Search

Purpose:The aim of the present paper was to study preferences for web based self-administered questionnaires (web SAQs) vs. paper-based self-administered questionnaires (paper SAQs) and to evaluate the feasibility of using web SAQs in patients referred to cardiac, lung, occupational and cancer rehabilitation programs. Methods:The patients were approached by mail and given the choice to answer the compulsory SAQs either on paper or on a web-based platform. Results:Hundred and twenty seven out of 183 eligible patients (69.3%) were willing to participate and 126 completed the study. Web SAQs were preferred by 77.7%, and these patients were significantly younger, more often cohabiting and tended to have higher level of education than paper SAQ users. Mean number of data missing per patient was less among the web SAQ users than the paper SAQ users (0.55 vs. 2.15,p < 0.001). Costs related to human resources were estimated to be 60% lower with web SAQs compared to paper SAQs. Conclusions:Web SAQs were well accepted among the patients scheduled for rehabilitation, led to less missing data and considerable cost savings related to human resources. Patients referred to rehabilitation should be offered the choice to complete self-administered questionnaires on internet platforms when internet access is common and available.Implications for RehabilitationThe high acceptability of web-based self-administered questionnaires among rehabilitation patients suggests that internet platforms are suitable tools to collect patient information for rehabilitation units.Web-based modes of patient data collection demonstrate low number of missing data and can therefore improve the quality of data collection from rehabilitation patients.Use of web-based questionnaires considerably reduces administrative costs of data collection in rehabilitation settings compared to traditional pen and paper methods. [ABSTRACT FROM PUBLISHER]

Purpose: This article aims to clarify the concepts used to understand, analyze and improve a patient's progress through a health service system. A patient pathway describes plans and intentions. Within it, we distinguish between the clinical pathway of decisions and interventions and the care pathway of supportive activities. As a patient pathway is implemented, it turns into a patient journey of what is done, what happens to a patient's medical condition and what is experienced and felt. We introduce "patient journey disruption" (PJD) as a concept describing the events that need to be prevented from happening to accomplish integrated, coordinated and seamless care. Design/methodology/approach: The method used in this paper is concept analysis. First, an expert steering group worked to refine the concept of PJDs; second, an analysis of similar concepts from related fields was done to root the concept into existing theories, and third, semi-structured interviews with professionals and patients were done to test the concept of PJDs in the home care context. Findings: PJDs are agency-based harmful events in the execution of the care pathway that deviate the patient journey from what can be reasonably expected. PJDs are management failures, which is why they should be studied by healthcare operations management (HOM) and service science scholars with the intention to find ways to prevent them from happening. Research limitations/implications: This study has limitations, including presenting conceptual ideas and preliminary results that are only indicative. Practical implications: We believe that the introduction of the concept of PJDs into the literature provides a new, systematic way of approaching the different shortcomings in our healthcare production systems. Moreover, by systematically identifying different PJDs, interventions can be designed and targeted more appropriately. Originality/value: Managerial challenges regarding healthcare processes have been studied but have not been well defined. The concept of PJDs is an original, well-thought-out definition. [ABSTRACT FROM AUTHOR]

Introduction: Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives: The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods: An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results: The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion: Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care. [ABSTRACT FROM AUTHOR]

The objectives of the study were: 1) Describe the thematic structure and evolution of the field of physical therapy; 2) identify the main research producers (i.e. countries and institutions); and 3) compare their research output and citation impact. Papers related to physical therapy indexed in Web of Science (2000–2018) were identified to delineate the field, using keywords, journals, and citation networks. VOSviewer software, advanced bibliometric text mining, and visualization techniques were used to evaluate the thematic structure. We collected data about the country and institutional affiliation of all the authors and calculated production and citation impact indicators. 85,697 papers were analyzed. Eleven thematic clusters were identified: 1) "health care and education"; 2) "biomechanics"; 3) "psychosocial, chronic pain and quality of life outcomes"; 4) "evidence-based physical therapy research methods"; 5) "traumatology and orthopedics"; 6) "neurological rehabilitation"; 7) "psychometrics and cross-cultural adaptation"; 8) "gait-balance analysis and Parkinson's disease"; 9) "exercise"; 10) "respiratory physical therapy"; and 11) "back pain." The United States, the United Kingdom, and Australia were the most productive countries. Netherlands, Norway, and Sweden had the highest citation impact. Our bibliometric visualization approach makes it possible to comprehensively study the thematic structure of physical therapy. The ranking of producers has evolved and now includes China and Brazil. High research production does not imply a high citation impact. [ABSTRACT FROM AUTHOR]

Background: Previous studies have demonstrated that the trauma population has needs for rehabilitation services that are best provided in a continuous and coordinated way. The discharge destination after acute care is the second step to ensuring quality of care. There is a lack of knowledge regarding the factors associated with the discharge destination for the overall trauma population. This paper aims to identify sociodemographic, geographical, and injury-related factors associated with discharge destination following acute care at trauma centers for patients with moderate-to-severe traumatic injuries. Methods: A multicenter, population-based, prospective study was conducted with patients of all ages with traumatic injury [New Injury Severity Score (NISS) > 9] admitted within 72 h after the injury to regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Results: In total, 601 patients were included; a majority (76%) sustained severe injuries, and 22% were discharged directly to specialized rehabilitation. Children were primarily discharged home, and most of the patients ≥ 65 years to their local hospital. Depending on the centrality of their residence [Norwegian Centrality Index (NCI) 1–6, where 1 is most central], we found that patients residing in NCI 3–4 and 5–6 areas sustained more severe injuries than patients residing in NCI 1–2 areas. An increase in the NISS, number of injuries, or a spinal injury with an Abbreviated Injury Scale (AIS) ≥ 3 was associated with discharge to local hospitals and specialized rehabilitation than to home. Patients with an AIS ≥ 3 head injury (RRR 6.1, 95% Confidence interval 2.80–13.38) were significantly more likely to be discharged to specialized rehabilitation than patients with a less severe head injury. Age < 18 years was negatively associated with discharge to a local hospital, while NCI 3–4, preinjury comorbidity, and increased severity of injuries in the lower extremities were positively associated. Conclusions: Two-thirds of the patients sustained severe traumatic injury, and 22% were discharged directly to specialized rehabilitation. Age, centrality of the residence, preinjury comorbidity, injury severity, length of hospital stay, and the number and specific types of injuries were factors that had the greatest influence on discharge destination. [ABSTRACT FROM AUTHOR]

To examine the prevalence of hearing loss (HL) among employed persons, the association between HL and non-employment, assessing whether this has changed over the last two decades. To identify susceptible groups for HL-related work problems and examine the association between HL and co-worker relations. Cross-sectional analyses of working-age participants (20–66 years). HL was defined as the pure-tone average threshold of 0.5–4 kHz in the better hearing ear: 20–34 dB (mild) or ≥35 dB (disabling). Associations were assessed with logistic regression. Data from two waves of the Trøndelag Health Study (HUNT): HUNT2 1996–1998 (N = 38,603), HUNT4 2017–2019 (N = 19,614). The nationally weighted prevalence of HL among employees was 5.8%. HL was associated with non-employment, more strongly in HUNT2 (odds ratio (OR) 2.2, 95% confidence interval (CI) 2.0–2.4) than HUNT4 (OR 1.9, CI 1.7–2.1). HL was not associated with poorer co-worker relations. The association between HL and non-optimal work performance was stronger among white-collar workers than blue-collar workers. Our study shows that HL is common in the employed population. It also indicates a weakened association between HL and non-employment in recent generations. White-collar workers appear to be more vulnerable to HL-related work problems than blue-collar workers. This paper evaluates employment and work performance among hearing impaired. We show a prevalence of hearing loss (HL) among employed persons of 5.8% and that HL is associated with higher odds of non-employment. Our study indicates that the association between HL and non-employment has weakened in recent generations. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate outcomes of multisystemic therapy (MST) using the Youth Level of Service/Case Management Inventory (YLS/CMI) – part I. Design/methodology/approach: This study, using a pre-post design, included a sample of 2,123 Norwegian youths (mean age = 14.7, SD = 1.34). The MST team supervisors assessed the YLS/CMI risk factors in addition to five behavioral treatment goals (Lives at home, Attends school/work, No violence/threats, Law-abiding and Drug-free) before and after treatment. In addition, data included responses from parent interviews six months post treatment. Findings: Significant correlations were found between the total and dynamic YLS/CMI change scores and the additive index of behavioral treatment goals. In addition, the YLS/CMI change scores predicted the five treatment goals at the termination of treatment and at six-month follow-up. Research limitations/implications: The results indicate that the YLS/CMI is a valuable assessment tool for predicting the achievement of MST behavioral goals in adolescents with serious problem behavior. Practical implications: This study provides an evaluation of the YLS/CMI in a Norwegian context and adds support for continued use of the YLS/CMI in MST. Originality/value: This paper provides new insights about the YLS/CMI inventory as a tool for examining treatment change in MST. Results show that the YLS/CMI captures relevant risk factors in the youths' environment. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The development and promotion of educational games are still outpacing knowledge of these games' effects, raising calls for evidence of benefits and challenges. Studies suggest that students and teachers like games, but the payoff of the investment in terms of increased motivation and achievement remains unclear. Objectives: This study investigates the pure effect of a marketing simulation game on motivation, perceived learning and achievement, above and beyond regular student‐active instruction. Methods: We applied a randomized, controlled experiment in a marketing course in upper‐secondary schools (Nclasses = 22; Nstudents = 433) comparing a collaborative–competitive marketing simulation game with regular, case‐based, student‐active instruction on three groups of outcome measures: motivation, perceived ability, and achievement. Additionally, students and teachers provided quantitative and qualitative feedback on game experiences. Results and Conclusions: We showcase the importance of a robust study design with valid compound instruments. Moreover, investigations of the game implementation and experiences reveal insights about intervention timing, differential negative consequences by gender and need for reflection opportunities. We find no clear evidence of positive or negative effects of the game, despite students' and teachers' satisfaction. Implications: Beyond the effect evaluation, we offer recommendations to researchers and developers of educational games about scaffolding, timing and teacher competence building. Lay Description: What is already known about this topic: Some curricula contains many terms and complex knowledge links.Simulation games are a popular remedy for these challenges.Prior studies have relied on users' satisfaction with the game and unrealistic comparisons. What this paper adds: This experiment compares game usage and regular student‐active instruction.They use various measures of satisfaction, motivation, perceived learning and achievement.The game has no effect on main outcomes. Implications for practice and/or policy: Game implementation requires digitally acquainted and trained teachers.Uncritical game design and use may motivate competitive boys over collaborative girls. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between professional work and standardization. There has been an increase in the use of standardized programmes in child welfare services (CWS) in Western society. Some researchers have criticized standardized programmes suggesting that they undermine professionals expertise and threaten their position, whereas others argue that such programmes strengthen professional practice. In this paper, we examine how standardized tools, in this case, a standardized parenting programme and a standardized Norwegian assessment tool, influence professional roles as experienced by child welfare workers (CWS professionals) in Norway. Semistructured individual and group interviews were conducted with 31 frontline workers in two CWS agencies. Our findings suggest that standardized tools increase the social workers experienced professional competence but challenge their professional knowledge base, reflective practice, and professional accountability. Professional and practical implications for CWS work are discussed in the light of these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: Schools are important arenas for the promotion of critical health literacy (CHL) among adolescents. Key domains of CHL are information appraisal, understanding social determinants of health, and abilities to act on determinants of health. In this paper, we examine the psychometric properties of the Critical Health Literacy for Adolescents Questionnaire (CHLA‐Q). METHODS: A cross‐sectional survey study was performed at 5 schools in Norway. Respondents included 522 pupils aged 13‐15 years old. Confirmatory factor analysis (CFA) was conducted to examine the structural validity. Internal reliability was assessed using ordinal Cronbach's alpha. RESULTS: The estimated model had acceptable closeness of fit. Five of 6 scales displayed adequate internal reliability. CONCLUSION: The results indicate acceptable fit of the CHLA‐Q framework and that 5 of the 6 scales are applicable to inform future research and interventions. More research is needed on measurement of the second domain of CHL. [ABSTRACT FROM AUTHOR]

Introduction: The aim of educational institutions in the field of nursing is to educate nurses with the competences to provide high-quality care to their patients, meaning that students need to learn about evidence-based practice and how to translate the knowledge, skills, competency, beliefs, attitudes, and behaviours into daily practice. The bachelor thesis is the ultimate test for undergraduate nursing students to present what they have learned. Objective: The aim of this study was to explore undergraduate nursing students' experiences of conducting clinical projects in their bachelor theses. Methods: We used qualitative focus-group interviews to gain a deeper understanding of the students' experiences of conducting clinical projects in their bachelor theses as an approach to learn about evidence-based practice. The analyses focused on meaning according to Brinkmann and Kvale. Results: Eighteen out of 22 eligible students who had chosen to participate in ongoing clinical research projects and write an academic paper as their bachelor thesis were included in this study. The students were all females and divided into three focus groups. The clinical projects were conducted in a public hospital, a private hospital, nursing homes, or within home-care nursing. The analyses showed that conducting clinical projects in the bachelor thesis provided the students with important knowledge for providing evidence-based care and it. motivated them to want to initiate future clinical projects as nurses., They got valuable hands-on experience for how to conduct research, and made the students aware of the importance of keeping themselves updated on the latest knowledge. Conclusion: Conducting clinical research projects on a bachelor level provide undergraduate nursing students with important knowledge of how to provide evidence-based nursing care to their patients. Learning how to conduct clinical research projects is also important for motivating future nurses to initiate research aiming to improve clinical nursing practice. [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]

Siblings are key actors in the social network of young people in care. This paper explores young people's perceptions of changes in the quality of sibling relationships and the pathways relationships follow during the transition from the biological family into care. A thematic analysis of interviews with young Norwegian people (n = 25) in care showed that, in the biological family, sibling relationships are characterized by alliances, parentification, conflicts or nonexistence. After admission to child welfare services care, sibling relationships developed along multiple pathways. Their sibling relationships reshaped into either close and supportive, conflictual or completely broken relationships. Sibling relationships were dynamic, complex, with the pathway, and its impact on well‐being, being unique to each young person. Sibling relationship quality in the biological home did not predict relationship quality after admission to child welfare services. The implications for social worker practice are discussed. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we explore and compare types and longitudinal trends of hospital adverse events in Norway and Sweden in the years 2013–2018 with special reference to AEs that contributed to death. Design: Acute care hospitals in both countries performed medical record reviews on randomly selected medical records from all eligible admissions. Analysis: Comparison between Norway and Sweden of linear trends from 2013–2018, and percentage rates of admissions with at least one AE according to types and severities. Setting: Norway and Sweden have similar socio-economic and demographic characteristics, which constitutes a relevant context for cooperation, comparison and mutual learning. This setting has promoted the use of GTT to monitor national rates of AEs in hospital care in the two countries. Participants: 53 367 medical records in Norway and 88 637 medical records in Sweden were reviewed. Results: 13.2% of hospital admissions in Norway and 13.1% in Sweden were associated with an AE of all severities (E-I). 0.23% of hospital admissions in Norway and 0.26% in Sweden were associated with an AE that contributed to death (I). The differences between the two countries were not statistically significant. Conclusions: There were no significant differences in overall rates (E-I) of AEs in Norway and Sweden, nor in rates of AEs that contributed to death (I). There was no significant change in AEs or fatal AEs in either country over the six-year time period. [ABSTRACT FROM AUTHOR]

Purpose: Persons with intellectual disabilities (ID) who offend are treated differently depending on the national jurisdiction. Norway and Denmark are two such examples. The differences in care models may also have an impact on staff perspectives. This paper aims to study the differences between Norwegian and Danish staff members within secure forensic ID services. Design/methodology/approach: A cross-sectional study involving Norwegian (n = 145) and Danish staff (n = 279) in secure forensic learning disabilities services was conducted. The response rates were 50% in Denmark (n = 147) and 69% in Norway (n = 98), respectively. An electronic survey covering five sets of topics (demographic characteristics, working conditions, workplace culture, work motivation and work resilience) was used. The findings was statistically analysed using SPSS. Findings: This study confirmed that staff in the two neighbouring countries have common conceptions of their employment. Danish staff were more exposed to violent incidents (t = 4.1(237); p < 0.001). There was greater concern with workplace safety in Denmark (t = 5.2(237); p < 0.001) compared to more team-based and rigid working conditions in Norway (t = −2.6(237); p < 0.01). Originality/value: These differences are discussed in relation to some important national differences in a professional culture, educational systems, service organisation and legal issues that possibly add realistic explanations to the findings. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many carers report feeling unrecognized by professional healthcare teams.Carers often report difficulty accessing mental health services for relatives.Carers who are also mental health professionals may experience role conflict as found for General Practitioners. What this paper adds to existing knowledge?: Carers who are mental health professionals are often not recognized for their professional knowledge and face similar communication barriers as other carers.Difficulties for carers who are mental health professionals are concerned with information sharing, decision‐making and continuity of care. What are the implications for practice?: Opportunity for services to learn from the experiences of mental health professional and carers to develop better communication and shared decision‐making methods for carersCarers who are mental health professionals should be recognized by services for their dual role (and skills).Service development opportunity for training in supporting and engaging carers who are mental health professionals Introduction: Around 60% of carers of relatives with mental health problems report feeling unrecognized by professional health care, and many report a lack of engagement, shared decision‐making and information sharing. There is a paucity of research examining these issues for carers who are also mental health professionals. Aims: This was an exploratory study to (a) explore the extent of this role among health service staff, (b) gather an indication of the issues faced by carers when interacting with the health system and (c) test the feasibility of conducting research. Methods: Mental health professionals in mental health services completed an online survey that assessed the frequency, content and satisfaction of the experiences of carers. Results: The sample comprised 453 mental health professionals (74% female), 52% being carers. Half of carers reported having therapist contact, and 25% were satisfied with the contact. Negative experiences were related to Information, Decision‐making and Continuity of care. Discussion: There was a high frequency of mental health professionals who were carers. The majority were dissatisfied, and this was primarily in relation to communication with services. Implications for practice: Improving information sharing through training of staff and identification of the system barriers is likely to enhance experiences for service users and families. [ABSTRACT FROM AUTHOR]

This paper explores a change process in the Central Norway Regional Health Authority that was brought about by the implementation of a new economics and logistics system. The purpose of this paper is to contribute to understanding of how employees' attitudes towards change develop over time and how attitudes differ between the five health trusts under this authority. In this paper, we argue that a process‐oriented focus through a longitudinal diary method, in addition to action research and feedback loops, will provide greater understanding of the evaluation of organizational change and interventions. This is explored through the assumption that different units will have different perspectives and attitudes towards the same intervention over time because of different contextual and time‐related factors. The diary method aims to capture the context, events, reflections and interactions when they occur and allows for a nuanced frame of reference for the different phases of the implementation process and how these phases are perceived by employees. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

In light of the challenges posed by an ageing population and tighter public budgets, governments worldwide are seeking innovative ways of improving health service delivery. Volunteers can contribute to such improvement, but this requires effective coordination and communication between volunteers and healthcare employees. In this case study, conducted in two Norwegian municipalities during September–October 2017, the aim was to understand how collaboration and coordination is carried out between several stakeholders: volunteers, volunteer family members of healthcare service users and healthcare employees. Our results show that daily cooperation was largely unsystematic, and stakeholders employed various informal communication procedures. Recruitment of volunteers was based on word of mouth and was coordinated by telephone and email. All processes were paper based, including contracting and confidential agreements. This unsystematic approach resulted in uncoordinated activities characterised by time‐consuming processes, with no quality assurance. We concluded that stakeholders would benefit from a technology solution that supports more systematic processes of recruitment, management and monitoring. This article outlines the challenges and needs for information exchange and communication between stakeholders. Furthermore, it describes possible functionality in a digital system that can address these needs, and hence improve coordination, quality of services and resource use. [ABSTRACT FROM AUTHOR]

Farm‐based day care for people with dementia is supposed to improve the participants quality of life by using activities and resources of the farm environment to promote mental and physical health. In this paper, we describe the characteristics of those attending farm‐based day care services in Norway and explore the association between individual and farm characteristics and the quality of life. A sample of 94 people with dementia who attended farm‐based day care was recruited from 25 farms between January 2017 and January 2018. The data collection was performed using standardized instruments. Information about the farms was retrieved from a former study. The association between the participants' quality of life and their individual and/or farm characteristics was examined with a linear multilevel regression model. The participants had a mean age of 76 years, 62% were men, and 68% had additional education after primary school. Most of them had mild (54.3%) or questionable dementia (18.3%). A few participants used antipsychotics (3.7%), tranquilizers (9.9%) and painkillers (13.6%), while a higher number used antidepressants (30.9%). Quality of life was associated with the experience of having social support (p =.023), a low score on depressive symptoms (p <.001), and spending time outdoors at the farm (p <.001). The variation between the farm‐based day care services in the participants' reported quality of life was related to time spent outdoors at the farm. In light of the present study, it seems as farm‐based day care is addressing people with dementia in an early stage, dominated by men, with quite good physical and medical condition. The strong association between quality of life and spending time outdoors underscores that facilitation for outdoor activity should be prioritized in all types of dementia care. [ABSTRACT FROM AUTHOR]

Introduction: Quality of life is included in the economic evaluation of health services by measuring the preference for health states, i.e. health state utilities. However, most intervention studies include a disease-specific, not a utility, instrument. Consequently, there has been increasing use of statistical mapping algorithms which permit utilities to be estimated from a disease-specific instrument. The present paper provides such algorithms between the MacNew Heart Disease Quality of Life Questionnaire (MacNew) instrument and six multi-attribute utility (MAU) instruments, the Euroqol (EQ-5D), the Short Form 6D (SF-6D), the Health Utilities Index (HUI) 3, the Quality of Wellbeing (QWB), the 15D (15 Dimension) and the Assessment of Quality of Life (AQoL-8D). Methods: Heart disease patients and members of the healthy public were recruited from six countries. Non-parametric rank tests were used to compare subgroup utilities and MacNew scores. Mapping algorithms were estimated using three separate statistical techniques. Results: Mapping algorithms achieved a high degree of precision. Based on the mean absolute error and the intra class correlation the preferred mapping is MacNew into SF-6D or 15D. Using the R squared statistic the preferred mapping is MacNew into AQoL-8D. Implications for research: The algorithms reported in this paper enable MacNew data to be mapped into utilities predicted from any of six instruments. This permits studies which have included the MacNew to be used in cost utility analyses which, in turn, allows the comparison of services with interventions across the health system. [ABSTRACT FROM AUTHOR]

Background: Frailty in older people is a rising global health concern; therefore, monitoring prevalence estimates and presenting projections of future frailty are important for healthcare planning. Aim: To present current prevalence estimates of frailty and pre-frailty and future projections according to both dominant frailty models in a large population-based observational study including adults ≥ 70 years in Norway. Methods: In this population-based observational study, we included 9956 participants from the HUNT4 70 + study, conducting assessments at field stations, homes, and nursing homes. Frailty was assessed using Fried criteria and a 35-item frailty index (HUNT4-FI). Inverse probability weighting and calibration using post-stratification weights and aggregated register data for Norway according to age, sex, and education ensured representativeness, and population projection models were used to estimate future prevalence. Results: According to Fried criteria, the current prevalence rates of frailty and pre-frailty in people ≥ 70 years were 10.6% and 41.9%, respectively, and for HUNT4-FI 35.8% and 33.2%, respectively. Compared to previous European estimates we identified higher overall frailty prevalence, but lower prevalence in younger age groups. Projections suggest the number of Norwegian older adults living with frailty will close to double by 2040. Conclusion: Frailty in older people in Norway is more prevalent than previous European estimates, emphasising the imperative for effective interventions aimed to delay and postpone frailty and ensure healthcare system sustainability in an ageing population. Future planning should consider the great heterogeneity in health and functioning within the 70 + population. [ABSTRACT FROM AUTHOR]

Background: Pakistani immigrants are the largest non-Western ethnic minority group in Norway. Traditional medicines (TM) are extensively used in Pakistan, and studies show that ethnic minorities also use them to recover from illness after migration to the Western world. This study aims to explore Pakistani immigrants' experiences and perceptions of risk regarding the use of TM to treat illnesses. Methods: A qualitative study was conducted through in-depth interviews (n = 24) with Pakistani immigrants in Norway from February to March 2023. Participants were recruited through purposive and snowball sampling methods. The data was analyzed using Braun & Clarke's reflexive thematic analysis (RTA) using Nvivo. Results: RTA revealed three main themes and six sub-themes. The main themes were: (a) House of knowledge, (b) Choosing the best possible approach for health restoration, and (c) Adverse effects of TM used. A total of 96 different TM were identified, including herbs, food items, animal products, minerals, herbal products, and ritual remedies. All participants used TM to restore health in acute and chronic diseases, and many used TM along with conventional medicines. The participants' mothers were the primary source of knowledge about TM, and they passed it on to the next generation. They also frequently used religious knowledge to recover from illness. Although TM is considered safe because of its natural origin, some participants experienced adverse effects of TM, but none of them reported it to the health authorities. Conclusion: The study helps to understand the experiences and perceptions of risk of Pakistani immigrants in Norway regarding traditional practices for treating health complaints. Public health policies to improve the health of these immigrants should consider the importance of TM in their lives. Further research is necessary to explore the safety and toxicity of those TM that are common in Pakistani households in Norway. [ABSTRACT FROM AUTHOR]

Background: Patient experience is an important indicator of the quality of healthcare. Patients with multimorbidity often face adverse health outcomes and increased healthcare utilisation. General practitioners play a crucial role in managing these patients. The main aim of our study was to perform an in-depth assessment of differences in patient-reported experience with general practice between patients living with chronic conditions and multimorbidity, and those with no chronic conditions. Methods: We performed secondary analyses of a national survey of patient experience with general practice in 2021 (response rate 41.9%, n = 7,912). We described the characteristics of all survey respondents with no, one, two, and three or more self-reported chronic conditions. We assessed patient experience using four scales from the Norwegian patient experience with GP questionnaire (PEQ-GP). These scales were used as dependent variables in bivariate and multivariate analyses and for testing the measurement model, including confirmatory factor analysis and a multigroup CFA to assess measurement invariance. Sentiment and content analysis of free-text comments was also performed. Results: Patients with chronic conditions consistently reported lower scores on the GP and GP practice experience scales, compared to those without chronic conditions. This pattern persisted even after adjustment for patient background variables. The strongest associations were found for the scale of "Enablement", followed by the scales of "GP" and "Practice". The subscale "Accessibility" did not correlate statistically significantly with any number of chronic conditions. The analysis of free-text comments echoed the quantitative results. Patients with multimorbidity stressed the importance of time spent on consultations, meeting the same GP, follow-up and relationship more often than patients with no chronic conditions. Our study also confirmed measurement invariance across patients with no chronic conditions and patients with multimorbidity, indicating that the observed differences in patient experience were a result of true differences, rather than artifacts of measurement bias. Conclusions: The findings highlight the need for the healthcare system to provide customised support for patients with chronic conditions and multimorbidity. Addressing the specific needs of patients with multimorbidity is a critical step towards enhancing patient experience and the quality of care in general practice. [ABSTRACT FROM AUTHOR]

Aim: To explore barriers and facilitators that influence adherence to evidence‐based guidelines for peripheral intravenous catheter care in different hospital wards. Design: Sequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings. Method: Data were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC‐miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings. Results: The PIVC‐miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership. Conclusion: This mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety. Implications for the Profession and/or Patient Care: Nurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards. Impact: The study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated. Reporting Method: The study adhered to the Good Reporting of A Mixed Method Study (GRAMM). Patient or Public Contribution: A patient representative has been involved in planning this study. [ABSTRACT FROM AUTHOR]

Purpose: First-line nurse managers are frequently torn between conflicting demands from management and employees, and previous research suggests that nurse managers use a variety of responses to cope with these demands. The purpose of this paper is to explore the influence of social support on nurse managers' responses to role-conflict. Design/methodology/approach: Two focused ethnographic studies involving participant observation and interviews with seven first-line nurse managers were completed. One study included first-line nurse managers from four units in two municipalities (2005), while the second included three first-line nurse managers from a hospital in Norway (2015-2016). Findings: Three types of responses were identified: the embracing managerialism career, the emphasising managerialism career and the emphasising professionalism career. Emphasising managerialism was associated with role distance from the role of nurse, whereas emphasising professionalism involved role distance from the managerial role. Originality/value: This study provides insights into first-line nurse managers' responses to role conflict, by identifying the mechanisms involved and an opportunity to develop a theoretical framework for future studies among nurse managers. [ABSTRACT FROM AUTHOR]

This study is a national cross‐sectional survey, conducted in November 2014, of 366 dental hygienists and dentists who had suspected maltreatment but did not report it to Norwegian Child Welfare Services (CWS). The aims of the present paper are to identify the reasons why public dental healthcare professionals are reluctant to report suspected child maltreatment to CWS and to determine whether there are differences in the identified barriers according to socio‐demographic variables. The questionnaire was based on earlier studies and was adapted to fit the Norwegian context. The most frequently chosen reason for not reporting was "unsure of own assessment" (90.4%). Thirteen items pertaining to not reporting were factorised into three factors of barriers. These factors were "insufficient knowledge of child maltreatment and reporting", "fear of the consequences for oneself and the dental clinic", and "fear of the consequences for the patient and their family". A t test revealed that public dental healthcare personnel who had not received training on maltreatment and reporting to CWS during their professional education scored significantly higher on the barrier "insufficient knowledge of child maltreatment and reporting" than did dental personnel who had received such training. Furthermore, dental personnel with more years of experience (11+) scored higher on this barrier than did dental personnel with less experience. No other significant differences in barriers were observed. Public dental healthcare personnel have a mandatory obligation to report to CWS if they suspect child maltreatment. Despite this obligation, the present study reveals that several barriers to reporting exist. This study underscores the importance of strengthening knowledge among dental hygienists and dentists about when and how to report, both during education and in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to improve understanding of how different kinds of power influence trust and motivation in hospitals.Design/methodology/approach To analyze the links between power, trust and motivation, a framework of social power is tested on measures of trust in managers and motivation. Quantitative data from 137 respondents were collected. Partial least square is used to evaluate the theoretical model.Findings Legitimate, referent and reward power has a positive influence on trust, while coercive power has a negative influence on trust. In total, 41.8 per cent of the variation in trust in managers was explained by power. Trust, reward power and expert power explained 30.9 per cent of the variation in motivation.Practical implications The research indicates that in knowledge organizations such as hospitals, leaders should be careful in using coercive power. Expert power seems to influence motivation but not trust, while legitimate power seems to influence trust directly and motivation only through trust. Referent power seems to have a weak influence on trust and no direct influence on motivation. Reward power has a very strong influence both on trust and motivation.Originality/value It is important for leaders to consider how power can influence trust, motivation and the performance of a health organization. Although this study was conducted in Norway and Finland, the findings may have relevance on a broader scale. [ABSTRACT FROM AUTHOR]

Aim: This paper reports associations among socio‐demographic variables, stressor experience, self‐efficacy and life satisfaction among Norwegian adolescents aged 15–21 years and the potential moderating role of self‐efficacy on the association between stressor experience and life satisfaction. Methods: The cross‐sectional school‐based survey study involved 1816 upper‐secondary school students from Mid‐Norway. Data were analysed with independent samples t test, Pearson's product moment correlation and multiple linear regression analysis. Results: Bivariate results showed that boys scored higher than girls on life satisfaction and self‐efficacy, whereas girls scored higher than boys on all stressor domains. Multiple linear regression analysis showed that life satisfaction declined weakly with age, whereas stronger family economy and having parents who work full‐time associated with higher life satisfaction. Stress with teacher interaction, peer pressure, home life, school attendance, school–leisure conflict and school performance were all negatively associated with life satisfaction, whereas self‐efficacy associated positively and strongly with life satisfaction. Self‐efficacy moderated the association between both interpersonal and school‐related stressors and life satisfaction. Conclusion: The results provide support for the unique role of stressor experience and self‐efficacy in association with adolescents' life satisfaction as well as self‐efficacy as a stress moderator in relation to life satisfaction. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the mechanisms through which change-oriented leadership in hospitals influences job performance and employee job satisfaction. The authors examine the direct and the mediating effects of perceived learning demands and job involvement.Design/methodology/approach This cross-sectional study is based on a survey of four public hospitals in a regional health authority in Norway.Findings The findings illustrate how change-oriented leadership directly and indirectly influences work performance and job satisfaction. Learning demands and job involvement play mediating roles. Higher levels of change-oriented leadership decrease learning demands and increase job involvement, work performance and job satisfaction. Learning demands have a negative influence on work performance and job satisfaction. Job involvement has a positive influence on work performance and job satisfaction. The strongest relationship in the structural modelling is between change-oriented leadership and job involvement.Research limitations/implications This study is based on cross-sectional data. Future studies should therefore explore this further using a longitudinal design.Practical implications The practical implication of the study is to show how leaders by change-oriented behaviour can influence work performance and job satisfaction by reducing learning demands and increasing job involvement.Social implications This study illustrates different paths towards influencing job performance and job satisfaction from change-oriented leadership. It is important to use the potential of reducing learning demands and increasing job involvement, to improve job performance and job satisfaction.Originality/value The authors have developed and validated a new theoretical mediational model explaining variance in job performance and job satisfaction, and how this is related to change-oriented leadership, job involvement and learning demands. This knowledge can be used to increase the probability of successful change initiatives. [ABSTRACT FROM AUTHOR]

Purpose – Hope is regarded central to recovery in a broad range of health conditions including mental health and substance use problems. Still the phenomenon, along with its implications to research and practice, has gained limited attention. The purpose of this paper is to explore first-person accounts of how practitioners nurture and inspire hope. Design/methodology/approach – This qualitative study is part of a larger action research project. Data were collected using in-depth interviews with eight participants. The interviews were transcribed verbatim and analyzed applying thematic analysis. Findings – Hope was perceived as a central phenomenon to practitioners within mental health and substance use services. The following overarching themes were identified through thematic analysis: “Believing in oneself and others,” “Seeing and acknowledging opportunities” and “maneuvering towards hope.” Research limitations/implications – It seems that there is a need for extending knowledge in how practitioners may inspire hope. In addition there seems to be a need for developing more knowledge on how practitioners’ own hope may be nurtured within a system that is constantly undergoing change and new demands. Practical implications – Participants considered their own hope as a prerequisite in being able to hope on behalf of others and strategies for inspiring hope were presented on both an individual and system level. Working conditions and challenges within the service system in itself entailed challenges, which at times made nurturing hope difficult. Systems need to embrace flexibility and openness, allowing efforts aimed at inspiring hope to be made. In addition, practitioner’s own hope and the importance of nurturing it, needs to be acknowledged within services. Hope needs to be viewed as a joint venture, in context and in relation to others. Originality/value – The paper contributes to the knowledge base on hope inspiring practices within a field sometimes associated with challenges and despair. It points out some important preconditions in relation to the challenges practitioners might encounter, both on an individual level and in relation to the service system per se. [ABSTRACT FROM AUTHOR]

Purpose - 22q11.2 deletion syndrome (22q11.2DS) is a rare genetic syndrome involving high risk of psychiatric disorders with average intellectual functioning in the lower borderline range. Due to the cognitive and social problems many adolescents with 22q11.2DS experience, adaptions may be needed to teach these adolescents cognitive behavioral therapy (CBT) skills. The purpose of this paper is to assess psychosocial functioning in adolescents with 22q11.2DS and to adapt CBT with this group. Design/methodology/approach - Totally twelve adolescents (M age=14.5 years, SD=1.4, range 12-17 years; 25 percent boys) with 22q11.2DS were recruited from a competence center for rare disorders. Their parents completed the Child Behavior Checklist and the Kiddie SADS screening interview. The adolescents participated in 7×45-minute CBT group sessions, comprising emotional awareness, cognitive restructuring tasks, and problem-solving skills. Findings - Adolescents had poor parent-reported social and school functioning at onset. The most frequent disorders indicated by screening interviews were attention deficit hyperactivity disorder (92 percent), anxiety (58 percent), depression (50 percent), autism spectrum disorders (50 percent), and potential post traumatic stress disorder (50 percent). Practical implications - The main adaptions made to CBT groups were shorter sessions, frequent breaks, and repetition of main points, limited use of written materials and items that could distract participants (e.g. balloons, papers), extensive and explicit use of turn taking, and two adult group facilitators per group. Originality/value - Offers practical advice on teaching CBT skills to adolescents with 22q11.2DS, which may also be applicable to other adolescents with lower borderline intellectual functioning or intellectual disabilities. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify sources of interruptions and distractions to medicine administration rounds in hospitals. Background: Nurses are frequently interrupted during medicine administration. There is no systematic description of nurses' behaviours and interruptions during administration of medicines to patients. Design: Exploratory nonparticipant observational study. Methods: Three hundred and fifty‐one episodes of medicine administration with 32 nurses from three hospitals in Norway were observed using paper‐based observation grids between December 2013 and March 2014. Results: Nurses were frequently interrupted and distracted, mainly by nurses and other healthcare professionals. One‐third of the nurses interrupted their medicine administration: They prioritised helping patients with direct patient care. When the nurses were interrupted, they left the round and re‐entered the procedure. Even so, they managed to refocus and continue to administer the medicines: Interruptions and disturbances made little difference to most behaviours and actions, possibly because nurses double‐checked more frequently. Some differences were seen in behaviours potentially affecting the safety of the medicine administration, such as leaving medicines at the bedside and not helping patients take their medicines. Some interruptions were avoidable, such as those by other nurses and professionals. Conclusions: This study offers insights into nurses' behaviours and actions when they are interrupted and distracted during medicine administration. The findings highlight a conflict for nurses administering medicines. Nurses are forced to prioritise between two important activities: direct patient care and medicine administration. Management and education providers need to recognise that nurse interrupting each other is a potential threat to patient safety. Relevance to clinical practice: Our data indicate that nurses and other healthcare professionals should be warned not to interrupt colleague administering medicines and managers should ensure other staff are available to respond to patients' immediate needs during medicine rounds. [ABSTRACT FROM AUTHOR]

Background and Purpose: The functional, communicative, and critical health literacy (FCCHL) scale is widely used for assessing health literacy (HL) in people with chronic diseases, such as type 2 diabetes (T2DM). Despite related subscales, researchers continue to apply a consecutive modeling approach, treating the three subscales as independent. This article studies the psychometric characteristics of the FCCHL by applying multidimensional modeling approaches. Methods: Rasch modeling and confirmatory factor analyses were applied to responses (paper-and-pencil) from 386 adults with T2DM. Results: Using a six-point rating scale and a three-dimensional Rasch model, this study found that a 12-item version of the FCCHL reduced within-item bias and improved subscale reliability indexes. Conclusion: This study suggests a parsimonious 12-item version of the FCCHL. The data fit a three-dimensional Rasch model best. [ABSTRACT FROM AUTHOR]

Some recent European research claims that immigrants settle in urban areas with low scores on level-of-living conditions and a high prevalence of health-risk factors, and that these settlement patterns adversely affect their health. Other studies question the association between immigrant segregation and area deprivation on one hand, and negative health outcomes on the other hand, and identify possible beneficial effects of segregation, specifically the ethnic density effect . This paper aims to explore the possible ethnic density effect among refugees, a sub-population that often appears relatively vulnerable compared with immigrants in general. The data comprise 30 871 individuals, aged 20–69, with an (post-1989) officially registered refugee status from six major countries, including Vietnam, Somalia, Iran, Iraq, Sri Lanka and Bosnia. Two outcomes are analysed, covering the 2008–2011 period – the probability of being admitted at least once to a mental health institution and the number of bed days during that period. The results show that all immigrant clusters have relatively high concentrations of negative level-of-living conditions. Despite this finding, refugees living in clusters tend to have less use of mental healthcare services. The results suggest that for most refugee groups, living in clusters has positive health outcomes. Many countries use settlement policies to direct the inflow of refugees away from immigrant-dense areas. Norway's settlement policy is no exception, aiming at a geographic dispersal of refugees to avoid the emergence of socially segregated urban ethnic communities. This paper discusses the relevance of such a policy for refugees' overall integration and level-of-living conditions. [ABSTRACT FROM AUTHOR]

Introduction: Implementation and adoption of quality improvement interventions have proved difficult, even in situations where all participants recognise the relevance and benefits of the intervention. One way to describe difficulties in implementing new quality improvement interventions is to explore different types of knowledge boundaries, more specifically the syntactic, semantic and pragmatic boundaries, influencing the implementation process. As such, this study aims to identify and understand knowledge boundaries for implementation processes in nursing homes and homecare services. Methods: An exploratory qualitative methodology was used for this study. The empirical data, including individual interviews (n = 10) and focus group interviews (n = 10) with leaders and development nurses, stem from an externally driven leadership intervention and a supplementary tracer project entailing an internally driven intervention. Both implementations took place in Norwegian nursing homes and homecare services. The empirical data was inductively analysed in accordance with grounded theory. Results: The findings showed that the syntactic boundary included boundaries like the lack of meeting arenas, and lack of knowledge transfer and continuity in learning. Furthermore, the syntactic boundary was mostly related to the dissemination and training of staff across the organisation. The semantic boundary consisted of boundaries such as ambiguity, lack of perceived impact for practice and lack of appropriate knowledge. This boundary mostly related to uncertainty of the facilitator role. The pragmatic boundary included boundaries related to a lack of ownership, resistance, feeling unsecure, workload, different perspectives and a lack of support and focus, reflecting a change of practices. Discussion: This study provides potential solutions for traversing different knowledge boundaries and a framework for understanding knowledge boundaries related to the implementation of quality interventions. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment is a global problem that puts children at risk of mental illness, substance abuse, and premature death. Interdisciplinary collaboration is important in preventing and detecting child maltreatment. In Norway, children undergo universal preventive health assessments and receive complimentary follow-up care from specialized public health nurses in child and family health clinics. These nurses conduct regular check-ups and home visits to monitor children for signs of maltreatment. Objective: The objective of this study is to describe how public health nurses at child and family health clinics follow the National Clinical Guidelines to prevent and detect child maltreatment, with a particular focus on clinical procedures and interdisciplinary collaboration. Furthermore, we aim to determine factors that are associated with identification of child maltreatment. Design: A cross-sectional online survey was conducted among public health nurses working in primary care between October 24th and December 31st, 2022. Public health nurses who worked with children aged 0–5 years and had consultations with families were eligible to participate, resulting in 554 responses. The study employed descriptive analysis, including frequency, percentage and mean, as well as a two-step logistic regression analysis. The study was approved by the relevant authority, and informed consent was obtained through questionnaire completion. Results: The public health nurses in this study displayed strong adherence to the guidelines and utilized various comprehensive assessment procedures to monitor child well-being, growth, and development. However, there was limited and infrequent collaboration with other professionals, such as child protection services, general practitioners, and hospitals. Most public health nurses reported occasional suspicion of child maltreatment, with age and years of experience in child and family clinics influencing these suspicions. Older public health nurses were more likely to suspect physical violence, while those with less than two years of experience reported less experience in suspecting maltreatment. Additional education increased the probability of suspecting sexual violence. Conclusions: This study provides insights into the practices of public health nurses in Norway regarding the detection and prevention of child maltreatment in child and family clinics. While adherence to guidelines is strong, suspicion of maltreatment is relatively rare. Collaboration across agencies is crucial in addressing child maltreatment. Age and experience may influence the detection of maltreatment. Improved collaboration, targeted guidelines, and ongoing professional development are needed to enhance child protection. [ABSTRACT FROM AUTHOR]

Introduction: Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of oncology and palliative care services would result in more time spent at home during end-of-life. Methods: A prospective non-randomized intervention trial was conducted in two rural regions of Mid-Norway. The hospitals' oncology and palliative care outpatient clinics and surrounding communities participated. An intervention including information, education, and a standardized care pathway was developed and implemented. Adult non-curative patients with cancer were eligible. Proportion of last 90 days of life spent at home was the primary outcome. Results: We included 129 patients in the intervention group (I) and 76 patients in the comparison group (C), of whom 82% of patients in I and 78% of patients in C died during follow-up. The mean proportion of last 90 days of life spent at home was 0.62 in I and 0.72 in C (p = 0.044), with 23% and 36% (p = 0.073), respectively, dying at home. A higher proportion died at home in both groups compared to pre-study level (12%). During the observation period the comparison region developed and implemented an alternative intervention to the study intervention, with the former more focused on end-of-life care. Conclusion: A higher proportion of patients with cancer died at home in both groups compared to pre-study level. Patients with cancer in I did not spend more time at home during end-of-life compared to those in C. The study intervention focused on the whole disease trajectory, while the alternative intervention was more directed towards end-of-life care. "Simpler" and more focused interventions on end-of-life care may be relevant for future studies on integration of palliative care into oncology. Trial Registration: ClinicalTrials.gov Identifier: NCT02170168. Plain Language Summary: Palliative care is an important part of cancer care to improve patients' quality of life. To be cared for and die in the preferred place are quality markers in palliative care. Patients with cancer often want to spend their final days at home. In Norway, most patients with cancer die in institutions. We hypothesized that full integration of cancer and palliative care would result in more time spent at home during end-of-life. An intervention that included information, education, and a standardized care pathway was developed and implemented in a region of Mid-Norway (the intervention region, I). A similar region served as comparison region (C). Adult patients with cancer treated with non-curative intent were eligible. Altogether, 129 patients in I and 76 patients in C were included in the study, of whom 82% in I and 78% in C died during follow-up. The mean proportion of time spent at home last 90 days of life was 0.62 in I and 0.72 in C (p = 0.044), and 22.6% and 35.6% (p = 0.073) died at home, respectively. A higher proportion died at home in both groups compared to pre-study national levels (12%). During the study period, C developed and implemented an alternative intervention to the study intervention, with the former placing more focus on end-of-life care compared to the she study intervention that focused on the whole disease trajectory. This may explain why the intervention did not result in more time spent at home during end-of-life as compared to C. "Simpler" interventions directed towards the study's primary outcome may be relevant for future studies on integration of palliative care into oncology. [ABSTRACT FROM AUTHOR]

Background Socioeconomic inequalities constitute an important focus area for public health, and it has long been established that higher educational level and longer lifespan are correlated. Little is known about decennial time trends in poor self-rated health and mental distress. Methods This study linked decennial cross-sectional survey data on self-rated health and mental distress from the Trøndelag Health Study (HUNT) from 1984 to 2019 with educational registry data using personal identification numbers. Survey participation ranged from 50 807 to 77 212. Slope index of inequality (SII) and relative index of inequality (RII) were calculated using generalized linear models in Stata. Analyses were stratified by sex and age, using the age categories of 30–59 years and 60–80 years. Results Absolute inequalities in self-rated health and mental distress between educational groups have stayed relatively stable throughout all rounds of HUNT. Relative inequalities in self-rated health and mental distress have generally increased, and both men and women with the lowest education level were more likely to experience poor self-rated health and mental distress relative to those with the highest education level. RII in self-rated health increased over time for both sexes and both age groups. RII for mental distress increased in both sexes and both age groups, except for men and women aged 60–80. Discussion This study shows that relative inequalities in self-rated and mental health in the Norwegian population are still persistent and have increased. Further knowledge about groups with a disadvantageous health situation should have implications for health care resource allocation. [ABSTRACT FROM AUTHOR]

Introduction: Spinal cord injury (SCI) affects many aspects of life, physically, emotionally and socially. Engaging in online videogames holds the potential to facilitate increased social interactions for individuals with SCI. The aim of this study is to increase our understanding of the experiences people with SCI have with using online videogames as an arena for social participation. Methods: A focus group interview was conducted with seven participants with SCI, aged 15-35, all experienced in using online videogames as a method of socializing. The data was analyzed using thematic analysis. Results: The participants highlighted that playing online videogames way of maintaining social connections and expanding their social network. However, they faced challenges due to limited knowledge and negative attitudes from others regarding use of videogames as a social arena. Three main themes were developed from the findings: "Disabling social barriers", "Attitudes towards gaming" and "Gaming--connecting people". Conclusion: Healthcare professionals should consider videogames as a leisure activity and facilitate their use, recognizing their potential for social interaction and well-being. Prioritizing activities that promote social interaction is crucial for good health. [ABSTRACT FROM AUTHOR]

Objective: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. Data and methods: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. Results: Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. Conclusions: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home. [ABSTRACT FROM AUTHOR]

There is increasing attention toward students' satisfaction and how they perceive the quality of the program they attend. This study examined stability and change across time with regard to the relationships between learning environment factors and occupational therapy students' satisfaction with the program. In the two consecutive cross-sectional analyses performed in this study, 163 second-year students and 193 third-year students from all six occupational therapy education programs in Norway participated. The Course Experience Questionnaire was used to assess learning environment factors and study satisfaction. The data were analyzed with Pearson's correlation coefficient r and with hierarchical linear regression. Bivariate associations between the learning environment scales were positive and most associations were statistically significant in both study years. Relatively stable associations between the learning environment variable "good teaching" and higher study satisfaction were detected, while other associations differed between years of study. Embedding quality into the learning process, in particular by emphasizing good teaching and the clear dissemination of goals and standards, is important for student satisfaction throughout years of study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to gain a deeper understanding of nurse academics' experiences with the transition from clinical practice to academia and throughout their whole career trajectory. Design: Qualitative study design. Methods: Three focus group interviews with 17 nurse academics employed at a University in Norway were conducted in May and June 2020. Data were analysed using qualitative content analysis. Results: Nurse academics experienced several diverse career transitions that continued throughout their whole career trajectory, affecting their daily life. Three interconnected themes were identified: ‘clinically confident, yet academically uncertain’, ‘balancing the academic role’ and ‘lost in academic transition’. Conclusion: This study contributes to a deeper understanding of nurse academics' experiences of transitioning into their academic role and identity. Transition was found not as separate occurrences but was described as several ongoing and concurrent processes throughout their whole career trajectory regardless of seniority level or academic experience. These transitions encompass shifts in identity, new responsibilities and increased tasks, yet often occur without adequate support. As a result, nurse academics may lack the essential skills and knowledge of the academic role. Impact: This study provides insights into nurse academics' transition from clinical practice to academia and throughout their whole career trajectory. This is not a onetime occurrence but a continuous process that takes place throughout their entire career trajectory. This transition is embedded within a complex environment that requires careful consideration and attention. To address challenges regarding career transitions for nurse academics, universities should provide more training and preparation opportunities for all nurse academics when facing different career transitions. Reporting Method: Consolidated Criteria for Reporting Qualitative Research. [ABSTRACT FROM AUTHOR]

Background: Research has indicated that providing women with information about menopause can improve their attitudes towards it and symptom experience. Nevertheless, information shared on the menopause is often arbitrary. Aim: To examine women's information needs about menopause, and understand if, when, and from whom they want information. Design & setting: A cross-sectional study was undertaken. A questionnaire survey was distributed to women in the waiting room of 54 general practice clinics in South-Eastern Norway in autumn 2022. Method: Medical students recruited women in the clinic waiting rooms. A 1-page study-specific questionnaire was used, focusing on need for information about menopause. A multinominal logistic regression model was used to analyse the association between the desire for information and education level, country of birth, and menopausal status. Results: A total of 625 women were included, with a mean age of 44.4 years (standard deviation [SD] 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their GP to inform them, from a median age of 45 years. According to the women, only 10% of GPs had initiated a discussion on the menopause. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The sex of the GP did not influence the results. Conclusion: Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options. [ABSTRACT FROM AUTHOR]

Background: In the Nordic healthcare systems, GPs regulate access to secondary health services as gatekeepers. Limited knowledge exists about the gatekeeper role of GPs during public health crises seen from the perspective of GPs. Aim: To document GPs' gatekeeper role and organisational changes during the initial COVID-19 lockdown in Norway. Design & setting: A cross-sectional online survey was addressed to all regular Norwegian GPs (n = 4858) during pandemic lockdown in spring 2020. Method: Each GP documented how patients with potential COVID-19 disease were triaged and handled during a full regular workday. The survey also covered workload, organisational changes, and views on advice given by the authorities. Results: A total of 1234 (25.4%) of Norway's GPs participated. Together, they documented nearly 18 000 consultations, of which 65% were performed digitally (video, text, and telephone). Suspected COVID-19 symptoms were reported in 11% of the consultations. Nearly all these patients were managed in primary care, either in regular GP offices (55.7%) or GP-run municipal respiratory clinics (40.7%), while 3.7% (n = 73) were admitted to hospitals. The GPs proactively contacted an average of 0.8 at-risk patients per day. While 84% were satisfied with the information provided by the medical authorities, only 20% were able to reorganise their practice in accordance with national recommendations. Conclusion: During the early stage of the COVID-19 pandemic in Norway, the vast majority of patients with COVID-19-suspected symptoms were handled in primary care. This is likely to have protected secondary health services from potentially detrimental exposure to contagion and breakdown of capacity limits. [ABSTRACT FROM AUTHOR]

Background: End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. Methods: Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. Results: Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). Conclusion: Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. Trial registration: NCT04678310. Registered 21/12/2020. [ABSTRACT FROM AUTHOR]

Purpose: The role of healthcare leaders is becoming increasingly complex, and carries great responsibility for patients, employees, and the quality of service delivery. This study explored the barriers and enablers that department leaders in nursing homes encounter when managing the dual responsibilities in Health, Safety and Environment (HSE) and Quality and Patient Safety (QPS). Methodology: Case study design with data collected through semi structured interviews with 16 department leaders in five Norwegian municipalities. We analyzed the data using qualitative content analysis. Results: Data analysis resulted in four themes explaining what department leaders in nursing homes experience as barriers and enablers when handling the dual responsibility of HSE and QPS: Temporal capacity: The importance of having enough time to create a health-promoting work environment that ensures patient safety. Relational capacity: Relationships have an impact on work process and outcomes. Professional competence: Competence affects patient safety and leadership strategies. Organizational structure: Organizational frameworks influence how the dual responsibilities are handled. Conclusion: Evidence from this study showed that external contextual factors (eg, legislations and finances) and internal factors (eg, relationships and expectations) are experienced as barriers and enablers when department leaders are enacting the dual responsibility of HSE and QPS. Of these, relationships were found to be the most significant contributor. [ABSTRACT FROM AUTHOR]

This study builds on and contributes to research on student teachers’ reflection during internships in teacher education. In order to gain insight into the research question ‘What characterizes four Norwegian third-grade students’ expressed collective and individual reflections during their internships’, the student teachers in question were followed during their internships for two periods of two weeks each. In this paper, video-observation from guidance sessions and the student teachers’ individual logs were used to collect data. In the analyses it appeared that that the content in the collective reflections during guiding sessions mostly concerned the concrete ‘how’ and ‘who’ of teaching. This result corresponds to former research on student teachers’ reflection. In the analyses of their individual logs, however, we found that that the student teachers not only reflected at a concrete level, but also at a more abstract level as their reflections contained contemplations regarding ‘why’ they sought to teach according to the expressed concerns in the collective reflections. The overall theoretical framework of the study is socio-cultural theory, and in particular the notion of ‘reflective mediation’ was useful both in the analyses of the data and in the further interpretation of the findings. As the findings partially contradict previous congruent research that argues for student teachers’ tenuous reflections, the paper concludes that this important aspect of student teachers’ development should be further scrutinized and discussed in a more nuanced manner than it has been until now. [ABSTRACT FROM PUBLISHER]

Introduction: Home-based reablement (HBR) has achieved significant international prominence in recent years. In the Nordic countries, HBR has been introduced as an innovative care model within the municipal health care sector that answers the need for better and more effective service delivery. But knowledge about how innovations can be spread in the municipal health care sector is scarce. We also know little about what role first-line managers (FLMs) may play for the diffusion of innovations. Purpose: To describe and explain adoption of HBR in municipalities in Norway and to explore if there is a relationship between early/late adoption and the FLM's perception of innovativeness in their organization. Such knowledge is valuable for the understanding of the role of FLM for the diffusion of innovations in the health care sector. Methods: A cross-sectional national online survey was carried out among FLM in the eldercare sector in 422 Norwegian municipalities. The response rate was 64%. The analysis was based on univariate and bivariate techniques, factor analysis, and multiple linear regression. Results: A bivariate analysis revealed that early adoption is associated with a high score on perception of innovativeness among FLMs. Innovators and early adopters scored highest (5.65) on perception of innovativeness, followed by early majority (5.31) and late majority (5.18). The lowest score was found among Laggards. A multiple regression analysis revealed that a substantial part of the positive relationship between early adoption and perception of innovativeness can be explained by FLMs' length of service in the organization and their educational level. Wealth of the municipality does not have an effect on innovativeness. Conclusion: An implication of the results is that mature and stable personnel in key positions in the organization, and personnel with higher education, can be positive for innovativeness in the municipal health care sector. [ABSTRACT FROM AUTHOR]