Driebergen, The Netherlands; National Information and Knowledge Center for Integrative Medicine, Amsterdam, The Netherlands.
authors.forename: Miek C
authors.initials: MC
authors.lastname: Jong
authors.affiliation: Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Kristiansen
authors.affiliation: Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Jong
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003376:Counseling; D005260:Female; D006293:Health Promotion / Q000379:methods* / Q000458:organization & administration; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D062405:Motivational Interviewing; D024802:Nurse's Role; D009723:Nurse-Patient Relations; D009726:Nurses / Q000523:psychology; D015279:Organizational Culture; D011320:Primary Health Care / Q000379:methods; D013548:Sweden
keywords: cardiovascular disease; counseling; health behavior; primary care; risk reduction behavior