Three ways of organising general practitioner's medical services in sheltered housing. A qualitative study.

OBJECTIVE: Explore care providers' experiences with the organisation of the medical services for residents in round-the-clock staffed sheltered housing. DESIGN: Qualitative study and thematic analysis of individual interviews after strategic sampling of participants. SETTING: Round-the-clock staffed sheltered housing in seven municipalities, inhabited by various user groups, and GPs in various locations in Norway. SUBJECTS: In-depth interviews with 18 participants: 11 managers or employees in sheltered housing and seven GPs. MAIN OUTCOME MEASURES: Main themes and subthemes reporting participants' experiences of medical provision to sheltered housing residents. RESULTS: Three main models of organizing medical services for round-the-clock staffed sheltered housing were identified: (i) the 'multiple GP' model, where each resident has their own individual GP; (ii) the 'single GP' model, where all residents in the sheltered housing have one common GP; (iii) the 'hybrid' model, where a few dedicated GPs follow up the residents. CONCLUSION: Residents in round-the-clock staffed sheltered housing constitute a varied group that generally has substantial medical assistance needs. Given that many residents lack autonomy to manage their own care needs and make decisions, models with fewer GPs like models ii and iii seem to provide a better medical professional offer. Moving towards such an organising of the medical services for sheltered housing residents could have implications for GPs' workload and competence needs. Future studies are needed to test models and assess implications.

KEY POINTSResidents in round-the-clock staffed sheltered housing are considered 'home residents' and consist of various user groups with extensive and often complex medical care needs.The GP scheme is the most important medical service for home residents.There is an emerging mismatch between the need for help of residents in sheltered housing and the GP scheme, and municipalities seek to remedy this by developing their own ad hoc solutions.There is a need for a more systematic approach to deal with the medical needs of residents in round-the-clock staffed care homes.

Volunteers and Informal Caregivers' Contributions and Collaboration with Formal Caregivers in Norwegian Long-term Care.

The article illuminates and discusses the realism of policy-makers' goals to increase involvement of volunteers and informal caregivers in long-term care services in Norway. Drawing on multiple data sources, the article investigates how commonplace volunteering and informal care are in long-term care, and it explores challenges experienced in collaboration between formal caregivers and volunteers and informal caregivers. The results show that only 4.4 percent of the Norwegian population carry out unpaid, voluntary work in long-term care. Twenty percent regularly provide informal care to someone with special care needs. Knowledge/information gaps and lacking coordination are common collaboration challenges between formal caregivers and volunteers/informal caregivers. The limitations identified in the current collaboration environment should be used actively by both policy makers and the practice field to critically assess goals and strategies for involvement and improving collaboration practices.

Planning future care services: Analyses of investments in Norwegian municipalities.

AIMS: To analyse whether the Norwegian Central Government's goal of subsidizing 12,000 places in nursing homes or sheltered housing using an earmarked grant was reached and to determine towards which group of users the planned investments were targeted. METHODS: Data from the investment plans at municipal level were provided by the Norwegian Housing Bank and linked to variables describing the municipalities' financial situation as well as variables describing the local needs for services provided by Statistics Norway. Using regression analyses we estimated the associations between municipal characteristics and planned investments in total and by type of care place. RESULTS: The Norwegian Central Government reached its goal of giving subsidies to 12,000 new or rebuilt places in nursing homes and sheltered housing. A total of 54% of the subsidies (6878 places) were given to places in nursing homes. About 7500 places were available by the end of the planning period and the rest were under construction. About 50% of the places were planned for user groups aged <67 years and 23% of the places for users aged <25 years. One-third of the places were planned for users with intellectual disabilities. Investments in nursing homes were correlated with the share of the population older than 80 years and investments in sheltered houses were correlated with the share of users with intellectual disabilities. CONCLUSIONS: Earmarked grants to municipalities can be adequate measures to affect local resource allocation and thereby stimulate investments in future care. With the current institutional setup the municipalities adapt investments to local needs.

Intended, Unintended, Unanticipated? Consequences of Social Distancing Measures for Nursing Home Residents During the Covid-19 Pandemic.

During the outbreak of the COVID-19 pandemic, Norwegian health authorities introduced social distancing measures in nursing homes. The aim was to protect vulnerable residents from contracting the potentially deadly infection. Drawing on individual interviews with nursing home managers and physicians, and focus groups with nursing staff, we explore and describe consequences the social distancing measures had on nursing home residents' health and wellbeing. The analysis indicates that most residents became socially deprived, while some became calmer during the nursing home lockdown. Nursing home staff, physicians and managers witnessed that residents' health and functional capacity declined when services to maintain health, such as physiotherapy, were put on hold. In conclusion, we argue that although Norwegian health authorities managed to keep the infection rates low in nursing homes, this came at a high price for the residents however, as the social distancing measures also negatively impacted their health and wellbeing.

Parents and Children Only? Acculturation and the Influence of Extended Family Members among Vietnamese Refugees.

The nuclear family is often the point of departure in much of the existing acculturation research on refugee youth and children of refugees. The influence of other extended family members appears to receive less attention in understanding acculturation processes and intergenerational perspectives. This qualitative study explores the influence of extended family members upon a small sample of Vietnamese refugee parents and their adolescents while they undergo acculturation through their long-term resettlement process in Norway. With repeated interviews over a time span of 3 years, we identified situations and processes in family life in which extended kin become particularly activated and influential. Vietnamese refugee families in Norway keep close contact with extended kin even in the face of geographical distance to kin remaining in Vietnam, or globally dispersed. Aunts, uncles, and cousins are experienced as significant persons in the lives of many adolescents. Additionally, birth order of parents can often influence relationship dynamics among siblings and siblings children. Extended kin surfaced as especially important and influential at critical stages and crisis situations in family life. Extended family, and in particular, parental siblings play important roles in the acculturation experience and family functioning of Vietnamese refugee families in Norway. This has important implications for the study of Vietnamese and other refugee and immigrant families in acculturation research.

Seeking balance between the past and the present: Vietnamese refugee parenting practices and adolescent well-being.

This qualitative study examines the resources that Vietnamese refugee parents use in raising their adolescent youth in exile and how they, and their adolescents, regard their experiences of different parenting styles. The study is based on 55 semi-structured interviews and several focus groups performed with a small sample of Vietnamese refugee parents and their adolescent children. Three main themes from the interviews were identified: the role of the extended family and siblings in bringing up children; language acquisition and cultural continuity and, finally, religion and social support. Our findings suggest extended kin are involved in the raising of adolescent children, providing additional family ties and support. Parents regarded Vietnamese language acquisition by their youth as facilitating both communication with extended kin and cultural transmission. Several parents stressed the importance of religious community to socialising and creating a sense of belonging for their youth. Vietnamese refugee parents seek a balance between Vietnamese values and their close extended family social networks, and the opportunities in Norway to develop autonomy in pursuit of educational and economic goals. Together these parenting practices constituted a mobilization of resources in support of their youth. These findings may have important implications for future research on resiliency and the role of these strategies as protective factors mediating mental health outcomes. They may also have implications for treatment, in terms of the types of resources treatment can access and for prevention strategies that maximize key cultural resources for Vietnamese refugee youth.

Challenging Behaviors as a Relational Phenomenon: Findings From a Qualitative Study in a Nursing Home in Norway.

Challenging behaviors are common in nursing homes. Drawing on rich qualitative data from fieldwork and in-depth interviews with staff in a nursing home in Norway, we will explore (a) how challenging behaviors unfolded, and (b) how such incidents were handled and talked about among staff. Our data is presented firstly through Anna's story as an introduction to discussing: (1) the problem of contrasting approaches to avoid challenging behaviors and (2) the importance of knowing the resident. Christopher's story then works as an introduction to discuss (3) the importance of understanding how to prioritize, (4) the importance of caring with connection and concern, and (5) the importance of sharing success stories among staff. In conclusion we argue that we should develop a more flexible organizational culture and a staffing practice in which care workers are empowered to use their discretion and thus to care for the residents with more connection and sensitivity than is currently the case.

Shared goals, communication and mutual respect in multicultural staff teams: A relational coordination perspective.

AIM: Task interdependence among staff in nursing homes is high, and staff teams are typically composed of employees from different cultural backgrounds with varying levels of skills and qualifications. By applying relational coordination theory as an analytic lens, we investigated how communication and cooperation challenges are experienced and dealt with. DESIGN: This is a qualitative study. METHOD: In-dept interviews with 31 members of staff in two nursing homes and thematic analysis of the material. RESULTS: The study identified challenges in direct communication and collaboration difficulties related to understanding how to use professional discretion in daily care practices in both nursing homes. The management in one of the two nursing homes arranged frequent meetings to share knowledge about the residents, their care status and introduced initiatives to build competence among all members of staff, including substitute and temporary staff. This contributed to ensuring shared goals and mutual respect at the workplace.

Staff perceptions of competence in a multicultural nursing home in Norway.

Nursing homes throughout the Western world are seeing a steady increase in migrant workers. Although migrant staff members' multicultural background may be perceived and used by management as a resource in the workplace, studies indicate that the qualifications and competencies of these workers are often underestimated. Numerous studies have examined and theorized on the challenges related to workplace diversity and the deskilling of migrant workers. However, our knowledge of how competence may be conceptualized in inclusive ways in diverse staff groups remains scarce. This study examines minority and majority staff members' perceptions of competence in a strategically selected multicultural nursing home unit in Norway with 15-20 years of experience in recruiting and including minority staff members to various levels of the organization. We performed a thematic analysis of in-depth interviews with 22 healthcare providers and found that in this nursing home unit, contrary to what has often been found in other organizations, competence was not primarily discussed as a matter of educational level or background, skin complexion or whether staff members spoke the majority language with a foreign accent. Rather, a competent care worker was perceived as a) having good professional knowledge on how to care for nursing home residents (regardless of the worker's educational level), b) either having the ability to speak well or working hard to improve one's skills in the majority language, c) exhibiting 'a genuine interest' in working in a nursing home despite the relatively harsh working conditions, and d) having the ability to prioritize to ensure that all tasks and duties were completed on each shift. Staff members' perceptions of competence were hence interrelated with educational, racial, linguistic and social dimensions, but in unexpected and transgressing ways, paving the way to ethnic equality among staff.

[General practitioners' experiences with refugee patients]. / Fastlegens møte med flyktninger.

BACKGROUND: Refugees are likely to suffer from complex medical conditions due to persecution and exile. The symptoms may persist several years after the individual has fled his or her homeland. Knowledge of refugees' health condition in their receptive countries is insufficient. MATERIAL AND METHOD: Qualitative interviews with 12 general practitioners (GPs) in and around Oslo. A narrative approach was chosen for the analysis. RESULTS: The GPs' consultations with refugee patients seem to be characterised by uncertainty on the relevance of their refugee experience to their health condition. The GPs were reluctant to invite the patient to talk about traumatic experiences connected to their homelands, the escape and the exile. Rather, they express that unfamiliar culture and foreign language act as barriers to good communication between doctor and patient. Specialised health services seem neither to be accessible to the patients nor to be providers of clinical supervision for the GPs. INTERPRETATION: Cultural status seems to cover up experiences related to escape and exile. A lack of specialised health services seems to place the GP as a single actor in the medical service to refugee patients. The interviews revealed a need for instruction material adapted to the GPs' situation.

Predictors of acculturative hassles among Vietnamese refugees in Norway: Results from a long-term longitudinal study.

We investigated acculturative hassles in a community cohort of Vietnamese refugees in Norway (n = 61), exploring cross-sectional data and longitudinal predictors of acculturative hassles using data from their arrival in Norway in 1982 (T1), with follow up in 1985 (T2) and in 2005-2006 (T3). To our knowledge, this is the first longitudinal study of predictors of acculturative hassles in a refugee population. Results indicated that more communication problems and less Norwegian language competence were related to most hassles at T3. Higher psychological distress, lower quality of life, lower self-reported state of health, and less education at T3 were associated with higher levels of hassles at T3. More psychological distress at T2 and less education at arrival (T1) were significant predictors for more acculturative hassles at T3. These data suggest that addressing psychological distress during the early phase in a resettlement country may promote long-term refugee adjustment and, in particular, reduce exposure to acculturative hassles.

Better mental health in children of Vietnamese refugees compared with their Norwegian peers--a matter of cultural difference?

BACKGROUND: There are conflicting results on whether immigrant children are at a heightened risk of mental health problems compared with native youth in the resettlement country. THE OBJECTIVE OF THE STUDY: To compare the mental health of 94 Norwegian-born children from a community cohort of Vietnamese refugees, aged 4 - 18 years, with that of a Norwegian community sample. METHODS: The SDQ was completed by two types of informants; the children's self-reports, and the parents' reports, for comparison with Norwegian data from the Health Profiles for Children and Youth in the Akershus study. RESULTS: The self-perceived mental health of second-generation Vietnamese in Norway was better than that of their Norwegian compatriots, as assessed by the SDQ. In the Norwegian-Vietnamese group, both children and parents reported a higher level of functioning. CONCLUSION: This surprising finding may result from the lower prevalence of mental distress in Norwegian-Vietnamese children compared with their Norwegian peers, or from biased reports and cultural differences in reporting emotional and behavioural problems. These findings may represent the positive results of the children's bi-cultural competencies.