Nurses' professional discretion in the purchaser-provider split in home care in Norway.

AIM: To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway. DESIGN: A qualitative descriptive study. METHODS: Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data. RESULTS: The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes. CONCLUSION: Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion. IMPACT: The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust. IMPLICATIONS: This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.

Exploring home-based care nurses' mindset for nursing practices: a phenomenological study.

BACKGROUND: Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. METHODS: This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. RESULTS: The analysis revealed three main patterns that characterise nursing practices in home care: 'To be vigilant', 'To be an all-rounder', and 'To act with independence'. The content and distinction of these patterns are discussed through a theoretical framework of 'clinical mindlines'. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. CONCLUSION: Nurses' vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses' practical knowledge and the importance of mindlines.

Exploring Participation and Interaction in a Bottom-Up Health Promotion Program for Migrant Women in Norway.

In this article, we examine the participation and interactions of migrant women and experts who attended health parties. Based on data from participation observations and semi-structured interviews from participants of health parties, we examine how health parties may be considered an innovative bottom-up community program that could influence how migrant women focus, learn, and discuss health issues as well as interact with health care. Through a qualitative analysis, the article demonstrates two ways of organizing health parties and different approaches to the health expert role, and how this impacts the social setting and interactions of a health party. In the Norwegian setting, migrant women are considered by health authorities to be the most difficult group to reach due to cultural and language barriers. Health parties may represent an alternative for bridging these barriers and may create a useful context for active participation and learning about health for migrant women.

Supporting children of parents with intellectual disability: A scoping review.

BACKGROUND: Parents with intellectual disability live normal lives and have children, but many of them lose custody of their children. However, little is known about the support, if any, that these children receive. Here, the present authors review the literature on the help and support given to children of parents with intellectual disability. METHOD: A scoping review of peer-reviewed and grey literature was conducted, covering 1997 to November 2017. RESULTS: Thirteen publications were identified. The children benefited from help and support received through informal networks. They also benefited from formal support if it focused on the children's needs and interests. CONCLUSIONS: The review shows that even though support from informal networks might be an influential factor in supporting children, there is a need for more research addressing the formal support these children receive and how they benefit from it.

Making things work-In spite of a pandemic small scale enterprise managers' approach to business changes and health issues.

BACKGROUND: Covid-19 is one of the worst crises in modern working life with a direct negative impact on many enterprises and organizations. The aim of this study is to explore what managers in Small Scale Enterprises (SSEs) changed in their business during the Covid-19 pandemic, particularly addressing health issues. METHODS: A longitudinal qualitative research methodology was used, interviewing 16 managers of SSEs in the Norwegian and Swedish manufacturing and service sector both before (round 1) and during the pandemic (round 2). In this approach, time is designed into the research process, making change a key focus for analysis. RESULTS: The analysis resulted in two main themes, resilience and demanding occupational health and safety conditions, and five sub-themes. Results show how managers in SSEs changed their business during the Covid-19 pandemic and the impact of these changes. Although, the enterprises were heavily affected in the beginning of the pandemic, several managers found new solutions for their businesses to maintain and reach new customers. They applied a socially responsible management which addressed different health issues. CONCLUSION: Crises like the Covid-19 pandemic will have future impact on SSEs making it important to understand how managers in such enterprises address business and health issues. This knowledge may have practical implications for supporting managers in SSEs in how to perform a socially responsible management and maintain occupational health and safety measures. The managerial implications from this research are that they need to be flexible, reorientable and, at the same time, be loyal to the core business. This study shows the importance of doing longitudinal studies about business and health issues among mangers in SSEs.

Correction: The disappointment of financial support measures during the COVID-19 pandemic among small business managers' in Sweden.

[This corrects the article DOI: 10.1007/s43546-022-00347-7.].

Practicing in a person-centred environment - self-help groups in psycho-social rehabilitation.

AIM: The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabilities. In this study, we explore person-centred support in which participants in self-help groups are undergoing rehabilitation to develop their knowledge, skills and confidence necessary to handle life's challenges. METHOD: The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilitation clients aged between 20 and 60 years; eight were men and twenty-six were women. RESULTS: Three main categories emerged as being important self-help processes that were likely to promote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives. CONCLUSION: Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.IMPLICATIONS FOR REHABILITATIONSelf-help groups may support the process of rehabilitation.Participating in self-help groups provides an enabling context for individuals to address challenges and limitations.Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote adjustment, and facilitate the establishment of new skills.Participating in peer led self-help groups can assist with the transfer of learning to new environments, including development of potential work capacity.

Small business managers and Covid-19-The role of a sense of coherence and general resistance resources in coping with stressors.

BACKGROUND: The response of small business managers to an external event such as the pandemic can have a profound effect on the work environment, health and well-being for themselves and their employees. Previous research on small business managers during the pandemic has mainly focused on traditional pathogenic effects, and there is a lack of studies looking at the issue from a salutogenic health promotion perspective. The aim of this study is to explore whether a sense of coherence and general resistance resources were experienced by small business managers in Sweden and Norway during the Covid-19 pandemic. METHODS: A qualitative design was applied through exploratory interviews with 16 managers of small businesses in Sweden and Norway. A content analysis of the interviews was conducted using the sense of coherence concept by Aaron Antonovsky, with the three main components of comprehensibility, meaningfulness and manageability acting as a conceptual framework for the analysis process. RESULTS: Within the three main sense-of-coherence categories, six general resistance resources were identified as being important for the managers to handle uncertainty during the pandemic. These were understanding rules and regulations, social support, optimism, proactivity, problem-solving and flexibility and cooperation. CONCLUSIONS: The small business managers handled the pandemic in a way that worked well in their contexts, and the pandemic generally did not have a negative effect on their businesses or themselves. A salutogenic approach, through which the managers focused on identifying and using resources, was an important factor for managing stressors and adversity during the pandemic. Hence, the concept of salutogenesis may be used as an intervention to foster better health in small businesses, both at a personal and organisational level in order to handle future challenges effectively.

Self-help and self-help groups for people with long-lasting health problems or mental health difficulties in a Nordic context: a review.

AIM: The aim of this review is to provide systematic knowledge of research from Nordic countries about the meaning of self-help and self-help groups when these are used as a concept or method addressing issues related to long-lasting health problems or mental health difficulties. METHODS: Included were studies conducted in the Nordic countries that were published between January 1999 and September 2009. These studies investigated self-help and self-help groups addressing issues related to long-lasting health problems. RESULTS: A total of 83 publications met the inclusion criteria. Four major characteristics of self-help were found to be present in the publications: self-help as an intrapsychological process, self-help as an interpsychological or group process, self-help as a coping, individual learning or empowerment process, and self-help as an alternative or complement to medical treatment. Of the 83 studies, 72 publications used a professional treatment perspective for studying self-help and 11 publications used a perspective derived from alternative or complementary therapies. CONCLUSIONS: The review shows that most of the research on self-help and self-help groups for people with long-lasting health problems or disability is conducted with an interest to improve the professional healthcare system. That is, the health-promotion strategy is mainly considered in the framework of treatment or care settings. This means that self-help in this context does not challenge the dominant biomedical health model.

The role of self-help groups in promoting self-confidence and hope for the future among people on sick leave in Norway: The importance of educational level.

BACKGROUND: Vocational rehabilitation is important for supporting long-term sick-listed employees in returning to work or continuing in working life. OBJECTIVE: The aim of this study was to analyse self-confidence and hope for the future among people on sick leave in Norway who joined a self-help group, with a special focus on the importance of educational level. METHODS: 109 persons who completed a 20-week program at a rehabilitation centre in the middle of Norway during the years 2007-2012 answered questions related to the importance of emotions as either motivating or discouraging forces influencing the individual's return to work. The response rate was 52 percent. RESULTS: Eighty-five percent of participants who joined a self-help group stated that the group helped them to tackle everyday life better than before. Low-educated participants in the self-help group, to a greater extent than high-educated, stated that the self-help group had increased their self-confidence and hope for the future. DISCUSSION AND CONCLUSIONS: Most of those who participated in the self-help group stated that joining a group increased their self-confidence and hope for the future. Motivational factors, such as hope for the future and self-confidence, can be important factors in the rehabilitation process, as they can enhance sick people's motivation to participate in rehabilitation and re-think their future prospects of returning to work.

Factors explaining return to work for long-term sick workers in Norway.

PURPOSE: This study investigates factors that will affect the chances of long-term sick workers returning to work. METHOD: The study is based on a representative sample of persons with mental illnesses and musculoskeletal disorders who received a rehabilitation allowance in Norway in 2002. Their occupational status in 2005 and experiences from the rehabilitation process were charted through their responses to a questionnaire in combination with national register data. Our analytical framework is based on three domains: the medical domain, the domain of authoritative bodies and the production domain (working life), as described by Lindqvist (Att sätta gränser: organisationer och reformer i arbetsrehabiliteringen. Umeå: Boréa; 2000). RESULTS: Our main findings are that earlier work experience, age and other members in household, in addition, to influence over one's own rehabilitation process explains whether workers on long-term sick leave return to work. Furthermore, individual factors such as gender and diagnosis (i.e. musculoskeletal disorder and mental illness) do not explain the probability to return to work. Experience and contact with representatives of the medical, the authoritative bodies and the production domain only explain to a small extent the probability to return to work. It is even interesting to note that regular contact with the social insurance office (SIO) has a negative effect on the probability to return to work. This may indicate that contact with the SIO subjects sick workers to a risk of developing a 'social insurance career' to secure their income. CONCLUSIONS: The findings show that the medical, the authoritative bodies and the production domain might represent different logics that can pull a sick worker in different directions during the rehabilitation process. However, these different logics do not fully explain, which outcome a rehabilitation process takes. It is important to extend the analysis to include how the individuals respond to these logics during the rehabilitation process.

Long-term sick workers experience of professional support for re-integration back to work.

In recent years researchers have tried to identify important factors that can explain re-integration to work for workers on long-term sick leave. The results indicate that multiple factors can explain whether or not people return to work. The aim of the study was to investigate long-term sick workers' experience of professional support for re-integration to work. Participants were drawn from the database of The National Social Insurance Board in Norway. A random sample was selected of persons with mental illness or musculoskeletal disorders (either p- or l-diagnosis/symptoms related to International Classification in Primary Care), who were in receipt of Rehabilitation allowance. The questionnaire was sent to 1 493 persons of whom 740 responded. The most significant finding is that work training/mastering actions were identified by the majority of the rehabilitation benefit recipients as being of slight or moderate use. This highlights the importance of work training/mastering actions being relevant in proportion to the specific situation the individual is presently within. Delays in waiting for treatment attributed to approximately half of the rehabilitation benefit recipient's problems returning to work. This study also highlights that rehabilitation benefit recipients experience loss of co-ordinated measures from those who are supposed to contribute to simplifying their return to work.

Cultural encounters in reflective dialogue about nursing care: a qualitative study.

AIM: This paper is a report of a study to explore how students developed reflective nursing practice through cultural encounters between students from Tanzania and Norway. BACKGROUND: Nursing students need to develop cultural care competence to care for patients in a globalized world. One way to achieve this goal may be through international practice experience. Previous studies have shown that students visiting developing countries matured personally and intellectually more than those who experienced encounters between developed countries. METHOD: The study was exploratory, using qualitative data about nursing practice and cultural encounters experienced by nursing students from Tanzania and Norway. Data were collected through participatory observation, students' logs and focus group interviews in 2006. FINDINGS: The encounter was characterized with an open attitude facilitating a good context for co-learning between the students. Three main themes were identified. The Norwegian students emphasized nurse-patient relationships, individualized care, direct communication and emotional involvement. The Tanzanian nursing students demonstrated a collectivist approach in nursing characterized by nurse-relative-patient relationships, and they emphasized curing attributes with skillful performance of procedures. CONCLUSION: A cultural encounter between students from different culture proved to be a fruitful way of teaching nurses. The opportunity to share thoughts, reflect on value systems and personal practice through dialogue with students from a different culture offer possibility in terms of cultural competence, reflexivity and consciousness of various ways practising nursing. This may contribute to bringing the practice of nursing a step forward in both cultures.

"I now have a life!" Lived experiences of participation in music and theater in a mental health hospital.

Participation in activities perceived to be meaningful is of importance in recovery processes among people with mental illness. This qualitative study explored experiences of participation in music and theater among people with long-term mental illness. Data were collected through in-depth interviews with 11 participants in a music and theater workshop carried out in a Norwegian mental health hospital context. Through a hermeneutical-phenomenological analysis, three central themes emerged: (a) engaging in the moment, (b) reclaiming everyday life, and (c) dreaming of a future. The findings indicate that participation in music and theater provided an opportunity to focus on enjoyable mundane activities and demonstrate how arts have the potential to bring meaning and more specifically small positive moments into participants' lives. Despite seeming to be small in nature, these moments appeared to be able to add pleasure and meaning to the lives of those experiencing them. Consequently, there is a need to raise professionals' awareness of these small positive moments of meaning, the power these experiences carry, and how to facilitate arenas which can provide such moments for people with long-term mental illness.

Transforming identity through participation in music and theatre: exploring narratives of people with mental health problems.

BACKGROUND: There is a growing understanding that mental health problems and prolonged contact with mental healthcare systems can affect people's identities. Working with identity is an important element in mental health recovery. PURPOSE: In this article, we explore the significance of participation in a music and theatre workshop in terms of people`s experiences of identity. DESIGN AND METHODS: This is a qualitative study based on a hermeneutical phenomenological epistemology. Data were collected from in-depth interviews with 11 participants at a music and theater workshop, analysed through a narrative analysis and presented in an ideographical "long" narrative form. The music and theater workshop is not overtly therapeutic although the activity takes place in a Norwegian mental health hospital for adults living with long-term mental health problems. RESULTS: We identified three crosscutting themes: (1) becoming a whole person, (2) being allowed to hold multiple identities and (3) exploring diverse perspectives. CONCLUSION: Findings show that participation in the music and theatre workshop transformed the participants' experiences of identity on two levels: individually and collectively. The participants developed a broader picture of themselves through their creative work with others. When they developed new identities, the narratives of themselves expanded.

Patients' contribution to the development of a web-based plan for integrated care - a participatory design study.

AIMS AND OBJECTIVES: The aim was to explore how a participatory design (PD) approach involving adult patients and parents of children with disabilities could contribute to the development of an electronic "Individual Care Plan" (e-ICP) in Norway. The system was intended to simplify multi-disciplinary cross-sector documentation and collaboration between care professionals and patients in care planning. METHODS: The data in the study comprised semi-structured interviews with patients and parents, as well as field notes. Systematic text condensation (STC) in a stepwise analysis model was performed on the data. RESULTS: Testing through three phases resulted in system improvements and additional functionality according to the participating patients' needs and requests. PD was initially applied, enabling a constructive dialogue between developers and patients. System training and collecting patient expectations was a preliminary task. Patients then brought testing experiences to the system developers, focusing first on access to information and document filing. Later, finalizing testing towards a tool for interaction with care professionals was a main concern. CONCLUSION: Adult patients and parents participating in the study provided various insights and expectations that informed system improvements and resulted in new functionality. System development and testing in healthcare can successfully incorporate patient involvement.