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There is a lack of studies on ethical responsibility in nursing. Nurses experience ethical responsibility in all settings where patients are exposed and vulnerable. The authors’ interest in public health and intensive care nursing provided a motivation to study these settings. The study aimed to explore how intensive care and public health nurses experience ethical responsibility. A qualitative design was chosen and 10 individual interviews were carried out. The data were analysed using hermeneutic phenomenological analysis. The study is reported in accordance with COREQ. Levinasian ethics provided the theoretical framework. The analysis resulted in four themes: Feeling alone, Feeling worried and uncertain, A sense of satisfaction, A personal commitment. Even though the settings differed, experiences of aspects of ethical responsibility were the same. Further in-depth studies in different settings can enhance an understanding of moral responsibility and facilitate the development of a theory of ethical responsibility in nursing practice.

In Finnmark, the northernmost county of Norway, many villages are remote and scattered between vast stretches of uninhabited land, with mountain crossings that are often closed in winter or where one can only drive in single file behind a snowplough. This may mean periodic total isolation and daily challenges with long distances to other professionals and hospitals. These special circumstances mean that nurses must act more independently than elsewhere. Objectives: The aim was to explore the challenges of rural nurses in palliative cancer care, and the prerequisites to maintain a suitable professional standard in their nursing. Methods: This study is qualitative with an explorative design and reports the results of the content analysis of interviews with five nurses, living in small, multi-ethnic villages. Findings: The main finding of the study is that the nurses experienced themselves as being alone geographically and professionally in their practice of palliative care. The established infrastructure for performing advanced nursing in patients’ homes is poorly adapted to the geographical and professional situation in rural areas such as Finnmark, and suboptimal information about patients arriving from hospitals can compromise the quality of care. Advanced nursing is performed when specialists are far away and there is no palliative team, and they care for patients who are often their family members, friends and acquaintances, which involves role ambiguity and a risk of over-involvement. Conclusion: The study shows that requirements to enhance palliative cancer care are to establish palliative teams, discharge summaries present in transition, the necessary drugs and medical equipment for several days, and relevant training of personnel.

© 2019 Author(s). This is an open access article distributed under the terms of the Creative Commons CC-BY-NC 4.0 License (http://creativecommons.org/licenses/by-nc/4.0/) Hensikten med studien er å få mer kunnskap om hvordan utviklingssentrene for sykehjem og hjemmetjenester (USHT) opplever sin rolle som pådrivere for utvikling, implementering og spredning av ny kunnskap i de kommunale helse- og omsorgstjenestene, og hvordan de opplever samarbeidet med Senter for omsorgsforskning (SOF) når det gjelder forskningsfaglig bistand og veiledning. Vi søker gjennom dette å bidra til ny kunnskap om samarbeidsbasert innovasjonsarbeid i skjæringsfeltet mellom statlige føringer, forskning og praksis. Undersøkelsen er gjennomført som en questback-undersøkelse med både lukkede og åpne svaralternativer sendt til alle USHT. Resultatene viser at USHT er ulike når det gjelder oppbygging, organisering, antall ansatte, kompetanse og fagsammensetning. Disse ulikhetene har betydning for både deltakelse og fokus i innovasjons- og FoU-arbeidet som foregår i de ulike sentrene og for samarbeidet med SOF. En tettere dialog mellom Helsedirektoratet, USHT og SOF om forventninger og behov, samt en konkretisering av rammer for samarbeidet, vil kunne bidra til utvikling av en mer hensiktsmessig struktur for utvikling, implementering og spredning av ny kunnskap i helse- og omsorgstjenestene. Nøkkelord: Samarbeid, Innovasjon, FoU-arbeid, Senter for omsorgsforskning utviklingssentrene for sykehjem og hjemmetjenester Abstract: The aim of the study is twofold: First, it aims to investigate how the Centre for Development of Institutional and Home Care Services (CDIH) experiences their role as a driving force for the development, implementation and dissemination of new knowledge in the municipal health and care services. Second, it aims to explore how the CDIH experiences the collaboration with the Centre for Care Research (CCR) and the research-related assistance and supervision they provide. We seek to provide new insights into cooperation-based innovation efforts in the intersection between governmental leadership, research and practice. The study draws on data from a questback survey with both closed and open-ended questions distributed to all CDIH departments. The results show that the CDIH differs in terms of structure, organization, number of employees and competence. This is important for research & development work in the various CDIH departments, and for cooperation with the CCR. A closer dialogue between the Norwegian Directorate of Health, the CDIH and the CCR about expectations and needs, as well as a concrete framework for cooperation, can contribute to the development of a more appropriate structure for the development, implementation and dissemination of new knowledge in the municipal health and care services.

Source at https://doi.org/10.1016/j.childyouth.2019.02.037. Child welfare services are often scrutinized in media reports, but few comparisons of how services are represented in different countries are available. The aim of this article is to assess whether systematic differences in the representation of child welfare services in Norwegian, Danish and German newspapers can be documented. A content analysis of major newspapers in each country revealed considerable differences among the countries. While Norwegian and German child welfare services are mostly presented as implementing adequately severe and timed interventions, their Danish counterparts are heavily criticized for a complete lack of interventions and for implementing interventions too late or not at all. In none of the three countries, interventions of child welfare services are in the reviewed newspapers presented particularly as too severe or too early. The cooperation with other welfare services is described mostly as neutral or negative in Norwegian newspapers, as positive, neutral or negative in German ones and not at all in most Danish articles. Cultural sensitivity in interventions is in the newspaper coverage of all three countries characterized mostly by an omission of the topic altogether. The comparative indicators applied in this study are suggested as powerful tools for further comparisons.

While expectations are well-known drivers of electronic health record (EHR) adoption, the drivers of expectations are more elusive. On the basis of interviews with general practitioners (GPs), we investigate how the early implementation process drives their expectations of an EHR that is being implemented in Norway. The GPs’ expectations of the prospective EHR are driven by (a) satisfying experiences with their current system, (b) the transfer of others’ experiences with the prospective EHR, (c) a sense of alignment, or lack thereof, with those in charge of the implementation process, (d) uncertainty about the inclusion of GP needs, and (e) competing technological futures. To manage expectations, starting early is important. Mismanaged expectations produce a need for convincing people to reverse their expectations. This appears to be the situation in Norway, where the GPs are currently skeptical of the prospective EHR.

Decisions on uptake of medicines and medical devices on health insurance schemes are increasingly based ona health technology assessment (HTA) process. In Norway, the process has included reimbursement of outpatientmedicines for two decades. During the past years, in-patient medicines, medical devices and morerecently vaccines are all included in the HTA system. In the present article, we outline the Norwegian HTAsystem including its central components and partners. HTA as a scientific approach puts evidence on efficacy,safety and value of interventions into a broader perspective, explicitly considering relevant factors, among theselegal, ethical and organisational aspects of the intervention. Although several combinations of aspects arepossible, the most common is an assessment of the relative effectiveness and cost-effectiveness of theintervention. Randomised controlled trials have long been considered the mainstay for assessment of clinicaleffectiveness pre-launch, while registry data have been used to inform safety post-lunch, by pharmacovigilance.Recently, we have seen a move towards more use of “real world evidence”, i.e. data from non-RCT sources,mainly from registries. A model-based approach is often used to assess cost-effectiveness, in this context,different types of evidence from different sources are often synthesized. In this paper we describe the centralcomponents of HTA with special emphasis on different observational data sources, such as the unique Norwegianhealth registries. We finally speculate on future directions for use of observational data in HTA, both in aglobal and Norwegian setting.

Introduction: This article addresses the pro­vision of rehabilitation services for torture victims with a refugee background in Norway. It engages the topic from the outset of relevant rehabilitation rights and duties, presenting the organisation of rehabilitation services within the Norwegian health care system, and ex­ploring the challenges and opportunities pro­fessionals see and experience as they seek to provide adequate treatment and rehabilitation for torture victims. Methods and material: Qualitative inter­views with 46 experts and practitioners that contribute to or otherwise focus on treat­ment and rehabilitation for torture victims in Norway, conducted between March and August 2019, and an email-based educational programme survey. Results and discussion: Re­habilitation services for torture victims suffer from the absence of a systematic approach to identification and documentation of torture injuries. Moreover, the quality of rehabilitation services suffers from a lack of coordination and inclusion of actors that can contribute to com­prehensive rehabilitation processes. Students of relevant professions, such as medicine, psy­chology, nursing, law, and policing, are to a large extent not exposed to knowledge about torture injuries and rehabilitation for torture victims during their professional studies. Conclusion: Rehabilitation services for torture victims in Norway are fragmented, and the resulting practice is highly person depen­dent. Three recommendations are proposed in order to ensure minimum standards in reha­bilitation services for this group: 1) develop­ing and implementing a national plan of action on torture rehabilitation; 2) knowledge and capacity-building within relevant educational programmes, the national health services and other relevant public sector services; and 3) strengthening and institutionalising interdisci­plinary communities of practice with special­ised expertise on the topic at all relevant levels.

I dette kapittelet ønsker vi å belyse hvordan systematisk refleksjon over praksiserfaringer bidrar til viktig kunnskapsdannelse i jordmorstudiet. Vi har utviklet reflekterende team (RT) som en undervisningsform der studentens praksiserfaringer danner grunnlag for personlig og profesjonell kunnskapsutvikling. Bevissthet om og trening i kommunikasjon og veiledning er sentrale tema i arbeidet. For å lykkes med dette er det vesentlig at studenten med egne ord får fortelle frem og dele det vesentlige i erfaringen, og undersøke hvordan hennes forståelse former hennes yrkespraksis. Studentenes refleksjonslogger etter hver arbeidsøkt er analysert med tanke på å forstå hvilken kompetanse RT som undervisningsform kan bidra til.

Source at https://www.tannlegetidende.no/i/2020/9/m-1912. The original research paper that is discussed is available in Munin at https://hdl.handle.net/10037/18994. Tannhelsetjenestens kompetansesenter Øst (TkØ) har gjennomført en spørreundersøkelse om tannhelsepersonells erfaringer under nedstenging i perioden 13. mars–17. april 2020. Første del av studien er nå publisert i International Journal of Environmental Research and Public Health og er den første norske studien som omhandler håndtering av covid-19-pandemien i tannhelsetjenesten.

Background: In Norway, due to demographic challenges with an ageing population and lower fertility rates, current government policies have encouraged municipalities and volunteers to collaborate. Moreover, present policies recommend an increase in volunteer activities within care services. Co-production is advocated as a functional and innovative method of activating resources when citizens and public employees interact in the care sector. Method: This study has scrutinised ongoing volunteer activities in nursing homes and home care facilities by utilising the results from a survey targeting employees in public care services. Aim: The aim has been to identify the extent to which long-term care units (LTC units) in Norwegian municipalities and voluntary organisations collaborate in the coordination of volunteer activities at the local level by answering the following research questions: when LTC units and voluntary organisations collaborate in coordinating voluntary activities within caring services: are they sharing tasks, dividing the tasks between them or both? Findings: The results show that LTC units often coordinate volunteer activities that correspond to statutory public care services. Additionally, LTC units also contribute considerably in coordinating other volunteer activities, either alone or to a small extent in collaboration with voluntary organisations. This limited task sharing when coordinating volunteer activities in municipal care services can be seen as a suboptimal way of using the resources. Hence, a large part of this paper concerns a discussion of the theory of co-production in public care services, drawing on the findings of the survey.

Background There is a gap in the literature regarding what takes place between the announcement of a regulatory intervention, such as an external inspection of a health care organisation, and the inspecting body’s site visit. This study aimed to explore inspecting bodies’ expectations of how inspected organisations should prepare before an external inspection and to elucidate how inspected health care organisations prepare before site visits. Methods This qualitative study was based on data from 17 group interviews with a total of 75 participants representing inspection teams, organisation leaders and clinicians in inspected health care organisations. The data were analysed using a qualitative content analysis method. Results We identified two approaches to how the inspection teams expected that the inspected organisations should prepare before site visits. In the first approach the inspection teams did not expect any improvement activities to be initiated during this period and focused on identifying inadequacies that the inspected organisations should subsequently improve. In the second approach the inspection teams expected organisations to review their own practices and begin improvement activities if necessary. The inspected organisations responded in different ways to an upcoming site visit, and the organisations’ leaders were important in determining which activities would be initiated. Organisations in which leaders involved clinicians in assessing care delivery tended to initiate action to improve and expected inspection teams to assess their ongoing improvement work and provide guidance on further improvements. Leaders who did not involve clinicians in assessing the quality of care tended to perceive the current quality of care as adequate on the basis of reviewing written guidelines. They did not initiate action to improve care delivery apart from updating written guidelines describing how care should be delivered, and they expected the inspection team to confirm that their current practices were in line with the guidelines and external standards. Conclusions To promote anticipatory effects in inspected organisations, inspecting bodies should stress the importance of assessing clinical practice and involving frontline clinical staff and leaders in the assessment and in improvement work before the site visit.

This is a pre-print of an article published in International Journal of Clinical Pharmacy 2017:1-7. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11096-017-0556-x . Background: Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective: To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method: For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure: Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results: Mean score per discharge summary was 7.4 (SD 2.8; range 0–14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion: In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.

Objective: To investigate knowledge of and attitudes to human papillomavirus (HPV) infection, HPV vaccination, cervical cancer, related sources of information and factors associated with willingness to vaccinate one’s own daughter among primary health care (PHC) personnel. Design: Cross-sectional study. Setting: PHC. Subjects: All public health nurses (PHNs) and general practitioners (GPs) in Northern Norway were invited to answer a structured electronic questionnaire; 31% participated (N = 220). Main outcome measures: Self-reported and actual knowledge, information sources, attitudes and willingness to vaccinate their (tentative) daughter. Results: 47% of respondents knew that HPV infection is a necessary cause of cervical cancer. PHNs had higher self-reported and actual knowledge about HPV vaccination and cervical cancer than GPs. PHNs used the Norwegian Institute of Public Health’s numerous information sources on HPV, while GPs had a low user rate. 88% of PHNs and 50% of GPs acquired information from the pharmaceutical industry. 93% PHNs and 68% of GPs would vaccinate their 12-year-old daughter. In a multivariate logistic regression analysis, willingness to vaccinate one’s daughter was positively associated with younger age, being PHN (OR = 5.26, 95%CI 1.74–15.94), little concern about vaccine side effects (OR = 3.61, 95%CI 1.10–11.81) and disagreement among experts (OR = 7.31, 95%CI 2.73–19.60). Conclusions: Increased knowledge about HPV infection and vaccination is needed, particularly among GPs. Those least concerned about side effects and disagreements among experts were most likely to vaccinate their daughter. These findings are of interest for public health authorities responsible for the Norwegian vaccination and cervix cancer screening programmes, and providers of training of PHC personnel.Key points One year after introduction of HPV vaccination among 12-year-old schoolgirls in Norway, a cross-sectional study in Northern Norway among general practitioners (GPs) and public health nurses (PHNs) showed that • barely half of PHC professionals knew the causal relationship between HPV infection and cervical cancer • PHNs and GPs had higher self-reported than actual knowledge about HPV vaccination and cervical cancer nearly all PHNs and two thirds of GPs wanted to vaccinate their 12-year-old daughter. Those most concerned about side effects and disagreement among experts were less likely to vaccinate.

Tema for denne avhandlingen er sykehuskirurgers arbeidsorganisering, arbeidspraksiser og individuelle profesjonelle autonomi. Et sentralt spørsmål som stilles er på hvilke måter påvirker den temporale og stedlige organiseringen av kirurgers arbeid kirurgenes individuelle autonomi og betingelsene for kollegial profesjonell kontroll? Avhandlingen har forsøkt å svare på denne ambisjonen ved å undersøke kirurgers individuelle autonomi, forstått som muligheten til å forme egne arbeidsforløp, gjøre skjønnsmessige vurderinger, fatte beslutninger og få dem gjennomført, innenfor de komplekse sosiale og organisatoriske kontekster sykehuset utgjør. Avhandlingens data er fremskaffet gjennom et etnografisk feltarbeid blant kirurger ved et universitetssykehus’ gastrokirurgiske avdeling. Det ble utført i overkant av 600 timer med skygging av kirurger fra alle stillingskategorier mens de utførte sitt hverdagsarbeid, på alle døgnets tider og i alle de kontekster kirurger arbeider. Dette inkluderer blant annet legemøter, legekontorer, operasjonsstuer, sengeposter og akuttmottak. Analyser av avdelingens viktigste styringsverktøy for temporal og stedlig koordinering av kirurgenes arbeid, tjeneste- og arbeidsplanene, er også gjennomført. Andre dokumenter innhentet fra avdelingen inngår også i datagrunnlaget for avhandlingen. I menneskebehandlende organisasjoner preget av uforutsigbarhet og kompleksitet er autonomi en nødvendig forutsetning for å kunne utøve profesjonelt arbeid. I avhandlingen utvikles det et empirisk fundert, teoretisk-analytisk begrepsapparat knyttet arbeidsforløp, sammenkjeding og to typer av beslutninger kirurger tar i hverdagsarbeidet: kunnskapsbaserte og logistikkbaserte beslutninger. Skillet mellom de to beslutningstypene tydeliggjør forskjellen mellom kirurgenes medisinsk-faglige vurderinger, og mulighetene de faktisk har til å få gjennomført beslutningene og styre eget arbeid. Skillet er basert på kjente profesjonsteoretiske begreper, men videreutviklet for å benyttes i analyser av observerbar handling i komplekse arbeidsorganisasjoner. Analysene av tjeneste- og arbeidsplanene viser at de produserer kontinuerlig tilgang på kirurger på sykehuset, men også diskontinuitet. Diskontinuiteten er knyttet til kirurgenes arbeidsforløp over dager og uker, mulighetene for lege–pasientkontinuitet og til informasjonsog beslutningsforløp. Disse formene for diskontinuitet reduserer kirurgenes muligheter til å ta beslutninger. Fordi kirurgene på grunn av tjenesteplanene blir arbeidende i temporal utakt, produserer dette også relasjonell diskontinuitet internt og på tvers av stillingshierarkiet. Det vanskeliggjør kirurgenes mulighet til å bli kjent med hverandre, noe som igjen reduserer muligheten for kollegial læring og profesjonell kollegial kontroll. Tendensen forsterkes ytterligere når arbeidet som utføres skjer over flere geografiske steder preget av utstrakt arbeidsdeling. Analysene av kirurgenes arbeid viser at det ofte ikke er den enkelte kirurg som er igangsetter av det arbeidet som gjøres. Oftere stilles det uten forutgående varsel krav fra andre (leger, sykepleiere eller pasienter) om at kirurgen skal fatte en beslutning. Krav oppstår stedlig spredt utover i sykehuset. Dette gjør at kirurgens arbeid er vanskelig å styre og kontrollere – både for kirurgen selv og for ledelsen. Dermed må kirurgene forsøke å sikre seg et eget handlingsrom for å styre eget arbeidsforløp, for på den måten komme i posisjon til å fatte beslutninger. Det gjør kirurgene ved å ta i bruk en rekke forskjellige strategier. Aktiv regulering av den stedlige avstanden til kollegaer, sykepleiere og pasienter er en av flere slike strategier. Samtidig er det store forskjeller på i hvilken grad kirurgene har mulighet til å regulere avstanden. Det avhenger blant annet av hvilken stilling og arbeidsposisjon kirurgen har, samt på hvilket tidspunkt av døgnet arbeidet gjøres. Avhandlingen viser også at kirurgene, uavhengig av om de er erfarne overleger eller underordnede leger, ønsker seg kollegiale beslutningsprosesser når kunnskapsbaserte beslutninger skal tas. De fleste etterlyste flere felles møtepunkter for å gjøre dette. Men på grunn av stort antall pasienter, distribuert over mange steder på sykehuset, var dette vanskelig å få til. Særlig vanskelig var det for underordnede leger, som opplevde at de var overlatt til seg selv når de arbeidet på sengepostene. Avhandlingen viser på den annen side at overlegenes fravær i liten grad skyltes unnvikelse fra visse typer arbeid, men derimot at overlegene tok et systemansvar. Uavhengig av årsaken til manglende kollegiale møtepunkter for faglige diskusjoner, gjør dette at betingelsene for kollegial kontroll svekkes. Avhandlingen synliggjør også kirurgers behov for ikke bare ha autonomi knyttet til de rent medisinskfaglige sidene ved arbeidet, men også handlingsrom til å få tilstrekkelig nærhet til nødvendig informasjonen og til kollegial støtte i de skjønnsmessige vurderingene de må gjøre i pasientbehandlingen. Med tilstrekkelig stort rom for å styre sine arbeidsforløp legges ikke bare grunnlaget for gode arbeidsvilkår for kirurgene, gode medisinskfaglige beslutninger og kvalitativt bedre pasientbehandling og -forløp, men også en mer robust profesjonell kollegial kontroll. Avhandlingens innsikter er derfor relevant for fremtidig planlegging av velfungerende sykehus. Avhandlingens analyser av de stedlige og temporale aspektenes virkning på kirurgers handlingsrom, gir viktig kunnskap om de komplekse sammenhengene som foreligger mellom hverdagsarbeidets betingelser og autonomi på sykehus. Ved å undersøke både rammene for kirurgenes profesjonelle virksomhet, ved hjelp av detaljerte analyser av tjenesteplanerenes konsekvenser for hverdagsarbeidets informasjons-, beslutnings-, og arbeidsforløp, og analyser av kirurgers forsøk på å styre eget arbeid, bidrar avhandlingen med ny, empirisk basert kunnskap om kirurgers arbeid og autonomi, profesjonelle relasjoner, samt betingelsene for kollegial kontroll og faglig gode beslutninger i dagens svært arbeidsdelte og komplekse sykehus. The topic of this dissertation is the organization of work, work practices and individual professional autonomy of hospital surgeons. A central question that is asked is in what ways does the temporal and spatial organization of surgeons' work influence the individual autonomy of the surgeon and the conditions for collegial professional control? The dissertation has attempted to answer this by examining the individual autonomy of surgeons, understood as the opportunity to shape their own work trajectories, make discretionary assessments and decisions and get them implemented, within the complex social and organizational contexts the hospital represents. The dissertation's data was obtained through an ethnographic fieldwork among surgeons at a university hospital's gastro-surgical department. It was carried out in excess of 600 hours of shadowing surgeons from all levels of the intra-professional hierarchy, while performing their everyday work, at all hours of the day and in all the contexts surgeons work. This includes intra-professional meeting, the surgeons’ office spaces, operating rooms, hospital wards and emergency rooms. Analyzes of the department's most important management tools for temporal and spatial coordination of surgeons' work, the duty and work schedules, were also conducted. Other documents obtained from the department are also included in the data analyzed. In human-treating organizations characterized by unpredictability and complexity, autonomy is a prerequisite for professional work. The dissertation develops an empirically grounded, theoretical-analytical conceptual approach related to work trajectories, articulation and two types of decisions surgeons make in everyday work: knowledge-based and logistics-based decisions. The distinction between the two types of decision makes clear the difference between the surgeons' medical-professional assessments, and the opportunities they actually have for getting the decisions done and managing their own work. This distinction is based on well-known theoretical concepts from sociological studies of professions, but further developed to be used in analyzes of observable action in complex work organizations. The analyzes of the duty and work schedules show that they produce continuous coverage of surgeons in the hospital, but also discontinuity. The discontinuity is linked to the surgeons' work trajectories throughout days and weeks, the possibilities for doctor-patient continuity and to information and decision-making trajectories. These forms of discontinuity reduce the surgeons' ability to make decisions. Because the surgeons work asynchronous or out of step of each other due to the duty schedules, this also produces relational discontinuity within and across all levels of the intra-professional hierarchy of surgeons. This makes it difficult for surgeons to get to know one another, which in turn reduces the opportunity for collegial learning and professional collegial supervision. This tendency is further amplified when the work done is carried out over several geographical locations characterized by extensive division of labor. The analyzes of the surgeons' work show that it is often not the individual surgeon who initiates the work that is done. More often, without prior notice, others (doctors, nurses or patients) are requesting (or demanding) the surgeon’s decision. The requests arise dispersed throughout the hospital. This makes the surgeon's work difficult to manage and control - both for the surgeon himself and for the department management. Thus, surgeons must try to secure their own room for maneuver to manage their own work trajectories, in order to be able to make decisions. The surgeons do this by applying a variety of strategies. Active regulation of proximity to colleagues, nurses and patients is one of several such strategies. At the same time, there are major differences in the extent to which surgeons are able to regulate distance and proximity. It depends, among other things, on the hierarchical position and allotted work position of the surgeon, and at what time of day the work is done. The dissertation also shows that surgeons, regardless of whether they are experienced consultants or junior doctors, want collegiate decision-making processes when making knowledge-based decisions. Most of the surgeons called for an increased number of points of contact to do this. But because of the large number of patients, distributed across several places in the hospital, this was difficult to obtain. It was particularly difficult for junior doctors, who felt that they were left to themselves when working on the hospital wards. The thesis, on the other hand, shows that the superior's absence was to a small extent due to avoidance from certain types of work, but rather that the superiors took a system responsibility. Regardless of the reason for the lack of collegial meeting points for discussions, this weakens the conditions for collegial supervision. The dissertation also highlights the need for surgeons not only to have autonomy related to the purely medical aspects of their work, but also to have room for sufficient closeness to the necessary information and for collegial support in the discretionary assessments they must make in patient care. With sufficient room to manage their work trajectories, not only is the basis for good working conditions for the surgeons, good medical decisions and qualitatively better patient care and treatment ensured, but also a more robust professional collegial control. The dissertation's insights are therefore relevant for future planning of well-functioning hospitals. The dissertation's analysis of the effect of the spatial and temporal aspects on the surgeons' room for maneuver provides important knowledge about the complex relationships that exist between the conditions of everyday work and autonomy in hospitals. By examining both the conditions for the surgeons’ professional activities, using detailed analyzes of the impact of work schedules on everyday work's information-, decision-, and work trajectories and analyzes of the surgeons' attempts to manage their own work, the dissertation contributes with new, empirically based knowledge about surgeons’ work and autonomy, their professional relationships, as well as the conditions for collegial control and professional decisions in today's highly labor divided and complex hospitals.

Journal home page at https://sykepleien.no/publication-overview/sykepleien-forskning. Bakgrunn og hensikt: Utfordrende atferd er hyppig forekommende på sykehjem. Hensikten med studien er å få kunnskap om sykepleieres erfaringer med utfordrende atferd hos personer med demens i forsterket skjermet enhet på sykehjem. Metode: Dette er en kvalitativ studie der data er samlet inn ved hjelp av fire semi-strukturerte forskningsintervju. Data er analysert ved å bruke systematisk tekstkondensering. Studien er tilrådd av Norsk Senter for forskningsdata (NSD). Resultat: Resultatene viste at sykepleierne vektlegger at kjennskap til pasienten, kunnskap om demens og forståelse for atferd som kommunikasjonsutrykk er grunnleggende elementer for å kunne tilpasse tilnærmingsmåten slik at de møter hver enkelt pasient på best mulig måte. Kjennskap, kunnskap og forståelse gjør det mulig å være bedre forberedt på det uforutsigbare i møte med pasienten. Sykepleierne beskriver at hyppige situasjoner med utfordrende atferd kan være krevende og det erfares spesielt krevende når de ikke blir satt i posisjon til å hjelpe. Nødvendigheten av å reflektere sammen med kollegaer i hverdagen fremheves. Konklusjon: Studien belyser nødvendigheten av å tilpasse tilnærmingsmåten på bakgrunn av kjennskap til pasienten, kunnskaper om demens og forståelse om atferd som kommunikasjonsutrykk. Muligheter for refleksjon bør settes i system. Background and purpose: Challenging behaviour is common in nursing homes. The aim of this study is to gain knowledge about nurses› experiences of challenging behaviour in people with dementia in reinforced sheltered units in nursing homes. Method: This is a qualitative study. Data is collected by four semi-structured interviews. Data was analysed using systematic text condensation. The Norwegian Centre for Research Data (NSD) approved the study. Results: The results revealed that nurses emphasize knowledge of the patient, knowledge of dementia and understanding of behaviour as a way of communication, as essential elements when meeting the patient in a best way possible. Knowledge and understanding help nurses prepare for unpredictable situations. The nurses describe that frequent situations with challenging behaviour can be demanding, and it is especially demanding when they are not put in a position to help. They emphasize a need to reflect with colleagues. Conclusion: This study highlights the need to approach the patients based on knowledge of the patient, knowledge of dementia and understanding of behaviour as a way of communication. Possibilities for nurses to meet for reflection should be facilitated.

As effective communication is a key ingredient for the provision of quality healthcare services, this study aimed to explore the communication experiences in the remote monitoring of older adults with a pacemaker. The study was based on a non-masked randomized observational design. The Healthcare Communication Questionnaire and in-depth interviews were conducted for data collection. A total of 49 patients participated in the study. The study findings reveal overall positive communication experiences by pacemaker users in remote monitoring with no significant differences from users in hospital monitoring. The remote option is perceived as safe and convenient, and communicating with the clinicians from home is considered comfortable and confidential. The study provides insights into the content of communication experiences in telehealth and practical implications in healthcare contexts. In a world that increasingly relies on remote communication, it is crucial to match technologies to patient needs and assess communication with patients. This will ensure the success of new models of care and establish appropriate criteria for the use of telehealth services. These criteria are all relevant in the implementation of health technology in the future as a part of effective patient-centered care.

Background. Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals’ ability to support the families when patients are parents. Methods. Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals’ background and role (N = 280) along with exploring predictors of parent, child, and family support. Results. While most health professions had begun to have conversations with parents on children’s needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals). Conclusion. The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals’ needs in order to strengthen their ability to better support children and families when a parent is ill. This study was funded by a research grant from the Northern Norway Regional Health Authority and was part of a large, multi-centre study funded by the Research Council of Norway (ID: 213477), with additional funding from the Norwegian Directorate of Health and the participating partners in the study. The publication charges for this article have been funded by a grant from the publication fund of UiT, The Arctic University of Norway.

BackgroundArterial hypertension (HT) is common in the Russian adult population, with half of affected individuals inadequately controlled. Low adherence to medication seems likely to be a factor. We report a scoping review of studies on adherence to antihypertensive therapy (AHT) in Russia to determine the extent of research undertaken, the frequency of adherence among adults diagnosed with HT, methodologies used in the studies, and their ability to describe determinants of adherence.MethodsA scoping review of published studies that have assessed adherence to AHT in Russian HT patients searched the main Russian and international electronic databases eLIBRARY.ru, Russian Medicine, Embase, MEDLINE for full-text reports published in the Russian language between 2000 and 2017. The last search was on November 28, 2017. Among 520 reports identified, 31 were included in the review.ResultsEighteen studies assessed adherence using the 4-item Morisky Medication Adherence Scale (MMAS-4); others used bespoke questionnaires or pill counts. 25 studies assessed levels of adherence, 11 examined its determinants, and 18 examined intervention strategies. The proportion of “adherent” patients varied from 11 to 44% using the MMAS-4, from 23 to 74% when using bespoke questionnaires, and from 5 to 43% when using pill counts. Adherence was associated with sociodemographic factors, access to free drugs provided through the Medicine Assistance Scheme (MAS), use of home blood pressure (BP) monitoring, anxiety, and comorbidity. There was no evidence that adherence was associated with income or physical activity. Evidence of an association between MAS, grade of HT, or experience of hypertensive crisis was inconclusive. Various methods to improve adherence were studied including patient education (improved from 1.8 to 3.9 points,p = 0.0002 or 2.80 to 3.79 points,p p ConclusionsThe main determinants of adherence to AHT are sociodemographic characteristics, the severity of HT, and presence of comorbidity. Patient education and use of fixed-dose combinations of drugs were identified as most important for improving adherence. Most studies assessing adherence use self-reported methods so there is a need for greater use of objective methods.Trial registrationThis scoping review has not been registered.

Accepted manuscript version. Published version available at https://doi.org/10.1016/j.nedt.2016.06.021. Licensed CC BY-NC-ND 4.0. Background: Health care systems in Norway and the western world have experienced extensive changes due to patients living longer with complex conditions that require coordinated care. A Norwegian healthcare reform has led to significant restructuring in service delivery as a devolution of services to municipalities. Action Research Design: Partners from three rural healthcare services, students from four professional programmes, and one lecturer from each of the professional programmes used a collaborative approach to obtain new knowledge through interprofessional practice. Using an action research design, the research group facilitated democratic processes through dialogues with healthcare services and students. The design is visualised as a cyclical process in which each cycle contributes to improvements, innovations, and increased understanding. A total of 32 students and 3 supervisors were interviewed before and after the clinical practice experiences. Fieldwork was conducted during three clinical periods. Findings: Interprofessional student groups formed small healthcare teams and assessed patients with chronic and long-term conditions. Students prepared and negotiated patient follow-up. The teams' responsibilities led to reflective practices that enhanced their professional knowledge. The teams achieved a new understanding of patient situations, which influenced “second opinions” for patients with complex conditions and led to innovative practices. The change in perception of patient needs led to a changed professional approach. The students' perceptions changed as they learned from and about each other and in collaboration with the health service; this led to more coordinated care of patients with complex conditions. Interprofessional learning in community settings provided a platform to improve both healthcare education and rural healthcare services. Conclusion: This research contributes to knowledge of how students' placement in interprofessional teams can enhance students learning from, with and about each other. The student teams promoted new ways of approaching and delivering complex patient treatment and care in community healthcare service. Collaborative partnerships in interprofessional learning have potential in the wider international arena as a means for practice improvement.

Welfare technologies have within the last few years become a new mantra for reforming the Nordic public health and social care, and are increasingly making their impact on working life of care professionals. Welfare technologies – a term exclusively used in a Nordic context – is a broad and loosely defined concept that covers a wide array of technologies such as tele-care solutions, automatic toilets, eating robots, GPS-trackers, and many others. They are envisioned as leading to a new and smarter form of retrenchment, promising better quality, empowerment of clients, and work that is smarter and more qualified (e.g., Danish government et al. 2013). Together with other reform initiatives like coproduction, rehabili- tation, and user-involvement, welfare technologies aim at enabling a change in the role of the clients/patients, stressing their resourcefulness and potentials and encouraging to self-responsibilization and self-care (Rose 1998; Triantafillou 2017). This implies a fundamental reorganization of care work, a transformation of what care and care work is about, and consequently of meaning and identity in work (see, e.g., Barnes & Cotterell 2012; Järvinen 2012; Kirkegaard & Andersen 2018; Meldgaard Hansen & Kamp 2018). More concretely, we may expect changes in work tasks, social relations and forms of cooperation between occupational groups, and new relations to clients/patients and their relatives. This may not only imply new challenges and strains in work but may also present new possibilities for employees to engage creatively in shaping work in ways that makes care work more meaningful and sustainable. (...) Copyright (c) 2019 Author and Journal Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Master i sykepleie - klinisk forskning og fagutvikling Bakgrunn og hensikt: Mange sykepleiere i Tverrfaglig spesialisert rusbehandling (TSB) og psykisk helsevern beskriver sin rolle som uklar, med vanskeligheter for å definere sykepleierens særegne kompetanse. Det stilles i TSB krav til en tverrfaglig tilnærming som inkluderer medisinskfaglig, sosialfaglig og psykologfaglig kompetanse. Det kan være utfordrende å definere klart hva som er sykepleierens rolle er i spennet mellom disse fagene. Hensikten med denne studien er å fremme kunnskap om sykepleierens funksjon i TSB ut i fra et tverrfaglig perspektiv. Forskningsspørsmålet er formulert slik: Hvilke erfaringer og forventninger har sykepleierne selv og de andre yrkesgruppene i TSB til sykepleiernes funksjon i TSB? Metode og analyse: Studien har et kvalitativt design med semistrukturerte individuelle intervjuer med 5 sykepleiere og 6 informanter fra de andre yrkesgruppene i TSB. Datamaterialet er analysert i henhold til Systematisk tekstkondensering (STC), jamfør Malterud (2017). Resultater: Studien viser til et stort samsvar i informantenes beskrivelse av sykepleiernes funksjon i TSB. Sykepleiernes kompetanse på somatikk og miljøterapi verdsettes, og deres bidrag i det tverrfaglige samarbeidet anerkjennes. Samtidig tydeliggjøres det stor variasjon i hvordan sykepleierne jobber, og det etterlyses at de som gruppe jobber mer likt. Kjernebegreper i sykepleie som grunnleggende behov og omsorg er fremtredende, og det understrekes at det er mye grunnleggende sykepleie i jobben sykepleierne gjør i TSB. Konklusjon: Ut i fra denne studien kan man forstå sykepleiernes funksjon i et tverrfaglig team som tydeliggjort med kunnskap om somatikk, miljøterapi og sammenhengen mellom disse. Nasjonale retningslinjer og pakkeforløp peker mot en mer somatisk tilnærming av pasientene, og er det lett å se til sykepleiergruppen som viktige aktører å spille på i denne sammenhengen. Studien synliggjør at tydeligere ledelse, struktur og faglig standard kan sikre kvalitet i tjenesten. Å fremstå som samlet overfor pasientene vil styrke tilbudet og kvaliteten på tjenestene i TSB. Background and purpose: Many nurses in Interdisciplinary Specialized Drug Treatment (TSB) and mental health care describe their role as unclear, with difficulties in defining the nurse's peculiar competence. TSB demands a multidisciplinary approach that includes medical, social and psychological expertise. It can be challenging to define clearly what the nurse's role is between these subjects. The purpose of this study is to promote knowledge of the nurse's function in TSB from an interdisciplinary perspective. The research question is formulated as follows: What experiences and expectations do the nurses themselves and the other occupational groups in the TSB have in the function of the nurses in TSB? Method and analysis: The study has a qualitative design with semi-structured individual interviews with 5 nurses and 6 informants from the other occupational groups in TSB. The data material is analyzed according to Systematic Text Condensation (STC), cf. Malterud (2017). Results: The study refers to a large correspondence in the informants 'description of the nurses' function in TSB. Nurses' expertise in somatics and environmental therapy is appreciated, and their contribution to interdisciplinary collaboration is recognized. At the same time, it is made clear that great variation in how the nurses work, and it is requested that those as a group work more equally. Core concepts in nursing as basic needs and care are prominent, and it is emphasized that there is a lot of basic nursing in the job nurses do in TSB. Conclusion: Based on this study one can understand the nurses' function in an interdisciplinary team that clarified with knowledge of somatics, environmental therapy and the connection between these. National guidelines and package paths point to a more somatic approach of the patients, and it is easy to look to the nursing group as important actors to play on in this context. The study highlights that clearer management, structure and professional standards can ensure quality in the service. Appearing as united to the patients will strengthen the provision and quality of the services in TSB.

Master i psykisk helsearbeid Bakgrunn: Ungdom og unges helse er gjenstand for omtale i medier og interesse fra politisk hold, og forskning viser til at det kan være grunn til oppmerksomheten. Skolehelsetjenesten har vært under opptrapping, og skal være et lavterskeltilbud til unge med ulike utfordringer. Helse er et sammensatt fenomen, psykiske sider og kroppslige forhold er sammenvevd, skolehelsetjenesten skal ivareta helheten. Formålet med denne studien var å bidra til å belyse hvordan profesjonsutøvere i skolehelsetjenesten forstår og framstår i møte med ungdom de kommer i kontakt med. Hensikten var å få et innblikk i tenkning, erfaringer og handlinger, sett fra fagpersonenes ståsted og ut ifra en kroppslig synsvinkel. Teoretiske perspektiver: Prosjektleder er psykomotorisk fysioterapeut, og har sin forankring i NPMF sitt teorigrunnlag. Perspektiver fra dualisme, kroppsfenomenologi, nyere biologisk forskning, ungdomstiden som en viktig fase i identitetsdannelsen, sosiale og kulturelle rammer i det senmoderne, samt Lipskys teorier om «bakkebyråkratiet» benyttes i drøftingen av materialet. Metode: Det er benyttet et kvalitativt design, inspirert av fenomenologisk og hermeneutisk vitenskapssyn. Datamaterialet er innhentet via to fokusgruppe-diskusjoner med utgangspunkt i en temaliste. Informantene er profesjonsutøvere i skolehelsetjenesten. Det deltok fysioterapeut, psykomotorisk fysioterapeut, lege, psykolog, miljøterapeut og helsesøstre, totalt 12 fagpersoner. Gruppene ble satt sammen av deltagere fra samme tjenestested. Analysen tok utgangspunkt i kvalitativ innholdsanalyse. Resultater: Det ble identifisert tre hovedkategorier fra det samlede datamaterialet fra de to fokusgruppediskusjonene: «Livet leves i og gjennom kroppen», «Samspill», «Å møtes innenfor rammene». Oppsummering: Informantene i denne studien viser en sensitivitet for kroppen og dens betydning i arbeidet med elevene. Kropp er tema i mange sammenhenger og på ulike nivåer i møtene med elevene, men ordene med dialog og kunnskapsformidling har forrang i tiltakene for å legge til rette for de unges mestring av egen helse. Samtidig ser profesjonsutøverne et behov for å arbeide med tilnærminger som involverer kroppen i større grad. Background: Youth health is currently being debated at length in media and attracts interest from the political sphere as well. Research shows that there might be good reasons for this. The school health service has been stepped up and is supposed to act as a lowthreshold service to youth with different challenges. Health is a phenomenon with multiple facets – physical as well as psycological aspects need to be taken into consideration – while the school health services are ment to cater it all. The intention with this study has been to shed light on how professionel working in the school health services understand and interact with the youth they encounter. The aim has been to gain insight into the thoughts, experiences and actions as they are seen by the professionals themselves and through a bodily perspective. Theoretical perspectives: The project leader is a psycomotor physical therapist and has her theoretical foundation in the NPMF. In addition perspectives including dualism, the phenomenology of the body, recent developements in biology, the understanding of adolescence as important in the shaping of identities, the soscial and cultural context of late modernity as well as Lipskys theories of «street-level-bureaucracy» are all taken into account througout this study. Methodology: A qualitative method, inspired by phenomenology and hermeneutics, has been employed througout this study. The data has been collected through two focus-group-interviews, which were based on a set of given topics. The participants were all professionals in the school health service. A total of 12 professionals made up this two groups, consisting of physical therapist, psycomotor physical therapist, medical doctor, psychologist, soscial worker and school nurses. The groups were established with participants from each work place. The analysis undertaken was based on qualitative content analysis. Results: Three main categories were identified through the analysis of the content of the interviews. These were «Life is experienced in and through the body», «Interaction» and» «To meet within a framework». Summary: The participants in this study show a high degree of sensitivity towards the body and its significance in their work with the pupils. The body is a topic in many contexts and on several levels in the professional`s interaction with the pupils, but words still have the primary role in the measures taken to improve youth`s mastering their own health. At the same time, the professionals identify a need to further develope approaches that will involve the body to a greater degree.

Master i sykepleie - klinisk forskning og fagutvikling Bakgrunn og hensikt: Norge mangler i dag minst 4550 sykepleiere. Sammenlignet med spesialisthelsetjenesten, har kommunehelsetjenesten den største utfordringen knyttet til sykepleiermangelen. Studiens hensikt er å bidra med ny kunnskap om sykepleieres turnoverintensjoner. Teoretisk rammeverk: Teorier og forskning om turnover, turnoverintensjon, jobbinvolvering og motivasjon. Metodologi: En deskriptiv sammenlignende studie med et tverrsnittsdesign hvor 297 sykepleiere fra kommune- og spesialisthelsetjenesten er inkludert. Deskriptiv statistisk analyse ble benyttet. Resultater: Sykepleiere i kommunehelsetjenesten er eldre, har flere barn under 18 år og flere har faste stillinger. Jobbinvolvering er den eneste variabelen som assosieres med sykepleiernes intensjon om å bli i sin nåværende jobb uavhengig av om sykepleieren jobber i kommune- eller spesialisthelsetjenesten. Konklusjon: Studiens resultater tyder på at kommunehelsetjenesten har samme utgangspunkt som spesialisthelsetjenesten til å beholde sykepleierne i nåværende jobb. Background and Aim: Norway lack approximately 4550 nurses, and nursing shortage is common in the community health service. This study aims to examine nurses´ turnover intentions. Theoretical framework: Theories and research on turnover, turnover intention, job involvement and motivation. Methodology: A descriptive comparative study with a cross-sectional design including 297 nurses. Results: Nurses in the community health service are older, have younger children and hold more permanent positions. Job involvement is the only variable associated with nurses´ intention to continue in their current position regardless of whether the nurse works in the community- or the specialist health service. Conclusion: The results indicate that the community health service has the same possibilities for retaining nurses in their current position as the specialist health service.

Master i psykisk helsearbeid Bakgrunn og formål: Norsk Psykomotorisk Fysioterapi (NPMF) er en spesialisering innen fysioterapi. Samfunnet stiller nå økende krav til forskningsbasert kunnskap, men det er publisert få studier om NPMF i internasjonale og skandinaviske databaser. NPMF har blitt kritisert for å ha et manglende forskningsbasert kunnskapsgrunnlag. Formålet med oppgaven er å øke kunnskapen omkring psykomotoriske fysioterapeuters forståelser og refleksjoner omkring forskningsbasert kunnskap og hva forskningsbasert kunnskap forstås som. I et samfunnsperspektiv undersøkes dette for å forstå hvordan faget kan møte samfunnets krav til forskningsbasert kunnskap i helseprofesjoner. Teoretisk forankring: Det teoretiske rammeverket for masteroppgaven er forankret i teori om NPMF, teori om ulike former for kunnskap og kunnskapsbasert praksis. Metode: Masteroppgaven er en kvalitativ studie. Datamaterialet er innhentet ved semistrukturerte intervjuer av åtte psykomotoriske fysioterapeuter. Vi har latt oss inspirere av hermeneutisk metode og en trinnvis strukturering av analyseprosessen presentert av Kvale og Brinkmann (2017). Resultater: Resultatene peker på at det er flere og komplekse forhold som synes å ha hatt innvirkning på forskningsproduksjonen i NPMF og at dette har hatt konsekvenser for fagutviklingen. Gjennom analysen av datamaterialet kom vi frem til tre ulike temaer som problematiserer fagets akademiske status og kunnskapssynet i fagtradisjonen: Intern fagutvikling og indre dynamikk og eksterne krav og påvirkning som forklaringer på mengden av forskningsproduksjon i NPMF og Forskning i NPMF, som beskrivelse av kunnskapsstatusen i faget. Konklusjon: Datamaterialet kan ikke generaliseres til å gjelde hva hele fagmiljøet mener om temaet. Det empiriske materialet i denne oppgave synliggjør at det har rådet en kritisk holdning til teoriens betydning i profesjonskvalifisering og -uvikling i NPMF tradisjonslinjer. Kunnskapssynet ser ut til å ha blitt opprettholdt av maktstrukturer i faggruppa og manglende ytre krav til utdanning og dokumentasjon, og kan ha hatt stor betydning for hvilken posisjon både ervervelse og produksjon av forskningsbasert kunnskap har hatt i NPMF. Det vises nå til endringer i kunnskapssynet og at NPMF har behov for forskningsbasert kunnskap for å tydeliggjøre og posisjonere seg i helsevesenet. Praksisnær forskning kan ha potensielle positive konsekvenser for dette. Integrert mastergrad i profesjonskvalifiseringen antas å være nødvendig for å stimulere til videre forskningsproduksjon. Background and purpose: Norwegian Psychomotor Physiotherapy (NPMP) is a physiotherapeutic specialization. There are increasing demands for evidence and research in making decisions about patient care and documentation of practice. However, few studies have been investigating NPMP and NPMP has been criticized for being insufficiently documentet. The purpose of this study is to increase knowledge about psychomotor physiotherapists' understanding and reflections on research and documentation and how research and documentation is understood. In a social perspective, this is investigated to understand how the NPMP can meet the demands for evidence, research and documentation in health professions. Theoretical basis: The theoretical framework in the study is based on theory from NPMP, theory about different understandings of theoretical and practical knowledge and evidence based practice. Method: A qualitative approach was used based on semi-structured interviews with eight psychomotor physiotherapists. The data were analyzed with an inspiration from hermeneutic method and a step by step structuring of the analysis process presented by Kvale and Brinkmann (2017). Results: Three main categories indicate that there are several and complex conditions that seem to have an impact on the production of research in NPMP. Internal professional development and internal dynamics and External requirements and influence – are explanations of the amount of studies that are published, investigating (NPMP). Research, investigating NPMP is a description of the status of production of knowledge in the discipline and the need for research and documentation investigating NPMP. Conclusion: Findings from eight informants are not sufficient to generalize the results to representant what all psychomotor physiotherapists reflects around this subject. Allthougt the findings shows that a critical attitude towards the importance of reading theory and the need for documentation in professional qualification and - development has existed in the NPMP tradition. This may have had a great significance for the amount of studies that has been published. There are now changes in the view of knowledge and it is clear that NPMF needs research and evidence to clarify and position itself in the health service. Research on practice can have potential positive consequences for this. The academic positioning that is gained in NPMP is assumed to be necessary for production of research and documentation of NPMF.

Background The internet is being widely used for seeking health information. However, there is no consensus on the association between health information seeking on the internet and the use of health care services. Objective We examined the association between health information seeking via the internet and physician visits. In addition, we investigated the association between online health information seeking and the decisions to visit and not to visit a physician. Methods We used the cross-sectional electronic health (eHealth) data of 18,197 participants from the seventh survey of the Tromsø Study (Tromsø 7). The participants were aged ≥40 years and living in Tromsø, Norway. We used logistic regression models to examine the association between online health information seeking and physician visits, the decision to visit a physician, and the decision not to visit a physician, with adjustment for the demographic status, socioeconomic status, and health status of the participants. Results The use of Web search engines was associated with a physician visit. However, the association was moderated by age, and the OR decreased as age increased. The ORs for the use of Web search engines were 1.99 (95% CI 1.94-2.02) and 1.07 (95% CI 1.03-1.12) at ages 40 and 80 years, respectively. The decision to visit a physician was associated with the use of Web search engines (OR 2.95, 95% CI 2.03-4.46), video search engines (OR 1.43, 95% CI 1.21-1.70), and health apps (OR 1.26, 95% CI 1.13-1.42). The association between social media use and the decision to visit a physician was moderated by gender. Women who used social media had 1.42 (95% CI 1.31-1.55) times higher odds of deciding to visit a physician, whereas the decision to visit a physician was not different between men who used social media and those who did not use social media. Conversely, the decision not to visit a physician was associated with the use of Web search engines (OR 2.78, 95% CI 1.92-4.18), video search engines (OR 1.27, 95% CI 1.07-1.51), social media (OR 1.28, 95% CI 1.10-1.49), and health apps (OR 1.20, 95% CI 1.07-1.35). Conclusions Health information found on the internet was positively associated with both the decision to visit a physician and the decision not to visit a physician. However, the association of health information seeking with the decision to visit a physician was slightly stronger than the association with the decision not to visit a physician. This could imply that the use of eHealth services is associated with a resultant increase in physician visits. In summary, our findings suggest that the internet serves as a supplement to health care services rather than as a replacement.

Publisher's version. Source at https://doi.org/10.1186/s12873-018-0153-x. Licensed CC BY 4.0. Background: Major incidents affect us globally, and are occurring with increasing frequency. There is still no evidence-based standard regarding the best medical emergency response to major incidents. Currently, reports on major incidents are non-standardised and variable in quality. This pilot study examines the first systematic reports from a consensus-based, freely accessible database, aiming to identify how descriptive analysis of reports submitted to this database can be used to improve the major incident response. Methods: Majorincidentreporting.net is a website collecting reports on major incidents using a standardised template. Data from these reports were analysed to compare the emergency response to each incident. Results: Data from eight reports showed that effective triage by experienced individuals and the use of volunteers for transport were notable successes of the major incident response. Inadequate resources, lack of a common triage system, confusion over command and control and failure of communication were reported failures. The following trends were identified: Fires had the slowest times for several aspects of the response and the only three countries to have a single dialling number for all three emergency services had faster response times. Helicopter Emergency Medical services (HEMS) were used for transport and treatment in rural locations and for triage and treatment in urban locations. In two incidents, a major incident was declared before the arrival of the first Emergency Medical Services (EMS) personnel. Conclusion: This study shows that we can obtain relevant data from major incidents by using systematic reporting. Though the sample size from this pilot study is not large enough to draw any specific conclusions it illustrates the potential for future analyses. Identified lessons could be used to improve the emergency medical response to major incidents.

Objectives: To explore general practitioners ’(GPs’) specific negotiation strategies regarding sick-leave issues with patientssuffering from subjective health complaints. Design: Focus-group study. Setting: Nine focus-group interviews in three citiesin different regions of Norway. Participants: 48 GPs (31 men, 17 women; age 32–65), participating in a course dealing with diagnostic practice and assessment of sickness certifi cates related to patients with subjective health complaints. Results: TheGPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patientswith subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patient’s perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effectsof staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave. Conclusions and implications: GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctorand patients in these complex encounters is needed.

Background: Introducing self-collected health data from patients with diabetes into consultation can be beneficial for both patients and clinicians. Such an initiative can allow patients to be more proactive in their disease management and clinicians to provide more tailored medical services. Optimally, electronic health record systems (EHRs) should be able to receive self-collected health data in a standard representation of medical data such as Fast Healthcare Interoperability Resources (FHIR), from patients systems like mobile health apps and display the data directly to their users—the clinicians. However, although Norwegian EHRs are working on implementing FHIR, no solution or graphical interface is available today to display self-collected health data. Objective: The objective of this study was to design and assess a dashboard for displaying relevant self-collected health data from patients with diabetes to clinicians. Methods: The design relied on an iterative participatory process involving workshops with patients, clinicians, and researchers to define which information should be available and how it should be displayed. The assessment is based on a case study, presenting an instance of the dashboard populated with data collected from one patient with diabetes type 1 (in-house researcher) face-to-face by 14 clinicians. We performed a qualitative analysis based on usability, functionality, and expectation by using responses to questionnaires that were distributed to the 14 clinicians at the end of the workshops and collected before the participants left. The qualitative assessment was guided by the Standards for Reporting Qualitative Research. Results: We created a dashboard permitting clinicians to assess the reliability of self-collected health data, list all collected data including medical calculations, and highlight medical situations that need to be investigated to improve the situation of the patients. The dashboard uses a combination of tables, graphs, and other visual representations to display the relevant information. Clinicians think that this type of solution will be useful during consultations every day, especially for patients living in remote areas or those who are technologically interested. Conclusions: Displaying self-collected health data during consultations is not enough for clinicians; the data reliability has to be assured and the relevant information needs to be extracted and displayed along with the data to ease the introduction during a medical encounter. The prestudy assessment showed that the system provides relevant information to meet clinicians’ need and that clinicians were eager to start using it during consultations. The system has been under testing in a medical trial since November 2018, and the first results of its assessment in a real-life situation are expected in the beginning of next year (2020). © Alain Giordanengo, Eirik Årsand, Ashenafi Zebene Woldaregay, Meghan Bradway, Astrid Grottland, Gunnar Hartvigsen, Conceição Granja, Torbjørn Torsvik, Anne Helen Hansen. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 09.07.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/)

Purpose The aim of this study was to describe a number of electronic healthcare databases in Europe in terms of the population covered, the source of the data captured and the availability of data on key variables required for evaluating medicine use and medicine safety during pregnancy. Methods A sample of electronic healthcare databases that captured pregnancies and prescription data was selected on the basis of contacts within the EUROCAT network. For each participating database, a database inventory was completed. Results Eight databases were included, and the total population covered was 25 million. All databases recorded live births, seven captured stillbirths and five had full data available on spontaneous pregnancy losses and induced terminations. In six databases, data were usually available to determine the date of the woman's last menstrual period, whereas in the remainder, algorithms were needed to establish a best estimate for at least some pregnancies. In seven databases, it was possible to use data recorded in the databases to identify pregnancies where the offspring had a congenital anomaly. Information on confounding variables was more commonly available in databases capturing data recorded by primary-care practitioners. All databases captured maternal co-prescribing and a measure of socioeconomic status. Conclusion This study suggests that within Europe, electronic healthcare databases may be valuable sources of data for evaluating medicine use and safety during pregnancy. The suitability of a particular database, however, will depend on the research question, the type of medicine to be evaluated, the prevalence of its use and any adverse outcomes of interest. © 2014 The Authors. Pharmacoepidemiology and Drug Safety published by John Wiley & Sons, Ltd. publishedVersion

This paper focuses on one of the first efforts to implement large-scale Electronic Patient Records (EPRs) in Western hospitals conforming to the international openEHR architecture. A key aim with the openEHR architecture is to offer clinical users the possibility to define structured content of the EPR themselves. This is supposed to contribute to interoperability across various health care systems. The paper contributes with empirical insight in the first two years of the process and argues that establishing working systems in this area entails huge socio-technical challenges to make such systems work.

Background Self-treatment of acute exacerbations of COPD with antibiotics and/or oral corticosteroids has emerged as a promising strategy to reduce hospitalization rates, mortality and health costs. However, for reasons little understood, the effect of self-treatment, particularly when not part of comprehensive self-management programs, remains unclear. Therefore, this study aims to get insight into the patients’ perspective on self-treatment of acute exacerbations of COPD, focusing specifically on how patients decide for the right moment to start treatment with antibiotics and/or oral corticosteroids, what they consider important when making this decision and aspects which might interfere with successful implementation. Methods We interviewed 19 patients with chronic obstructive pulmonary disease using qualitative semi-structured interviews, and applied thematic analysis for data analysis. Results Patients were well equipped with experiential knowledge to recognize and promptly respond to worsening COPD symptoms. Worries regarding potential adverse effects of antibiotics and oral corticosteroids played an important role in the decision to start treatment and could result in hesitation to start treatment. Although self-treatment represented a practical and appreciated option for some patients with predictable symptom patterns and treatment effect, all patients favoured assistance from a medical professional when their perceived competence reached its limits. However, a feeling of obligation to succeed with self-treatment or distrust in their doctors or the health care system could keep patients from timely help seeking. Conclusion COPD patients regard self-treatment of exacerbations with antibiotics and/or oral corticosteroids as a valuable alternative. How they engage in self-treatment depends on their concerns regarding the medications’ adverse effects as well as on their understanding of and preferences for self-treatment as a means of health care. Caregivers should address these perspectives in a collaborative approach when offering COPD patients the opportunity for self-treatment of exacerbations. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0582-8) contains supplementary material, which is available to authorized users.

Master i sosialfag Studiens bakgrunn var kritikk av barnevernet fra leger og forskere om at beslutninger som omhandlet mødre i legemiddelassistert rehabilitering (LAR), ble fattet på feilt grunnlag, samt at denne gruppen ble stigmatisert av hjelpeapparatet. Jeg ønsket å få økt kunnskap om hvordan barnevernet arbeider i familier der mor har brukt LAR-medisiner i svangerskapet. Problemstillingen i denne undersøkelsen er: 1. Hva vektlegger barnevernsarbeidere i saker der mor har brukt metadon eller buprenorfin i svangerskapet når de skal fatte beslutninger? og 2. Hvilke utfordringer oppstår i forbindelse med disse beslutningene? Relevant forskning har vært om LAR-medisiner i svangerskap, mødrene og barna i den aktuelle gruppen. Dessuten har forskning om beslutninger i barnevernet vært relevant for problemstillingen. Bakkebyråkratiteori og en modell for beslutningsteori er benyttet som forståelsesramme i undersøkelsen. Dette er en kvalitativ undersøkelse og ble utført ved bruk av semistrukturerte intervjuer. Det ble intervjuet fem barnevernsarbeidere om konkrete saker ved fire barnevernskontorer i Hordaland. I denne undersøkelsen utgjorde lovverk og andre rammebetingelser en stor det av beslutningsgrunnlaget for barnevernsarbeiderne. De samme betingelsene utgjorde en større begrensing i denne konteksten enn det en ser ved andre problemstillinger barnevernet jobber med. Andre profesjoners informasjon om foreldres fungering ble tillagt stor vekt i beslutningene selv om opplysningene var tvetydig og motstridende. Barnevernsarbeiderne hadde mangelfull kunnskap om den aktuelle gruppen. Det ble ikke identifisert tilpassede rutiner for arbeid med LAR-saker. Kompleksiteten i sakene førte til utfordringer med å få tilstrekkelig grunnlag for beslutninger om treffende tiltak. LAR var en risikofaktor som ble vurdert i et helhetlig bilde av omsorgssituasjonen. Oppsummert kan en se ut fra denne undersøkelsen at LAR-sakene var komplisert og en utfordring for barnevernsarbeiderne å håndtere. Lovens begrensinger om at barnevernet ikke kan beslutte tiltak om et ufødt barn, kan utgjøre en risiko for senere beslutninger og tiltak i barnevernet. Kunnskapsmangel om LAR, NAS og atferd hos foreldre skapte utfordringer i det faglige skjønnet. Mangel på innarbeidede prosedyrer for arbeid med barn av mødre i LAR vurderes som en risiko for tilstrekkelelig og tidlig nok tiltak. Det ble ikke indentifisert at motstridende verdier og holdninger hos barnevernsarbeiderne til den aktuelle gruppen, påvirket beslutningene som ble fattet. The background of the study was criticism from doctors and researchers about decisions regarding mothers in opioid maintenance treatment (OMT). They meant that the decisions were made on a wrong basis and that this group were stigmatized by child welfare. I had a wish about getting increased knowledge about how child welfare worked with families where the mother had used OMT-medicines during pregnancy. This paper has the following research question: 1. What does child welfare workers emphasize when they are making decisions in cases where the mother has used methadone or buprenorphine during pregnancy? and 2. What challenges may also occur when making these decisions? Research has been done about OMT-medicines during pregnancy, mothers and the children in the relevant group. Research about decisions within the child welfare has been relevant for this research question. Street-Level bureaucracy theory and a model for decision-making is used as a frame for understanding in the survey. This study is qualitative and were executed by using interviews that were semi-structured. Five child welfare workers has been interviewed about cases from four different child welfare offices in Hordaland. Laws and other framework conditions in this survey made a big part of the foundation in decisions from child welfare workers. The same conditions made for an even bigger limitation in this context than what you see with other issues that child welfare works with. Information from other professionals about the functioning of the parents was given great importance in the decisions even though the information was ambiguous and contradictory. Child welfare workers lacked knowledge about the relevant group in question. Routines for work with OMT-cases were not identified. Challenges came up due to the complexity of the cases. The challenges were about getting a sufficient basis for decisions on effective measures. OMT were a factor of risk that were evaluated as a holistic image of the situation of care. Experience of powerlessness were more prominent than power. In summary, one can see that OMT-cases are complicated and a challenge for the child welfare to handle. Limitations of law regarding that child welfare can not make decisions about measures in the pregnancy can become a risk for decisions and measures in a later stage within child welfare. Lack of knowledge about OMT, NAS and behaviour of the parents made challenges regarding the professional judgement. Missing routines on regular procedures while working with children of mothers within OMT is accessed as a risk for early and enough measures. Contradictory values and opinions were not identified as a cause of wrong decisions from child welfare workers in the relevant group.

Source at http://dx.doi.org/10.1136/bmjqs-2016-006422. Background: Medication errors are frequent and may cause harm to patients and increase healthcare expenses. Aim: To explore whether a new labelling influences time and errors when preparing medications in accordance with medication charts in an experimental setting. Method: We carried out an uncontrolled before and after study with 3 months inbetween experiments. Phase I used original labelling and phase II used new generic labelling. We set up an experimental medicine room, simulating a real-life setting. Twenty-five nurses and ten pharmacy technicians participated in the study. We asked them to prepare medications in accordance with medication charts, place packages on a desk and document the package prepared. We timed the operation. Participants were asked to prepare medications in accordance with as many charts as possible within 30 min. Results: Nurses prepared significantly more medication charts with the generic labelling compared with the original 3.3 versus 2.6 (p=0.009). Mean time per medication chart was significantly lower with the generic labelling 6.9 min/chart versus 8.5 min/chart (p Conclusions: A new labelling of medication packages with prominent placement of the active substance(s) and strength(s) in the front of the medication package may reduce time for nurses when preparing medications, without increasing medication errors.

© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.e. The Creative Commons Public Domain Dedication waiver applies to the data made available in this article, unless otherwise stated. Background: The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality’s market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPMinspired municipal executive leadership. Method: This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Result: Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality’s hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. Conclusion: The priorities of municipal senior management and the focus of the municipality’s care service need clarification in the light of this reform. The voices of those at the frontlines of the caring services need to be heard as the restructuring of the caring services may have implications both for funding allocation and for the quality of patient care.

Background The CONSORT statement is intended to improve reporting of randomised controlled trials and focuses on minimising the risk of bias (internal validity). The applicability of a trial’s results (generalisability or external validity) is also important, particularly for pragmatic trials. A pragmatic trial (a term first used in 1967 by Schwartz and Lellouch) can be broadly defined as a randomised controlled trial whose purpose is to inform decisions about practice. This extension of the CONSORT statement is intended to improve the reporting of such trials and focuses on applicability. Methods At two, two-day meetings held in Toronto in 2005 and 2008, we reviewed the CONSORT statement and its extensions, the literature on pragmatic trials and applicability, and our experiences in conducting pragmatic trials. Recommendations We recommend extending eight CONSORT checklist items for reporting of pragmatic trials: the background, participants, interventions, outcomes, sample size, blinding, participant flow, and generalisability of the findings. These extensions are presented, along with illustrative examples of reporting, and an explanation of each extension. Adherence to these reporting criteria will make it easier for decision makers to judge how applicable the results of randomised controlled trials are to their own conditions. Empirical studies are needed to ascertain the usefulness and comprehensiveness of these CONSORT checklist item extensions. In the meantime we recommend that those who support, conduct, and report pragmatic trials should use this extension of the CONSORT statement to facilitate the use of trial results in decisions about health care., Pragmatic trials are designed to inform decisions about practice, but poor reporting can reduce their usefulness. The CONSORT and Practihc groups describe modifications to the CONSORT guidelines to help readers assess the applicability of the results

Source at http://doi.org/10.2196/medinform.6323 Background: Telemedicine services have been successfully used in areas where there are adequate infrastructures such as reliable power and communication lines. However, despite the increasing number of merchants and seafarers, maritime and Arctic telemedicine have had limited success. This might be linked with various factors such as lack of good infrastructure, lack of trained onboard personnel, lack of Arctic-enhanced telemedicine equipment, extreme weather conditions, remoteness, and other geographical challenges. Objective: The purpose of this review was to assess and analyze the current status of telemedicine services in the context of maritime conditions, extreme weather (ie, Arctic weather), and remote accidents and emergencies. Moreover, the paper aimed to identify successfully implemented telemedicine services in the Arctic region and in maritime settings and remote emergency situations and present state of the art systems for these areas. Finally, we identified the status quo of telemedicine services in the context of search and rescue (SAR) scenarios in these extreme conditions. Methods: A rigorous literature search was conducted between September 7 and October 28, 2015, through various online databases. Peer reviewed journals and articles were considered. Relevant articles were first identified by reviewing the title, keywords, and abstract for a preliminary filter with our selection criteria, and then we reviewed full-text articles that seemed relevant. Information from the selected literature was extracted based on some predefined categories, which were defined based on previous research and further elaborated upon via iterative brainstorming. Results: The initial hits were vetted using the title, abstract, and keywords, and we retrieved a total of 471 papers. After removing duplicates from the list, 422 records remained. Then, we did an independent assessment of the articles and screening based on the inclusion and exclusion criteria, which eliminated another 219 papers, leaving 203 relevant papers. After a full-text assessment, 36 articles were left, which were critically analyzed. The inter-rater agreement was measured using Cohen Kappa test, and disagreements were resolved through discussion. Conclusions: Despite the increasing number of fishermen and other seafarers, Arctic and maritime working conditions are mainly characterized by an absence of access to health care facilities. The condition is further aggravated for fishermen and seafarers who are working in the Arctic regions. In spite of the existing barriers and challenges, some telemedicine services have recently been successfully delivered in these areas. These services include teleconsultation (9/37, 24%), teleradiology (8/37, 22%), teledermatology and tele-education (3/37, 8%), telemonitoring and telecardiology (telesonography) (1/37, 3%), and others (10/37, 27%). However, the use of telemedicine in relation to search and rescue (SAR) services is not yet fully exploited. Therefore, we foresee that these implemented and evaluated telemedicine services will serve as underlying models for the successful implementation of future search and rescue (SAR) services.

Source at https://doi.org/10.1080/22423982.2019.1612703. Background - Citizens of Norway have free and equal access to healthcare. Nurses are expected to be culturally sensitive and have cultural knowledge in encounters with patients. Culturally safe care is considered both a process and an outcome, evaluated by whether the patients feel safe, empowered and cared for, or not. All patients request equal access to quality care in Norway, also Sami patients. Objectives - The aim of the study is to identify whether Sami patients and relatives feel culturally safe in encounters with healthcare, and if not, what are the main concerns. Methods - This qualitative study used semi-structured interviews in the North Sami language, with 11 North Sami participants.The transcribed data were analysed through a lens of cultural safety by content analysis. Findings - Data analysis explicated themes including: use of Sami language, Sami identity and cultural practices, connections to positive health outcomes to enhance cultural safe care and well-being for North-Sami people encountering the Norwegian health-care system. Conclusion - Culturally safe practices at the institutional, group and individual levels are essential to the well-being of Sami people. An engagement in culturally safe practices will facilitate (or) fulfil political and jurisdictional promises made to the Sami people, consequently improving positive impact of healthcare.

The following article, Granja, C., Janssen, W. & Johansen, M.A. (2018). Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. Journal of Medical Internet Research, 20(5), can be accessed at https://doi.org/10.2196/10235. Background: eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. Objective: Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. Methods: We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. Results: Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). Conclusions: The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

Global health is a concept which in recent years has evoked a lot of interest from both academics, politicians, celebrities, and the media. The term “global health” implies a globally shared responsibility to provide health as a public good through an expansive number of initiatives. This emerging era of consciousness about our international interdependence, regardless of a problem’s geographic location or type of disease, may be a good moment for exploring the strengths and weaknesses of an international law approach to global health challenges: a global health convention.The most prominent global health initiatives are the Millennium Development Goals (MDGs), the 2005 Paris Declaration Process on Aid Effectiveness on the need for alignment and coordination (PDP), and the 2008 Accra High Level Forum on Aid Effectiveness (AHLF). These instruments have yet to prove their value, and the funds annually disbursed, approximately $25 billion in 2009, could have better effect if the negotiated principles from the PDP and the AHLF were followed.

Background. GPs and patients are frequently asked to evaluate mental health care, but studies including evaluations from both groups are rare. Objective. To assess the association between GPs' and patients' assessment of mental health outpatient clinic in Norway and identify important health care predictors for patient and GP satisfaction with the clinics. Methods. Two cross-sectional national surveys were carried out: survey of GPs in 2006 and patients in 2007 evaluating outpatient clinics at 69 community mental health centres in Norway. A total of 2009 GPs and 9001 outpatients assessed the clinics by means of a postal questionnaire. Main outcome measures were correlations between GP and patient ratings of the outpatient clinics at the clinic level and health care predictors for patient satisfaction and GP satisfaction with the clinics. Results. Clinic scores for GPs' and patients' assessment of waiting time were moderate to highly correlated (0.65), while clinic scores for GP and patient satisfaction had a lower but significant positive association (0.37). Significant positive correlations between clinic scores for GP and patients ratings were found for 38 of the 48 associations tested. The most important predictors for patient satisfaction with the clinics were interaction with the clinician (beta: 0.23) and being met with politeness and respect at the clinic (beta: 0.19), while the most important predictors for GP satisfaction with the clinics were perceived competence (beta: 0.25), rejection of referrals (beta: −0.17) and waiting time for patients (beta: −0.16). Conclusions. A consistent positive association between GP and patient ratings at the clinic level was identified. Mental health services aiming at improving GP and patient satisfaction should be sensitive to the fact that the two groups prioritize different health care factors.

Title. Service quality in hospital wards with different nursing organization: nurses’ ratings. Aim. This paper is a report of a study to assess: (1) the relations between nursing organization models in hospital wards and nurses’ perception of the quality of patient care and dimensions of the practice environment, and (2) if these relations were modified by variations in local conditions at the ward level. Background. Previous literature is inconclusive concerning what model of nursing organization maximizes the quality of nursing services. Method. A cross-sectional survey was carried out in a representative sample of Norwegian hospital wards in 2005. Intra-ward organization models were classified as: (1) Team leader (n = 30), characterized by extensive responsibilities for team leaders, (2) Primary nurse (n = 18), with extensive responsibilities for named nurses, and (3) Hybrid (n = 37), (1) and (2) combined. We prepared multilevel regression models using scales describing quality of patient care, learning climate, job satisfaction, and relationships with physicians as dependent variables. As independent variables, we used variables representing local ward conditions. Results. Eighty-seven wards and 1137 nurses (55% response rate) provided complete data. The ward level proportion of variance ranged from 0·10 (job satisfaction) to 0·22 (relationships with physicians). The univariate effect of organization models on quality ratings was not statistically significant. Introducing local ward conditions led to a statistically significant effect of primary nurse organization on relationships with physicians, and to a substantial proportional reduction in ward level variance, ranging from 32% (quality of patient care) to 24% (learning climate). Conclusion. Caution is needed about using service quality arguments when considering the possible benefits and drawbacks of different organizational models.

This is the second in a Series of eight papers about Alma-Ata Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

Master i sykepleie - klinisk forskning og fagutvikling Bakgrunn: Skolehelsetjenesten betegnes som den viktigste helsetjenesten rettet mot barn og unge, men studier av sammenheng mellom ungdoms helse og bruk av skolehelsetjenesten er mangelfull. Hensikt: Studiens hensikt var å kartlegge sammenheng mellom jenter og gutters egenrapporterte fysiske, psykiske og sosiale helse, og økt bruk av skolehelsetjenesten. Design: Studien er en tverrsnittsundersøkelse, og datagrunnlaget er fra Ung i Oslo 2015 hvor 12449 ungdommer fra offentlige og private ungdomsskoler i Oslo besvarte spørreskjema vinteren 2015. Resultat: Funnene viser at 49 % av jentene og 40 % av guttene oppgir å ha brukt skolehelsetjenesten i løpet av de siste 12 månedene. En av ti ungdommer oppgir å ha brukt skolehelsetjenesten tre ganger eller mer. Det å være jente, samt egenrapporterte utfordringer knyttet til fysisk, psykisk og sosial helse, øker oddsen for økt bruk av skolehelsetjenesten. Depressive plager og mobbing er faktorer som i særlig grad gir økt odds for økt bruk av skolehelsetjenesten for både jenter og gutter. Resultatene viser en tendens til at fysiske plager er viktigere for gutters økte bruk enn jenters, og konflikt i hjemmet er viktigere for jenters økte bruk enn for gutters. Konklusjon: Funnene understreker skolehelsetjenestens viktighet for ungdommer som opplever utfordringer knyttet til fysiske, psykiske og sosiale faktorer. Resultatene understreker også viktigheten av at helsesøster har kompetanse på å møte ungdom med disse utfordringene, og behovet for evaluerte tiltak for intervensjon. Background: The school health service is considered the most important health service targeting children and adolescents. However, studies examining the relationship between adolescent health and their use of the school health service are lacking. Purpose: The purpose of this study was to examine the association between girls’ and boys´ self-reported health related to physical, mental and social factors in relation to increased use of the school health service. Design: This study is a cross-sectional study, and the source data are taken from the “Young in Oslo study” where 12449 adolescents from public and private secondary schools answered a questionnaire during the winter of 2015. Results: The findings show that 49 % of the girls and 40 % of the boys report having used the school health service during the last 12 months, and 10 % report having used it three times or more. Female gender and self-reported challenges related to physical, mental and social health increase the odds of more frequent use of the school health service. Depressive symptoms and being bullied are factors that particularly increase the odds for more frequent use of the school health service both for girls and for boys. The results show a trend towards physical complaints being more important for the boys’ increased use than for the girls, while conflicts at home seem to be a more important factor for girls than boys. Conclusion: The findings emphasize the important role of the school health service for adolescents who experience challenges related to physical, mental and social factors. The results also underline the importance of school nurses having sufficient qualifications to meet the adolescents struggling with these challenges and the need for evaluated measures for intervention.

Master i intensivsykepleie Bakgrunn Studien er gjennomført i forbindelse med masterprogram i intensivsykepleie ved Høgskolen i Oslo og Akershus. Studien tar for seg tidligere intensivpasienters erfaringer første året etter utskrivelse. Det rettes særlig fokus mot sykepleieledet dagbok og oppfølgingssamtale til intensivpasienter. Problemstillingen lyder følgende: ”Hvordan har intensivpasienter erfart det første året etter utskrivelse fra intensivavdelingen?” – En studie med særlig fokus på dagboken- og oppfølgingssamtalens betydning. Metode Undersøkelsen har utelukkende anvendt en kvalitativ metode. Det er utført fem kvalitative forskningsintervju med tidligere intensivpasienter. Resultat Erfaringer fra intensivoppholdet påvirker livet etterpå. Intensiverfaringene ett år etter intensivoppholdet, preget informantene både emosjonelt og fysisk. Dagboken hadde en betydning. Den hjalp informantene og huske samt plassere minnene fra intensivoppholdet . Oppfølgingssamtalen ble positivt mottatt, men studiens funn var noe mer vag på oppfølgingssamtalens på betydning. Konklusjon Å komme hjem fra intensivavdelingen byr på utfordringer. I denne studien var de fysiske utfordringene mer fremtredende enn de psykiske. De psykiske problemene kunne muligens synes mindre enn beskrevet i eksisterende forskning. Særlig dagboken hadde en funksjon i form av å gjenskape og plassere minner. I tillegg til at dagboken og oppfølgingssamtalen var viktige informasjonskilder, spilte familien en essensiell rolle som kilde til informasjon. Det er interessant å spørre seg hvordan pasienter som mangler en eller flere av disse kildene til informasjon i etterkant opplever det første året etter intensivoppholdet. Denne studien underbygger eksisterende forskning på dagbokens betydning, og viser et behov for videre forskning både på dagboken og oppfølgingssamtalens betydning. Background The study has been conducted as part of the master program in intensive care nursing at Høgskolen in Oslo and Akershus. The study addresses former intensive care patients’ experiences the first year after returning home. Intensive care diaries and follow-up-conversations will be in focus. The study asked the following question: “How does former intensive care patients experiences the first year after being discharged from the intensive care unit?” - A study with particular focus on the significance of intensive care diaries and follow-up-conversations. Method It has been used a qualitative method. Five former intensive care patients have been interviewed. Results Experiences from the intensive care unit affected the informants when they returned home. One year after, the experiences affected the informants both emotional and physical. The diary was significant in helping the informants recall and place memories. The informants where positive towards the follow-up-conversation, but the results were more vague on the significant of the follow-up-conversation. Conclusion Returning home after experiencing intensive care is difficult. In this study, the physical problems seemed more prominent then the emotional problems. It could possible look as if the emotional problems seemed less significant then described in previous research. Especially the diary had a function in form of recreating and placing memories. In addition to the diary and the follow-up-conversation, the family was an essential source of information. It`s interesting wondering how patients missing one or more of these sources of information experiences the first year after discharge. This study supports previous studies in the significant of the intensive care diary`s function. It also support the need for more research on the meaning of both the diary and the follow up-conversation

Master i barnesykepleie Bakgrunn: Erfaring og forskning viser at flere barn med livstruende eller livsbegrensende sykdom og familier ønsker å la barnet få avslutte livet i hjemmet. Kandidatene ser derfor behov for en fagprosedyre som kan sikre at barnesykepleieren tilrettelegger for at familien og det døende barnet kan få være hjemme i livets siste fase. Fagprosedyren omhandler barnesykepleierens indirekte pasientrettede funksjon, for å kvalitetssikre den direkte pasientrettede funksjonen. Hensikt: Hensikten med eksamensarbeidet er å utarbeide forslag til en kunnskapsbasert fagprosedyre for barnesykepleierens funksjon og ansvar vedrørende organisering av barnepalliasjon ved ønske om hjemmedød. Målet er at barn får palliativ behandling og omsorg i eget hjem, når det er ønsket av barnet selv og barnets familie. Fagprosedyren er kunnskapsbasert, det vil si at den bygger på systematisk innhentet forsknings kunnskap, erfaringskunnskap og pasientkunnskap. Problemstilling: Forslag til fagprosedyre for barnesykepleierens funksjon og ansvar vedrørende organisering av barnepalliasjon ved ønske om hjemmedød. Metode: Kandidatene har valgt å benytte Helsedirektoratets Veileder for utvikling av kunnskapsbaserte retningslinjer som mal for utvikling av fagprosedyren. Eksamensarbeidet er strukturert etter Kunnskapssenterets modell for kvalitetsforbedring. Kunnskapssøket er gjort i anerkjente databaser ved hjelp av verktøyet PICO. Funnene er kritisk vurdert etter sjekklister for evaluering av forskningsartikler fra Kunnskapssenteret. Funnene er rangert etter S-pyramiden. Evaluering av fagprosedyren er gjort med verktøyet AGREE 11. Resultat: Resultatet av eksamensarbeidet er forslag til en kunnskapsbasert fagprosedyre for barnesykepleierens funksjon og ansvar vedrørende organisering av barnepalliasjon. Background: Experience and research show that more children with life- threatening or life- limiting disease and families want to let the child end life at home. The Candidates therefore see the need for a clinical procedure to ensure that the paediatric nurse facilitates so that the family and the dying child can be at home in life´s final phase. The clinical procedure concerns the paediatric nurse´s indirect patient oriented function to assure the quality of direct patient oriented function. Purpose: The purpose of this master thesis is to prepare a proposal for an evidence - based clinical procedure concerning the paediatric nurse´s role and responsibility to organize paediatric palliative care when home death is desired. The aim is to give children palliative treatment and care in their own home, when this is the wish of the child itself and the child´s family. The clinical procedure is evidence based, that is to say, it is based on systematic research obtained knowledge, experiential knowledge and patient knowledge. Issue: Proposed evidence-based clinical procedure concerning the paediatric nurse´s role and responsibility to organize paediatric palliative care when home death is desired. Method: The candidates have chosen to use the Directorate of Health´s Guidelines for the development of evidence-based Guidelines as a template for the development of the clinical procedure. The master thesis is structured by The Knowledge Center´s model of quality improvement. The search for knowledge is done in reputable databases using the tool PICO. The findings are critically assessed by checklists for evaluating research papers from The Knowledge Center. The findings are ranked according to the S-pyramid. Evaluation of the clinical procedure is done with the tool AGREE 11. Result: The result of the master thesis is a Proposed evidence-based clinical Procedure concerning the paediatric nurse´s role and responsibility to organize paediatric palliative care. Keywords: Paediatric palliative care, organize, home death, paediatric nurse, clinical procedure

Master i psykisk helsearbeid Hensikt: Formålet med denne studien har vært å utvikle kunnskap om mannlige innsattes opplevelser av muligheten til å kunne medvirke i sin rehabilitering. Dette kan bidra til bedre forståelse og økt innsikt i hva innsatte er i behov av og trenger i forbindelse med tilbakeføringen til samfunnet. En slik forståelse kan sette ansatte i kriminalomsorgen i bedre stand til å tilrettelegge for innsatte i forbindelse med tilbakeføringen til samfunnet. Teoretisk forankring: I denne studien er det lagt vekt på et salutogenetisk perspektiv i tolkningen av resultatene. Funnene ble også drøftet i lys av bakgrunnskunnskap om empowerment, brukermedvirkning og rehabilitering i fengsel. Metode: Seks innsatte fra ett fengsel ble intervjuet ved hjelp av et semistrukturert intervju, og bedt om å beskrive hvordan de opplevde muligheten for å medvirke i sin rehabilitering. Intervjuene ble transkribert og analysert fenomenologisk, ved hjelp av analysemetoden systematisk tekstkondensering. Resultater: Tre hovedkategorier ble identifisert; Soning som hemmende for å være aktør i eget liv, å bli anerkjent og mulighet til mestring. Konklusjon: Funn fra studien viser at mulighetene for innsatte til å medvirke i sin rehabilitering begrenses ut i fra bestemmelsene i straffegjennomføringsloven. Opplevelsen av straffen og frihetsberøvelsen hadde også innvirkning på muligheten til å medvirke. Informantene erfarte at kontaktbetjenten hadde begrenset makt til å påvirke i saker som gjaldt innsatte. De erfarte at det var juristene i fengselet som hadde og utøvde makt. Avstanden mellom informantene og juristene førte til at informantene ikke visste om de fikk progresjon i soningen, og mulighet til en gradvis tilbakeføring til samfunnet. Dette i sin tur førte til at informantene ikke opplevde seg sett eller hørt. Støtte og hjelp av kontaktbetjenten, familie og venner ble fremhevet som en ressurs for informantene og av betydning for tilbakeføringen til samfunnet. Bistand til praktiske ting, psykisk støtte og det å ha noen ute som ventet på dem ble fremhevet. Informantene erfarte at helseavdelingen og sosialkonsulentene var tilgjengelige, og så hva de var i behov av. Dette førte til at informantene i større grad ble involvert i sine egne planer. Informantene erfarte også at det var mulig å få noe positivt ut av soningsforholdet, men fremhevet at de selv måtte jobbe hardt og engasjere seg for å få til en endringsprosess. Informantene fremhevet at det de var sysselsatt med i fengselet ga dem muligheter når de skulle tilbakeføres til samfunnet. Begrensninger som følge av frihetsberøvelsen ga også informantene muligheter til å starte på en endringsprosess.

Recognition of the need for systematically developed clinical practice guidelines (CPGs) has increased dramatically over the past 20 years. CPGs have focused primarily on the effectiveness of interventions, explicitly or implicitly addressing the following question: Will adherence to a recommendation do more good than harm? At times they have also focused on the cost-effectiveness of interventions: Are the net benefits worth the costs? They rarely have focused on equity: Are the recommendations fair? The Knowledge Plus Project of the International Clinical Epidemiology Network attempts to improve the process of CPG development by formulating strategies to consider not just technical issues (effectiveness, and efficiency) but sociopolitical dimensions as well (equity and local appropriateness). This article discusses a proposed lens for users to evaluate how well CPGs address issues of equity.

“If I get together with someone who is my age and has experienced the same, we start more and more to talk about it. I'll tell you something funny, growing up we did not talk about the War. But then we were older and so we meet... So one of the ladies said: "Do you remember the big bombing?” Do you remember the big bombing? And we all remember who were involved in it, where we were, and how scary it was. We had never talked about it before. I am hundred per cent sure that we never talked about it before, even though we went to school together. And suddenly we all start talking about it. This was actually our nine eleven!”1

This is the author's post-print version. The final publication is available at http://http://dx.doi.org/10.1177/1471301215584702 Scandinavian health policy supports prolonged home-based care for people with dementia. User participation is expected to reduce family burden. The aim of this study was to explore how formal and family caregivers experience collaboration while providing home-based dementia care, with a focus on user participation. Seventeen qualitative in-depth interviews were conducted among formal and family caregivers in rural municipalities. The theme identified during this process was ‘negotiating participation in decisions’. This theme was analysed using positioning theory. Concepts such as user participation are ambiguous, and caregivers negotiate positions during decision-making processes. Such negotiations are caused by the problematic relationships among patients’ legal consent, undefined spokespersons and pragmatic care practices. These constant negotiations enable or obstruct collaboration in several situations. User participation as a concept might contribute to conflicts during collaborations. Dialogues about user participation that focus on consent and spokespersons could reduce the burden created by negotiations in practice.

Source at: http://doi.org/10.4220/Sykepleienf.2017.64242 Bakgrunn: Helsesøsteryrket er i stadig utvikling og må tilpasses nye satsingsområder, nye faglige krav, nye oppgaver og mer ansvar. Hensikt: Hensikten med studien var å kartlegge 1) hvilke kunnskapskilder helsesøstre benytter i praksis, 2) hvilke ferdigheter helsesøstre har i å nne og vurdere forskning og nasjonale retningslinjer, 3) hvilke hindre helsesøstre møter når de skal finne og vurdere forskning og nasjonale retningslinjer, og 4) hva som påvirker ferdighetene i å vurdere forskningsbasert kunnskap. Metode: Studien er en tverrsnittsstudie der 708 helsesøstre besvarte et nettbasert spørreskjema. Vi benyttet statistiske analyser for å undersøke bruken av kunnskapskilder og faktorer som kan påvirke ferdigheter i å vurdere forskningsbasert kunnskap. Resultater: Nasjonale retningslinjer, kunnskap fra helsesøsterutdanningen, personlig erfaring og kommunens retningslinjer var de mest brukte kunnskapskildene. De største hindringene de oppga, var for lite tid til å finne forskning og utfordringer med å forstå engelskspråklige artikler. Helsesøstrene vurderte at de i stor grad var kompetente til å finne og vurdere nasjonale retningslinjer, men i mindre grad kompetente til å vurdere forskningsbasert kunnskap. Helsesøstre med mastergrad og helsesøstre i fulltidsstilling hadde signikant høyere odds for å vurdere seg selv som kompetente til å vurdere forskning. Konklusjon: Nasjonale retningslinjer er helsesøstrenes mest brukte kunnskapskilde. For å kunne ha en kunnskapsbasert yrkesutøvelse må helsesøstre ha kompetanse til å vurdere anbefalingene i nasjonale retningslinjer sammen med andre kunnskapskilder. Et fremtidig nasjonalt kompetanse- og utviklingssenter for helsestasjons- og skolehelsetjenesten vil kunne spille en viktig rolle for å implementere nasjonale retningslinjer og kvalitetssikre lokale prosedyrer i kommunene.