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Introduction: The implementation and evaluation of patient participation to obtain high‐quality transitional care for older people is an international priority. Intermediate care (IC) services are regarded as an important part of the patient's pathway from the specialist to the primary care levels, bridging the gap between the hospital and the home. Patients may experience varying capacities and conditions for patient participation. Yet, few tools for evaluating patients' preferences for patient participation within IC services are at hand. Accordingly, further knowledge is needed to understand and scaffold processes for patient participation in IC. Therefore, the aim of this project was to translate, validate and pilot test the Patient Preferences for Patient Participation (the 4Ps) with patients in IC services in Norway. Methods: This project comprised two phases: (1) a careful translation and cultural adaptation process, followed by a content validity trial among 15 patients and staff in Norwegian IC and (2) a cross‐sectional survey of the instrument with 60 patients admitted to IC. Results: The translation between Swedish and Norwegian required no conceptual or contextual adaptations. The subsequent cross‐sectional study, designed as a dialogue between the patients and staff, revealed that only 50% of the participants received a sufficient level of patient participation based on their preferences, mostly indicating that patients were receiving less‐than‐preferred conditions for engaging in their health and healthcare issues. Conclusion: The 4Ps instrument was deemed suitable for measuring patient participation based on patient preferences in the IC context and was feasible for both healthcare professionals and patients to complete in an interview when arriving at and leaving services. This may support person‐centred communication and collaboration, calling for further research on what facilitates patient participation and the implementation of person‐centred services for patients in IC. Patient or Public Contribution: First, the current paper is part of the IPIC study (i.e., the implementation of patient participation in IC). Influenced by a James Lind Alliance process, the study addresses research uncertainties identified by patients, next of kin, staff and researchers in the cocreation process. Second, cognitive interviewing was conducted with 15 representatives of the target population: seven patients receiving IC services, one home‐dwelling previous IC patient (altogether four women and four men, most of them 80 years or older) and seven healthcare staff working in IC services. The interviews determined the relevance, comprehensiveness and clarity of the 4Ps. Finally, 60 patients admitted to IC took part in the cross‐sectional study. [ABSTRACT FROM AUTHOR]

Background: Huntington's disease (HD) is a neurodegenerative disease characterized by a triad of motor, cognitive and psychological symptoms, leading to a gradual breakdown of communication skills. Few studies have investigated how people affected by HD and their professional caregivers, for example, medical doctors, physiotherapists and nurses, experience the patients' gradual loss of speech and language. Aims: To examine communication‐related experiences of patients and professional caregivers. Experiences with speech therapy and the use of augmentative and alternative communication aids (AAC) were also investigated. Methods & Procedures: Seven individuals with HD and seven professional caregivers were interviewed individually, using a semi‐structured interview guide. Transcripts were analysed using a conventional content analysis, and the results presented in three main categories. Outcomes & Results: Most individuals with HD were aware of having communication difficulties, struggling with understanding others as well as being understood. This was confirmed by professional caregivers, who also raised ethical issues encountered when patients struggled with communication. Both groups talked about external factors (such as noise or crowded social settings) as disrupting communication, and shared recommendations on how people in general, and speech and language therapists (SLTs) in particular, could optimize communication. Very few patients had received information about communication aids, and none was using AACs. Professional caregivers underlined the importance of interdisciplinary collaborations, including SLTs, in order to optimize care. Conclusions & Implications: Findings shed a light on everyday communication challenges faced by people with HD and their professional caregivers, and the lack of implementation of communication aids in this group. The dramatic impact of HD on patients' communication skills underscores the need to include SLTs in the follow‐up of this patient group, ideally from the early stages of the disease, while the patient is still capable of voicing his/her own wishes and thoughts. Future research that explores how to optimize communication and implement the use of AACs for individuals with HD is needed. What this paper addsWhat is already known on this subjectAlthough the ability to communicate gradually deteriorates in individuals affected by Huntington's disease (HD), there is little knowledge about how affected individuals experience the loss of speech and language skills. Interdisciplinary care is recognised as essential for this patient group. However, professional caregivers' thoughts and experiences of communicating with their patients have not been fully explored. Recent years have seen a rapid growth of available communication supporting technologies that could potentially be helpful for individuals with HD, but limited attention has been given to this subject.What this paper adds to existing knowledgeWhat do we now know as a result of this study that we did not know before the results highlight that patients are aware of problems with speech and language even in early phases of the disease, and include patients' personal outlook on problems with communication. Professional caregivers raised ethical issues encountered when patients struggled with communication. Both groups described specific strategies that could facilitate communication. There was a significant lack of experience and knowledge about augmentative and alternative communication aids (AACs).What are the potential or actual clinical implications of this work?Clinical implications of this study. The introduction of communication aids in the follow‐up of patients with HD needs to be discussed with the patients in the early phases of the disease, and implemented while the individual still has the capacity to learn and take advantage of alternative communication support. Results underline the importance of including speech and language therapists (SLTs) into multidisciplinary care of patients with HD. SLTs should be available also for professional caregivers who need advice on how to facilitate conversations and social interactions, in order to optimise care of patients with HD. [ABSTRACT FROM AUTHOR]

Background: The scope of this priority‐setting process is communication and collaboration in transitional care for patients with acute stroke. Actively involving persons with stroke and their family caregivers is important both in transitional care and when setting priorities for research. Established priority‐setting methods are time‐consuming and require extensive resources. They are therefore not feasible in small‐scale research. This article describes a pragmatic priority‐setting process to identify a prioritized top 10 list of research needs regarding transitional care for patients with acute stroke. Methods: A pragmatic priority‐setting approach inspired by the James Lind Alliance was developed. It involves establishing a user group, identifying the research needs through an online survey, analysing and checking the research needs against systematic reviews, culminating in an online prioritization of the top 10 list. Results: The process was completed in 7 months. A total of 122 patients, family caregivers, health personnel and caseworkers submitted 484 research needs, and 19 users prioritized the top 10 list. The list includes the categories 'patients and caregivers' needs and health literacy', 'health personnel's common understanding', 'information flow between health personnel and patients and caregivers', 'available interventions and follow‐up of patients and caregivers', 'interaction and collaboration between health personnel and caseworkers across hospital and primary healthcare' and 'disabilities after stroke'. Conclusion: This paper outlines a pragmatic approach to identifying and prioritizing users' research needs that was completed in 7 months. The top 10 list resulting from this priority setting process can guide future research relating to communication and collaboration during the transition from hospital to the community for patients with stroke. Patient and Public Contribution: Members of three stroke organizations participated in the advisory group. They gave feedback on the scope and the process, distributed the surveys and prioritized the top 10 list. Persons with stroke and their caregivers submitted research needs in the survey. [ABSTRACT FROM AUTHOR]

Using transition theory from political science, this paper analyses how the lives of children of Norwegians punished for collaboration with the German occupant were adversely influenced by transitional justice after the return to democracy in 1945. The paper highlights how the complexity and hectic character of such regime changes are associated with a high risk for unintended social outcomes, a risk that has received little attention in the study of transition processes. Findings indicate that in order to avoid harmful consequences for children, careful and long‐term thinking is essential when new democracies select a transitional justice strategy. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore the reasons for unintended placement disruptions in foster care. Based on a semistructured survey, the paper presents the views of 132 Norwegian foster parents who have experienced placement disruption between 2013 and 2015. Foster parents rated several relevant causes of placement disruption: the child's behaviour, the need for care, concern for the well‐being of their biological children, and lack of support from the Child Welfare Service (CWS). Although the child's behaviour was the cause most frequently reported in the quantitative data, CWS‐related factors such as poor collaboration, not being valued and listened to, insufficient support and follow‐up, and a mismatch between the child's needs and the foster carers' capacity were reported most frequently in the qualitative data. Placement disruption appears to be caused by the sum and interaction of several coexisting causes. It may not be the child's behaviour per se but rather the combination of challenging behaviour, concern for one's biological children, and insufficient support from CWS that lead to disruption. Good collaboration with the CWS in the form of respect, recognition, support, and follow‐up appears to be of the utmost importance in reducing the risk of placement disruption. [ABSTRACT FROM AUTHOR]

Services providing support for children and families are often described as fragmented and more concerned with the boundaries of their fields of responsibility than collaborating with other sectors. To meet the need for greater collaboration, there is increased impetus for establishing interdisciplinary services, such as family centres. This paper presents the results of a qualitative study based on in‐depth interviews and participant observation in 3 Norwegian family centres. The findings provide insight into central challenges in developing new practices within the field of family support; we discuss how intersectorial collaboration is constructed in relation to the core objectives of the family centre, professional competence, and service stability. This study demonstrates that both managers and professionals struggle with prioritizing intersectorial work, which mainly focuses on prevention and health promotion, over and above their traditional sectoral responsibilities. It also illustrates the necessity of articulating intersectorial collaboration as an explicit aim and exploring its implications and examining how this contributes to family centres building supportive communities. Building integrated services is not the ultimate goal of this particular form of service provision but rather the first step towards building interconnected support systems for all children in the community. [ABSTRACT FROM AUTHOR]

Collaboration and conversations are important in meeting vulnerable children's needs in the context of Child Welfare Services (CWS). Building on 10 qualitative interviews with parents of children in Norwegian Child Welfare Services, this paper discusses parents' views on collaboration between children and child welfare professionals. The parents stated that a constructive collaborative relationship depends on professionals' attitudes towards the child, their ability to connect with the child and their awareness of how the child's emotions and how the parents influence the child–professional relationship. A collaborative relationship is essential for child welfare professionals to meet the child's needs and to help improve relations between the child and the parents. The parents asked for more collaboration between children and child welfare professionals. The findings call for more discussion of child welfare workers' tasks and competence. [ABSTRACT FROM AUTHOR]

Background: Collaboration with care partners is a political aim in recent white papers in Norway and internationally. Home care services regularly work closely with care partners, but there are many indications that the collaboration does not work satisfactorily. Aim: To explore home care staff and leaders' experiences of collaborating with care partners of older people with mental health problems through a personhood perspective. Methods: The study had a qualitative design and comprised eight health professionals in two focus groups and in‐depth interviews with three leaders in one home care district. The data were analysed using a thematic framework analysis building on previous research on personhood. criteria for reporting qualitative reporting guidelines were used to ensure comprehensive reporting. Results: Four themes were identified in the analysis: 'non‐negotiated relationships', 'contradictory agendas', 'weak paternalism' and 'moral compromise'. Conclusion: There seems to be a lack of facilitation of collaborative relationships through all levels of the home care organisation. The interactions between care partners and home care staff sometimes appear to produce low or negative levels of emotional energy, and situations where the personhood of neither of them is respected occurs. Paying attention to the four modes of being as a framework for understanding personhood creates the foundation for a person‐centred approach that enhances the potential of creating stronger partnership in care relationships. [ABSTRACT FROM AUTHOR]

The aim of this paper is to address facilitators for successful interprofessional collaboration (IPC) between social workers (SWs) and teachers. Individual interviews were carried out with seven SWs employed in municipal child welfare services and six teachers from primary and secondary schools. The informants had at least two years' experience within multidisciplinary teams. The transcripts were analysed using an inductive thematic approach and the NVIVO9 computer software package for qualitative data analysis. Thematic analysis revealed three themes: ‘personal commitments’, ‘creating a positive atmosphere for IPC’ and ‘pulling together towards future goals’. Results are discussed in relation to the Norwegian context concerning IPC in multidisciplinary teams for children at risk. [ABSTRACT FROM AUTHOR]

Abstract: Within the context of Norwegian Child Welfare Services, children's best interests are often promoted through inter‐professional collaboration. Although children have the right and desire to participate, research reveals that professionals do not listen to them. On the basis of qualitative interviews with 10 children about their experiences collaborating with professionals, we have identified ways in which professionals can facilitate children's participation. The findings show that trusting relationships, emotional support, and pedagogical approaches increase children's participation in their interactions with professionals. The results show the importance of including a relational understanding of participation as a theoretical concept in child welfare and an awareness that power and dominance are in play. [ABSTRACT FROM AUTHOR]

Background: Health and social care systems face difficulties in managing multimorbidity, disease burden and complex needs in long‐term conditions such as Parkinson's disease. Objective: This study aimed to develop a European understanding of how health and social care professionals can collaborate with stakeholders from different organizations and sectors to enhance the management of Parkinson's disease in a community setting by identifying the existing gaps in this process and how people with Parkinson's disease and their family carers could benefit from these partnerships. Methods: A mixed‐methods sequential study was conducted in Denmark, Norway, Spain and the United Kingdom. The findings from the qualitative phase are presented. Individual semistructured interviews were analysed using Braun's and Clarke's thematic analysis. A meta‐ethnography approach was used to analyse and synthesize cross‐national findings. Results: A total of 41 healthcare professionals and 39 stakeholders from different disciplines and sectors were interviewed in the four countries. The participants acknowledged a lack of awareness of available resources and poor communication between the different support systems in the management of Parkinson's disease. To promote multiagency collaborations, the participants highlighted the need to organize services along the Parkinson's disease journey, patient involvement and strategic involvement of carers in organizing resources and Parkinson's disease care pathways. According to the participants, the benefits from multiagency partnerships could lead to an enhanced continuity of care and specialized knowledge, mobilization of resources in the community, personalized support and improved access to services. Conclusions: Policymakers are called upon to create formal structures that facilitate multisectoral collaborations to promote an integrated system of care for the management of Parkinson's disease in the community. To address this challenge, we propose five strategies showing how organizations can work together to optimize the use of resources and enhance the management of Parkinson's disease throughout the illness trajectory. Patient or Public Contribution: Patient and Public Involvement groups made up of stakeholders, healthcare professionals, patients with Parkinson's disease and family carers participated in the design of the study, the development of the interview guides and the validation of the findings. [ABSTRACT FROM AUTHOR]

Background: Approximately 30% of patients admitted to an intensive care unit experience respiratory distress. The COVID‐19 pandemic has led to an enormous increase in patients with respiratory symptoms. Nurse competence is essential for ensuring quality treatment and care for these patients; however, research on nursing strategies for patients with respiratory insufficiency is limited. Aim: This study explored nurses' perspectives on and nursing strategies in patients with respiratory insufficiency when admitted to three different intensive care units. Design: The study had an exploratory, descriptive, qualitative design. Methods: Four focus group interviews with a total of 20 nurses, critical care nurses, and critical care nursing students were conducted. Data were analysed using content analysis. Results: Participants' perspectives fell into two main themes: "nurse competence" and "the art of balancing." "Nurse competence" incorporated the sub‐themes "observations and assessments," "to make decisions," and "collaboration." The theme 'the art of balancing' incorporated the sub‐themes "nursing interventions," "patients feeling safe," and "patient participation." Conclusion: This study contributes new knowledge about nurses' perspectives on patients with respiratory insufficiency. Nurse competence was assumed essential to observe, assess, and treat patients with respiratory insufficiency. Nursing strategies included balancing nursing interventions, conducting medical treatment, and taking a whole‐person approach to patients' needs. Relevance to clinical practice: The COVID‐19 pandemic has shown the need for nurse competence in caring for patients with respiratory insufficiency. This study adds to existing literature emphasizing the need for competence in health care services. Caring for patients with respiratory insufficiency requires nurses with experience; competence in observation, assessment, and medical treatment; and a whole‐person approach to patients' needs. [ABSTRACT FROM AUTHOR]

Alongside other Nordic countries, the Norwegian government has introduced Cancer Patient Pathways (CPPs) for faster diagnostic assessment and timely treatment to improve the quality of cancer care. A key aspect of CPPs is the introduction of time limits for each phase of the diagnostic investigation. Occurring simultaneously are ongoing advances in medical technology, complicating the process of diagnosing and treating cancer. In this article, using institutional ethnography, we examine: how does the CPP policy influence physicians' experiences of diagnostic work? Data were collected from May 2018 to May 2019, through semi‐structured interviews with physicians across five hospitals in Norway (N = 27). Our findings indicate that the implementation of various strategies aimed at enhancing quality in cancer care collide, compelling physicians to negotiate between diagnostic precision and rapid decision‐making. We conclude that attention to interfaces between multiple guidelines and their implications for practice is crucial for understanding and developing quality of care. [ABSTRACT FROM AUTHOR]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

Background: Multiple factors can influence the working alliance and treatment outcome in speech and language therapy. The 'working alliance' is an important concept in treatment and can be described as the degree to which a treatment dyad is engaged in collaborative, purposive work. To date, relatively little attention has been paid to this concept within speech and language treatment in general, and within stuttering treatment research in particular. Aims: To investigate the role of the working alliance within stuttering treatment, and to evaluate whether the quality of the working alliance correlated with clients' concept of motivation and treatment outcomes 6 months post‐therapy. Methods & Procedures: Eighteen adults (21‐61 years) participated in this multiple single‐case treatment study, with treatment facilitated by an experienced speech and language therapist. The working alliance was investigated using the Working Alliance Inventory—Short Version Revised (WAI‐SR), an Extended version of the Client Preferences for Stuttering Treatment (CPST‐E), the Overall Assessment of Speakers' Experience of Stuttering—Adult version (OASES‐A), the Wright & Ayre Stuttering Self‐Rating Profile (WASSP) and the Hospital Anxiety and Depression Scale (HADS). Outcomes & Results: Analyses demonstrated significant associations between the working alliance and client motivation (r = 0.781) and treatment outcomes (r = 0.644) 6 months post‐treatment. The association between client‐led goals and therapy tasks appeared particularly important. Conclusions & Implications: : The working alliance between speech and language therapists and persons who stutter matters. Within the alliance, the level of client–clinician agreement on treatment goals and therapy tasks may be of greater importance than the bond between client and clinician. Further research with greater numbers of participants is warranted. [ABSTRACT FROM AUTHOR]

There is an urgent need for educational institutions to prepare students for collaborative practices in health care in the years to come. Facilitation of interprofessional learning (IPL) can be challenging for small campuses with few healthcare and social care education programmes. The aim of this study was to identify hindrances to, and opportunities for accessible interprofessional learning, for nursing students in a uniprofessional learning environment on the Norwegian West coast. Three focus group interviews were conducted with the following groups: nursing teachers, a hospital rehabilitation team and informants from a municipal home rehabilitation team. The data were analysed by hermeneutical phenomenological method. The following four main themes emerged the following: the tradition for interprofessional learning is not yet well established, IPL in the context of existing teams is better than IPL with other students, there is an urgent need to strengthen and adjust professional responsibilities and roles, and there is a need for communication to overcome hindrances to IPL. [ABSTRACT FROM AUTHOR]

Focusing on Swedish and Norwegian cohorts of community‐dwelling older adults between age 65 and 70, this study aimed to identify predictors of the prevalence and incident cases of daytime and night‐time xerostomia. It was hypothesized that the prevalence increases with increasing age and is higher in women than in men and that the prevalence of persistent xerostomia and the 5‐yr‐incident cases are higher in people with consistent use of medication and need for health care. Of the Norwegian participants who completed the 2007 survey (age 65 yr), 70% (n = 2,947) participated in 2012. Individuals participating in both 2007 and 2012 constituted the Swedish panel (80%, n = 4,862). The prevalence of xerostomia was higher in women than in men and increased from age 65 to age 70, most markedly in the Swedish cohort. The risk of persistent xerostomia was greatest for participants with consistent use of medication (OR = 1.3) and contact with a physician (OR = 2.3). The risk of incident cases of xerostomia during daytime was greatest for participants with recent and consistent use of medication and recent contact with a physician. Dental professionals should identify patients with xerostomia, emphasize early prevention, and alleviate oral symptoms in collaboration with physicians. [ABSTRACT FROM AUTHOR]

Introduction: As a growing number of seniors with complex needs are living at home, the implementation of telecare has become a priority. This article aims to identify factors influencing inter‐ and intra‐organisational collaboration in Norwegian primary care. The focus is on collaboration in service provision for senior users with telecare solutions, in this case personal alarms. Methods: Data were collected from two individual interviews with each of seven middle managers from four different units. Additionally, group interviews were conducted during two workshops, both with 16 and 17 front‐line staff members from four local authority units. Results: Challenges and barriers to collaboration and integration were information flow and information sharing, unclear understanding of the division of duties between the units involved and their employees and the lack of meeting points between the emergency medical centre and home nursing. Interagency meetings between the purchasing office and home nursing enhance collaboration. Conclusion: The introduction of telecare does not simplify collaboration or improve services; technology does not solve collaboration challenges. Technology limits information to written form, which may not meet the needs of the service provider and user. Collaboration and integration require common strategies and leadership that implements them, including in telecare. [ABSTRACT FROM AUTHOR]

Background: In contemporary Western liberal society, patient participation has become a key goal in psychiatric healthcare treatment. Health professionals must encourage patients to play an active and involved part in their treatment. According to Danish health law, patients have the right to participate in their treatment, and the mental health system therefore needs to be reformed in order to ensure that treatment is based on individual, liberal, values. However, patient participation is not clearly defined, and it is therefore a challenge to transfer it to clinical practice. Aims: This integrative review's aims are to explore how professionals perceive the challenges regarding patient participation in the treatment course in mental health care. Design: An integrative review. Findings: Seven studies met the inclusion criteria: six employed qualitative methodologies and one utilised a mixed‐methods approach. The empirical studies took place in Norway, the UK and Australia, all in a mental health setting. Three themes were identified: ‘Patient participation as collaboration between the healthcare professional and patient’, ‘Challenges to participation’ and ‘From a professional's perspective – what expectations do patients have when participating in decision‐making?’ Conclusion: Different synonymous terms describing the patient's active role during treatment – user participation, collaboration, partnership, user involvement and patient participation – are linked to a recovery‐oriented approach, shared decision‐making, shared ownership and care plans. This integrative review achieves specific knowledge around patient participation, comparing the situation for adult patients with various mental disorders. However, upon reflecting on the included studies, patient participation is not clearly defined, and it is therefore difficult to transfer it to clinical practice. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. Methods An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. Results Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. Conclusion Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress. [ABSTRACT FROM AUTHOR]