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

Introduction: Since 2016, Norwegian municipalities have been obliged to provide municipal acute 24-hour services representing a service before or instead of hospital treatment. This study explores two municipal acute units (MAUs) as part of the clinical pathway for older patients. Methods: Patients and healthcare providers from MAUs, purchaser offices, home-based nursing, and physicians were interviewed. Interview transcripts were analysed using systematic text condensation. Results: The collaboration between the MAU staff and the GPs, the purchaser offices and the home-based services is described as challenging, mostly due to disagreement regarding patients’ admission and discharge. The providers’ different understanding seems to derive especially from where they are working in a way that suits their own work functions. An exigent collaboration between providers in the MAUs and their collaborative partners hampers the clinical pathway for older patients in the municipal healthcare service. Conclusion and discussion: When a new healthcare service such as an MAU becomes a part of the clinical pathway in a municipality, it is important to invest a considerable effort in measures designed to strengthen relational and structural collaboration to make the clinical pathway smooth. [ABSTRACT FROM AUTHOR]

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

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

The increasing complexity of the healthcare system and of patients' conditions, as well as resource limitations, calls for collaboration between professionals and institutions. The objective of this study was to explore the significance of professional roles in collaboration on patients' transitions from hospital to home via an intermediate care unit. We studied collaboration in the intermediate unit and between healthcare providers in the unit, a hospital and four municipalities in the hospital catchment area. Data were drawn from interviews with thirty-eight healthcare providers within specialist and primary health care and from observations in six multidisciplinary meetings, six report meetings and four discharge meetings in the unit. Transcripts of interviews and observations were analysed using a method of systematic text condensation. The results show that collaboration inside the intermediate unit and between the healthcare institutions was primarily 'a nursing matter'. Collaboration among the nurses was generally good. Except for the physician, all the healthcare providers experienced the collaboration in the unit as unidisciplinary rather than interprofessional. Although they wanted to collaborate interprofessionally, they were unable to do so in practice. The unit's physiotherapists and occupational therapists found themselves to be excluded from the nurses' community of practice, while the physician experienced the collaboration as excellent. The findings indicate that healthcare providers have different understandings of interprofessional collaboration and that in certain situations, they consider interprofessional collaboration to be an inappropriate working method. Interprofessional collaboration can promote a learning environment among healthcare providers. To achieve better interprofessional collaboration, it is probably necessary to create mutual understandings of interprofessionality and to reach an agreement on the situations in which it is an appropriate way to work. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore the activities carried out and the conditions required to enable satisfactory work in an intermediate unit for patients aged 60 and older. Background In recent years, several intermediate units have been established to improve the clinical pathway from hospital to home for older patients. Design Qualitative study. Methods Data were obtained from interviews with eight patients and 16 healthcare providers working in the unit and from observations in six multidisciplinary meetings and six report meetings in the unit. Transcripts of interviews and field notes were analysed using a method for systematic text condensation. Results Care performed as a balance between relational, practical and moral aspects seems to be important to render good service to patients and to ensure the providers' job satisfaction. Most patients experienced their stay in the unit as positive. The providers highlighted 'suitable patients', an appropriate physical environment and communicating computer systems as significant factors for performing treatment and for providing nursing and rehabilitation in a caring manner. Conclusions When environmental and organisational conditions exert pressure on the working situation, care as a practical activity seems to be prioritised at the expense of the two other aspects. The findings indicate that unfavourable environmental and organisational conditions impede patients' recovery process and thereby a good clinical pathway. Relevance to clinical practice To recruit, support and retain a multidisciplinary staff to the best interest of patients, it seems to be important to perform care work as a balance between relational, practical and moral activities. [ABSTRACT FROM AUTHOR]

Introduction: Different care models have been established to achieve more coordinated clinical pathways for older patients in the transition between hospital and home. This study explores an intermediate unit's role in a clinical pathway for older patients with somatic diseases. Theory and methods: Qualitative data were collected via interviews, observations, and a questionnaire. Participants included patients and healthcare providers within both specialist and primary healthcare. Transcripts of interviews and field notes were analyzed using a method of systematic text condensation. Results: Healthcare providers in the hospital, the intermediate unit, and the municipalities have different opinions about who is a 'suitable' patient for the unit and what is the proper time for hospital discharge. This results in time-consuming negotiations between the hospital and the unit. Incompatible computer systems increase the healthcare provider's workload. Several informants are doubtful as to whether a stay in the unit is useful to the patients, while the patients are mostly pleased with their stay and the transferral. Conclusion and discussion: This study describes challenges that may occur when a new unit is established in an existing healthcare system in order to achieve an appropriate clinical pathway from hospital to home. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2011; 25; 53-61 The purpose of this study was to describe communicative patterns about change in demanding physiotherapy treatment situations. A multiple case study of eleven treatment courses was carried out, based on in-depth individual interviews, focus group interview, personal notes and repeated video-recordings. To compare communication within and over sessions, a two-step procedure was applied: identification of communication patterns and detailed analysis of selected dialogues from video-recorded sequences. One main communicative pattern was identified: Seeking for common ground - demanding negotiating process. This pattern was interrupted by short episodes of two types of challenges; the pattern of ambivalence and uncertainty, and the pattern of impatience and disagreement. Communication between the participants appeared as a demanding and complex process of negotiations during the treatment processes. The physiotherapists' sensitivity of and ability to negotiate the tasks, the emotions related to tasks and the nature of the relationships, seemed to facilitate change. The patients' and the physiotherapists' capacity to bear and come through demanding situations created new ways of interaction. The demanding situations may generate a potential for the development and the improvement of treatment outcomes. Understanding such episodes as open and dynamic, in contrast to defining the patient as demanding, suggests a useful perspective for treatment. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to acquire an understanding of the suicides among a group of elderly people by studying how they experienced their existence towards the end of life. Methods: This is a psychological autopsy study based on qualitative interviews with 63 informants in relation to 23 suicides committed by persons aged over 65 in Norway. Informants who knew the deceased persons well describe what the elderly person communicated to them about their experience of life in the period before the suicide and how they as informants saw and understood this. The informants comprise relatives, family doctors and home-based care nurses. The analysis of the interviews follows the systematic text condensation method. Results: The descriptions are divided into three main elements: the elderly persons' experiences of life, their perception of themselves, and their conceptions of death. "Experience of life" has two sub-topics: this life has been lived and life as a burden. Everything that had given value to their life had been lost and life was increasingly experienced as a burden. Their "perception of themselves" concerned losing oneself. Functional decline meant that they no longer had freedom of action and self-determination. "Conceptions of death" involve the following sub-topics: acknowledgement/acceptance and death is better than life. Life had entered into its final phase, and they seemed to accept death. For some time, many of them had expressed the wish to die. Conclusions: The results lead us to argue that their suicides should be considered as existential choices. The sum total of the different forms of strain had made life a burden they could no longer bear. Age meant that they were in a phase of life that entailed closeness to death, which they could also see as a relief. [ABSTRACT FROM AUTHOR]

Background: Suicidal behavior among the elderly is a research field in which qualitative and quantitative methods can and should supplement each other. The objective of this qualitative study is to investigate whether the descriptions of elderly people who committed suicide, given by those who knew them, can provide common features that create recognizable patterns, and if so whether these patterns can help to shed light on the suicidal process. Method: This is a psychological autopsy study based on qualitative interviews with 63 informants concerning 23 suicides committed by persons aged over 65 in Norway. The informants were relatives, their family doctors, and home-based care nurses. In general, the analysis of the interviews follows the systematic text condensation method. Results: The descriptions have three main topics: life histories, personality traits and relationships. "Life histories" includes the sub-topics ability to survive and action-oriented achievers. They describe people who came through difficult circumstances when growing up and who were action-oriented in life in general and in crises. "Personality traits" includes the sub-topics obstinacy and controlling others. The informants saw the elderly people as strong-willed, obstinate and possessing a considerable ability to control themselves and those around them. "Relationships" includes the sub-topics I didn't know him and He showed no ability to meet us halfway, and describes the informants' experience of emotionally closed persons who kept a distance in their relationships. Conclusions: On the basis of the descriptions of the elderly people given in this study, we argue that these individuals will find difficulty in accepting and adapting to age-related loss of function since their self-esteem is so strongly associated with being productive and in control. Loss of control reveals their vulnerability - and this they cannot tolerate. [ABSTRACT FROM AUTHOR]

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