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Objective: The aim of the study was to explore healthcare providers' perceptions of how Norwegian municipal acute units (MAUs) possibly can reduce hospital admittance and improve service integration. Method and material: Qualitative data were drawn from individual interviews with 40 healthcare providers, including general practitioners and staff in Norwegian MAUs, purchasing offices and home-based nursing services. Interview transcripts were analysed using systematic text condensation. Setting: Two MAUs operated by 12 municipalities in eastern Norway. Results: The healthcare providers disagreed on what MAUs are and should be. Frequent discussions between providers about which patients are appropriate for MAUs, as well as time- and resource-consuming procedures for patients' admittance and discharge, have hampered the efficient operation of MAUs. Although, MAUs are operated by municipalities, the providers expressed that the units represent a new level of organisation with new boundaries for collaboration. Having many physicians in part-time positions and lacking physicians during night shifts were also characterised as problematic. Conclusion: Several healthcare providers expressed uncertainty about the appropriateness of maintaining MAUs in Norway's healthcare system, given their questionable capacity to meet Norwegians' healthcare needs. It may appear that the MAUs are designed first to identify appropriate patients instead of identifying and mapping the population's needs and, thereafter, designing optimal healthcare services. As of 2016, Municipal Acute Units (MAUs) are statutory healthcare services in Norway. Exploring patients' and healthcare providers' views on MAUs can improve the services. Healthcare providers disagreed on which patients were suitable for the units The units were perceived as a new (healthcare) level, entailing a new collaboration arena, with more bureaucracy and time expenditure The patients were satisfied with their treatment and care in the MAUs and the units' proximity to their home [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore the structural mechanisms that facilitate or counteract collaboration between general practitioners (GPs) and other providers of municipal healthcare. Good collaboration between these actors is crucial for high-quality care, especially for persons in need of coordinated services. Material and methods: The study is based on semistructured interviews with 12 healthcare providers in four Norwegian municipalities: four GPs, six nurses and two physiotherapists. Results: GPs are key collaborating partners in the healthcare system. Their ability to collaborate is affected by a number of structural conditions. Mostly, this leads to GPs being too little involved in potential collaborative efforts: (i) individual GPs prioritize with whom they want to collaborate among many possible collaborative partners, (ii) inter-municipal constraints hamper GPs in contacting collaboration partners and (iii) GPs fall outside the hospital-municipality collaboration. Conclusions: We argue a common leadership for primary care services is needed. Furthermore, inter-professional work must be a central focus in the planning of primary care services. However, a dedicated staff, sufficient resources, adequate time and proper meeting places are needed to accomplish good collaboration. [ABSTRACT FROM AUTHOR]

Objective:There is limited knowledge about the communication of hope and denial in consultations with patients with life-threatening diseases on a practical level. In this study, we explored a real-life medical consultation between a doctor and a patient with incurable cancer, focusing on conveying hope. Design and methods:We found one consultation especially suited for illustrating how a physician can convey and reinforce hope without attaching it to curative treatment. The consultation was analysed using a method for discourse analysis, where we took as a point of departure that discourse means language in use. Results:The doctor communicated in a recognising manner, expressing respect for the patient as a subject and an authority of his own experiences. The doctor and patient succeeded in creating a good working alliance characterised by warmth and trust. Within this context, there was room for the doctor to challenge the patient’s views and communicate disagreement. Conclusions:The doctor succeeds in conveying and maintaining hope. Within a good working alliance with the patient the doctor can convey hope by balancing between supporting and challenging him. Exploring and grasping the patient’s real concerns is essential for being able to relieve and comfort him and convey hope. [ABSTRACT FROM PUBLISHER]

Setting and objective The growing elderly population and the rising number of people with chronic diseases indicate an increasing need for rehabilitation. Norwegian municipalities are required by law to offer rehabilitation. The aim of this study was to investigate how rehabilitation work is perceived and carried out by first-line service providers compared with the guidelines issued by Norway's health authorities. Design and subjects In this action research project, qualitative data were collected through 24 individual interviews and seven group interviews with employees - service providers and managers - in the home-based service of two boroughs in Oslo, Norway. The data were analysed using a systematic text-condensation method. Results The results show that rehabilitation receives little attention in the boroughs and that patients are seldom rehabilitated at home. There is disagreement among professional staff as to what rehabilitation is and should be. The purchaser-provider organization, high speed of service delivery, and scarcity of resources are reported to hamper rehabilitation work. Conclusion and implications A discrepancy exists between the high level of ambitious goals of Norwegian health authorities and the possibilities that practitioners have to achieve them. This situation results in healthcare staff being squeezed by the increasing expectations and demands of the population and the promises and statutory rights coming from politicians and administrators. For the employees in the municipalities to place rehabilitation on the agenda, it is a requirement that authorities understand the clinical aspect of rehabilitation and provide the municipalities with adequate framework conditions for successful rehabilitation work. [ABSTRACT FROM AUTHOR]

Objective. To explore experiences from a process of change for women with chronic pain. Design, setting, and subjects. A group-based treatment programme was intended to increase the awareness of how attitudes, habits and bodily practices are established, developed, and can be transformed, and thereby probably reduce pain. A single case story from this treatment programme is presented. A semi-structured interview was conducted with all participants about their experiences after completion of the programme. All eight women reported that they had benefited from participation. From these interviews a single case was chosen to represent the study's findings. A narrative analysis was conducted, focusing this patient's story from a phenomenological understanding of the body. Results. The patient's story illuminates how events and experiences can be connected, and how she interprets her contemporary situation in the light of previous experiences. In this way, she alters her understanding and develops a new approach to her situation. Her story demonstrated how symptoms can be understood as the result of stressful habits that the body has developed as a reaction to demands from the surroundings. Conclusions. Reflection on how the body functions may lead to a new realization of how phenomena are interconnected, thus making changes possible. [ABSTRACT FROM AUTHOR]

Objective. Medicine lacks good models for understanding and treating chronic muscle pain. The aim of this study was to explore whether participation in a treatment group for women with chronic muscle pain can help the participants to develop strategies to handle their chronic muscle pain. Methods. The study was carried out as a qualitative research project. Eight women completed a treatment programme consisting of movement training and group discussions. The qualitative data consisted of transcriptions from audio-taped individual interviews. The data material was analysed by systematic text condensation inspired by Giorgi. Results. All the women describe participation in the treatment group as useful. Their experiences could be categorized as follows: To know oneself, to negotiate with oneself and others, to be able to choose, and to be able to act. Conclusion. The participants developed strategies for handling their chronic muscle pain. Both the women's new understanding of their chronic muscle pain and increased confidence in themselves were important. These phenomena can help women in their encounters with their surroundings, for example when consulting doctors. The doctor's awareness of the women's resources and their own mastering strategies may contribute to a new understanding of the disposing, triggering, and maintaining factors, and of the curative and health-promoting forces at work in those with chronic muscle pain. [ABSTRACT FROM AUTHOR]

Objective - Experiences from 11 treatment groups for women with chronic muscular pain showed that recognition had a major impact on the way the participants benefited from treatment. In this article, based on Anne-Lise Løvlie Schibbye's psychological theories, we explore and analyse how recognising interaction can be enacted in practice. Design - Qualitative action research design. Setting - Ongoing treatment groups in Stovner/Oslo for women with chronic muscular pain. Subjects - A total of 31 women took part in 3 treatment groups with movement training and group discussions. Main outcome measures - Video recordings from six group discussions were analysed using Part Process Analysis (PPA), a qualitative research method addressing interaction on a micro-level. Results - PPA demonstrates how recognition is expressed by specific types of behaviour, and how recognition can lead to change and development of the participants in the treatment groups. Conclusions - Schibbye's recognition model, with emphasis on a fundamental respect for the experience perspective of the opposite party, may also help the doctor to understand the patient better, particularly in difficult relationships where there seem to be insurmountable differences between the doctor's and patient's perspectives. [ABSTRACT FROM AUTHOR]

Objective - To develop a group-based treatment programme in primary health care for women with chronic muscle pain, and adjust programme development according to experiences obtained by the participating women and health personnel. The aim of the programme was to help the women develop a tool for handling their chronic state of pain. The article describes and discusses experiences essential for elaboration of the treatment programme. Design - Action research design. Setting - Existing therapy groups in Stovner for women with chronic muscle pain. Subjects - We arranged eight treatment groups, each lasting 12 weeks, and three groups lasting 10 months, with a total of 133 participants. Main outcome measures - Experiences were systematised by means of pragmatic analysis of qualitative data from field notes, tape recordings of focus group interviews, and video recordings of training and discussion groups. Results - While initially the training programme aimed at increasing physical fitness and muscle strength, it gradually developed into activity based on movement with an emphasis on noticing and experiencing. The instruction programme initially aimed at providing information, and developed towards discussion groups with emphasis on mutual understanding and recognition. Conclusions - The training programme is now concentrated on a few, simple exercises and is characterised by awareness of the relationship between breathing and muscle tension. Groups were found to be the main pillar of the programme, characterised by security and a feeling of belonging with room for reflection and development. [ABSTRACT FROM AUTHOR]