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Background: Building friendship is crucial for attaining and upholding recovery from problematic substance use. However, how people who have used substances problematically develop friendships needs to be investigated more from a first-person perspective. Aim: To provide insight into how people in long-term recovery find meaning in their experience of building friendships. Method: In semi-structured interviews, 17 people in recovery drew network maps and reflected on how friendships had developed during the long-term process. We analysed the narratives by way of a thematic narrative approach. Results: Participants presented the friendship-formation process through four distinct storylines: (1) 'I don't make friends easily'; (2) overcoming barriers to building friendships; (3) 'birds of a feather flock together'; and (4) 'having "regular" friends makes me feel like an "average" person'. Conclusion: People in long-term recovery from problematic substance use felt haunted and hindered by past experiences when building friendships. These experiences created a social divide between those who had experienced problematic substance use and those who had not. The valuable insights that social workers can gain from this study can support friendship development for people in long-term recovery on multiple levels. By understanding someone's self-perceptions and their perspectives on others, social workers can engage with barriers when people in recovery enter social environments such as work. We emphasise the significance of a long-term approach to overcoming barriers to building new friendships. [ABSTRACT FROM AUTHOR]

Sex, relationships, and substance use often go hand in hand. Despite this, the impact of sex and relationships on recovery are often overlooked in the field of substance use disorder treatment (SUDT). This study aims to explore sex, relationships, and relapse risk for people in recovery and as an overlooked area of importance in SUDT. This qualitative study uses semi-structured interviews with people currently and/or formerly in prison, together with ethnographic field data from four high security prisons in Norway, collected between July 2021–April 2022. Common sources of anguish around sex after release and recovery included both forming new and maintaining long-term relationships with partners at a different stage in their recovery, dating and initiating sexual relationships with new partners, concerns about sexual performance and fears around attaining sexual pleasure without chemical enhancements. The implications that sex, dating and intimate relationships may have for individual relapse to substance use, can and should play a greater role in both SUD treatment and preparation for release from prison. These problems are exacerbated in carceral settings and should be considered when planning re-entry to the community and in the development of individual relapse prevention strategies. [ABSTRACT FROM AUTHOR]

Background: Global nursing shortages necessitate the identification of mitigatable factors that may reduce nursing absence and turnover. Fatigue has been shown to be associated with these issues. This study aimed to identify factors leading to development of or recovery from excessive fatigue in nurses as these can offer actionable avenues for protecting nurses against fatigue or supporting fatigue recovery. Methods: A longitudinal study among nurses randomly sampled from the Norwegian Nurse's Organization. The Chalder Fatigue Questionnaire measured fatigue. Dichotomized scoring was used, with scores ≥ 4 considered excessive fatigue. The study included questions on shift work schedules, psychosocial work characteristics, sleep, body mass index, physical activity, caffeine, alcohol, mental health, etc. Two sets of logistic regression analysis were conducted (one for development of and one for recovery from excessive fatigue), evaluating how changes in work, lifestyle and health between baseline (2015) and follow-up (2018) affected first, odds of development of excessive fatigue and second, odds of recovery from excessive fatigue. Results: Among 1,311 included nurses, 21.6% maintained, 13.3% developed, and 18.0% recovered from excessive fatigue (2015–2018). Within work characteristics, increased psychological work demands were associated with development of excessive fatigue OR = 1.77 (CI = 1.11–2.82). Several work characteristics were associated with recovery from excessive fatigue, including decreased decision latitude (OR = 0.39; CI = 0.19–0.82) and increased coworker support (OR = 1.90; CI = 1.11–3.24). Shift work variables were not associated with fatigue outcomes. Amongst lifestyle factors, changes in sleep duration, obesity, and exercise were significant. Notably, developing inappropriate sleep duration (OR = 2.84; CI = 1.47–5.48) increased odds of developing excessive fatigue, while maintaining inappropriate sleep duration (< 6 h or > 8 h) (OR = 0.19; CI = 0.54–0.65) decreased odds of recovering. All assessed health conditions (depression, anxiety, insomnia, and shift work disorder) were related to development of (ORs 2.10–8.07) or recovery from (ORs 0.10–0.50) excessive fatigue. Depression, for example, increased odds of development of (OR = 8.07; CI = 2.35–27.66) and decreased odds of recovery (OR = 0.10; CI = 0.04–0.26) from excessive fatigue. Conclusions: Changes in lifestyle factors, health conditions, and psychosocial work factors were associated with development of and recovery from excessive fatigue. Sleep and psychosocial work factors played important roles. We found no relationship with shift work schedules. [ABSTRACT FROM AUTHOR]

Fertility rates among individuals in their 20s have fallen sharply across Europe over the past 50 years. The implications of delayed first births for fertility levels in modern family regimes remain little understood. Using microsimulation models of childbearing and partnership for the 1970–1979 birth cohorts in Italy, Great Britain, Sweden, and Norway, we implement fictive scenarios that reduce the risk of having a first child before age 30 and examine fertility recovery mechanisms for aggregate fertility indicators (the proportion of women with at least one, two, three, or four children; cohort completed fertility rate). Exposure to a first birth increases systematically in the ages following the simulated reduction in first-birth risks, leading to a structural recovery in childbearing that varies across countries according to their fertility and partnership regimes. Full recovery requires an increase in late first-birth risks, with greater increases in countries where late family formation is uncommon and average family sizes are larger: in scenarios where early fertility declines substantially (a linear decline from 50% at age 15 to 0% at age 30), first-birth risks above age 30 would have to increase by 54% in Great Britain, 40% in Norway and Sweden, and 20% in Italy to keep completed fertility constant. [ABSTRACT FROM AUTHOR]

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Purpose: To explore the recovery narratives of 13 young women who had fallen ill with severe Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), during childhood and adolescence, with the focus on what they had to say about their past experiences from the perspective of the present. Method: A qualitative narrative approach, informed by a phenomenological theoretical perspective, was adopted to explore what the women found significant and meaningful in their recovery process. Data analysis of in-depth narrative interviews was performed which are presented to readers through the stories of two particular participants. Results: The first story describes how one participant made a recovery by testing her body's tolerance and working to create a more confident self. The second story describes a complex exploration of possibilities for action in recovery, along with a struggle to make sense of setbacks and hold on to what has been gained. Conclusion: Recovering from ME/CFS emerges as an inter-personal, contextual, fragile and nonlinear process of homecoming, based on gradually rising bodily based self-knowledge. Illness slowly fades away into the background, and there is the prospect of a healthier tomorrow. [ABSTRACT FROM AUTHOR]

Purpose: There is a pressing need for substance use services to know more about how to promote recovery from substance use problems, particularly in later life. Psychological sense of community (PSOC) is an important recovery dimension. This study aims to clarify in what ways PSOC and communities influence later life recovery processes. Method: A collaborative and deductive reflexive thematic approach was used to analyse 23 interviews with older adults in recovery from different substance use problems. Results: The findings suggest that PSOC and recovery in later life include multiple communities (relational, geographical, substance use-related, ideal and service-related) and affective states (PSOC and NPSOC). Older adults' recovery, moreover, can be described as personal and heterogenic (with respect to community relationships, individual needs, type of substance use problem, age of onset and meaningful activities). Conclusions: The findings confirm age of onset, type of substance use problem and community memberships as essential to later life recovery. They also supplement prior evidence on community resources and challenges to later life recovery. Importantly, the new findings extend and nuance current understandings of later life recovery. Taken together, the article illustrates MPSOC as a useful concept, with central practical and theoretical implications for later life recovery. [ABSTRACT FROM AUTHOR]

Rebuilding one's social network is essential to long-term social recovery from a substance-use problem. Despite this awareness, studies are needed for showing how people in long-term social recovery describe their networks and what they perceive as important in developing these networks. This study has sought to investigate (i) how people in long-term social recovery from substance-use problems describe their social networks and (ii) what they experience as key factors in developing their networks. We interviewed seventeen participants in long-term social recovery and mapped out their person-centred networks. Most of the participants were satisfied with their social networks, although some felt their networks were small and wanted more friends in the future. The qualitative thematic content analysis suggested that rebuilding networks was experienced as a demanding, anxiety-filled, long-term process. Access to social arenas, prolonged time spent with others and identification with and recognition from others were key to developing social networks. We argue that there is a need for tailored assistance and long-term support for people in long-term recovery to help them cope with the stresses of entering new social arenas, overcome societal stigma and develop social networks. [ABSTRACT FROM AUTHOR]

Musculoskeletal and mental health complaints are common in the general population and frequent reasons for healthcare utilization and work absence. Illness perceptions, coping expectancies, rumination and self-stigma are important factors in the management of these health complaints and factors closely linked to health literacy (HL). The aims of the study were to identify helpful elements in a brief intervention (BI) targeting HL regarding common musculoskeletal and mental health complaints and to identify patient perceptions of how the intervention was helpful and whether it affected their subsequent coping. Three focus group interviews with 14 patients were conducted. Systematic text condensation was used for the analysis, supported by the health literacy skill (HLS) framework to sharpen the focus on intervention elements related to the acquisition and utilization of HLSs. Results revealed the importance of receiving comprehensible health information and guidance, the use of metaphors to create recognizable narratives and the use of practical examples and exercises. Normalizing the experienced health complaints, together with a safe and accommodating clinical environment, facilitated the change process. The BI initiated processes that contributed to acceptance, resilience and empowerment, aiding work–life balance and return to work. The study presents authentic narratives of value for future focus in BI. [ABSTRACT FROM AUTHOR]

While recovery has been highlighted as a prime aspect in the flexible assertive community treatment (FACT) model, research on the application of this model in Norway suggests that there is still a potential for providing service users with better participation in the local society. Music therapy has been highlighted as a form of intersubjective activity that is relational and can promote empowerment and personal recovery. The social aspect of recovery has been highlighted in recent years, and this article explores how music therapy, offered through FACT, may support social recovery for service users. The research design was that of a qualitative interview study. Six semi-structured, joint interviews were conducted with FACT service users and their music therapist. Using reflexive thematic analysis, the main theme music therapy as social recovery was generated, with four relating sub-themes: musicking as activity, musicking as social handcraft, musicking as togetherness, and musicking as network. Using the framework of social recovery, this article discusses the potential of music therapy within FACT as a collaborative activity that can provide recovery capital – including social and musical capital – and potentially contribute to social recovery. [ABSTRACT FROM AUTHOR]

In this study, we aimed to examine health-related quality of life during the COVID-19 pandemic among a general sample of young people in Norway aged 11–19 years. More specifically, we examine: (1) Change over 2 time-points in five health-related quality of life dimensions, (2) Whether sociodemographic- and COVID-19-related factors contributed to change in these five dimensions, (3) Whether parental stress and socioeconomic status at T1 interacted with change in health-related quality of life across T1 and T2. Data collection lasted from April 27th to May 11th, 2020 (T1), and from December 16th, 2020, to January 10th, 2021 (T2). Youth aged 11–19 years (N = 2997) completed the KIDSCREEN-27, COVID-19 related and sociodemographic items. Parents (N = 744) of youth aged 15 years and younger completed the parental stress scale and sociodemographic items. Physical and psychological wellbeing declined significantly from March to December 2020. Subscale scores for social support and peers increased. Controlling for a broad number of sociodemographic and COVID-19-related factors did not make an overall impact on the estimates. Those worried about infection, older aged, girls, and youth born outside Norway had a steeper decline in health-related quality of life subdimensions from T1 to T2. In the wake of the COVID-19 pandemic, we warrant special attention to the recovery of youth's physical and psychological wellbeing. [ABSTRACT FROM AUTHOR]

Background: Unaccompanied asylum-seeking and refugee minors report low life satisfaction and high levels of mental health problems, nevertheless they often do not seek or receive help for their problems. Teaching Recovery Techniques (TRT) is a low-threshold, five sessions intervention developed to reduce distressing war- and disaster-related trauma reactions among children and youth. In this study, we investigate if TRT can contribute to increased life satisfaction among unaccompanied asylum-seeking and refugee minors. Methods: Asylum-seeking and resettled unaccompanied minors participated in TRT carried out in 15 locations throughout Norway, n = 147, mean age = 16.61 (SD = 1.80), 88% boys, and 67% from Afghanistan. Life satisfaction was measured by the Cantril Ladder before the intervention, and two- and eight weeks post-intervention. We also included indices of intervention compliance and contextual variables, such as asylum status. We applied a pre- and post-intervention design with linear mixed model analyses to investigate change in life satisfaction. Results: Life satisfaction significantly increased from pre- to post- intervention, but not for youth whose asylum application had been rejected or who were still awaiting a decision. Indices of intervention compliance were associated with an increase in life satisfaction. Conclusions: TRT is a potential useful intervention to enhance life satisfaction among unaccompanied asylum-seeking and refugee minors and can be a measure to support positive development among youth at risk for mental health problems. However, TRT initiatives should consider the participant's stage of asylum process, because harsh immigration policies may overburden the coping capacity. Without further adaptation, TRT seems most useful for youth granted residence. The manual has been revised to include asylum-related stressors. Trial Registration: ClinicalTrials.gov (16/54,571, registered 30.01.2019). [ABSTRACT FROM AUTHOR]

Introduction: Adolescent athletes who sustain a sports-related concussion may experience a prolonged recovery period.1 Evidence suggests female athletes and those with a history of previous concussion may have an extended recovery period, spanning multiple weeks to months.2 Objectives: To track recovery from a concussion across patient-reported measures and determine the time taken to return to pre-injury levels in adolescent rugby union players. Study design: A longitudinal study was utilised across a single rugby union playing season (2022-23). Ethical approval was granted from Ulster University Research Ethics Committee Methods: Male and female rugby union players were recruited from nine school and club rugby teams across Northern Ireland. To be eligible, participants had 16-18years of age, injury free and currently playing at First XV level. Participants completed demographic and established questionnaires including Post-Concussion Symptom Scale (PCSS), Concussion Clinical Profiling (CP), Paediatric Fear Avoidance Behaviour after Traumatic Brain Injury (PFAB-TBI), General Anxiety Disorder (GAD) and Patient Health Questionnaire (PHQ). Those who sustained a concussion were re-assessed at 3, 7, 14, 23, 90 and 180days post-event. Recovery was defined as questionnaire score at pre-injury level. Primary outcome measure with Post-Concussion Symptom Scale. Results: Of the 149 participants (113M (76%); 36F (24%)), 11 (7%) sustained a concussion during the season (9M: 2F), of which four had a previous history of concussion (2M: 2F). PCSS and PFAB-TBI took the longest time to return to baseline scores. Statistically significant differences in survival distribution (Chi-square 9.27 (df=4) p<0.05) across self-reported outcomes; pairwise comparisons show the largest differences in survival distribution were seen between PCSS and GAD (p=0.02) and PCSS and PHQ (p<0.04). Conclusions: Adolescent male and female rugby union players experienced prolonged post-concussive symptoms based on self-reported measures. Further research on male and female adolescent athletes is needed to track re- covery across various clinical measures. [ABSTRACT FROM AUTHOR]

Introduction: Chronic ankle instability (CAI) develops after 30-40% of ankle sprains.1 Etiological models suggest CAI is underpinned by pathomechanical and sensorimotor deficits, but this is largely informed by cross sectional data.2 Objectives: To prospectively record key clinical outcomes and evaluate their individual recovery at 6 and 12 weeks post ankle sprain Study design: Prospective cohort study Methods: Athletes (>18y) presenting with an acute lateral ankle sprain (LAS) (<14 days) were recruited from hospital ED's, social media and physiotherapy clinics. The following outcomes were recorded at 6 and 12 weeks post injury: perceived instability (CAIT), self-reported ankle function (Q-FAAM), range of motion (ROM), strength, joint positional sense (JPS), balance and jump performance. For each outcome, recovery was considered as the point at which scores for the affected ankle were ≥ to the contralateral side (± minimal detectable change - MDC). We also recorded re-injury (%), and time to return to sport. Results: We have recruited N=33 patients (61% male; mean age 29y (range 18-60)), with 28 completing 6 and 12 week follow ups. At weeks 6 and 12, many participants had comparable side to side scores for ROM (61%; 89%) and balance (82%; 86%). Fewer participants reported normal scores for CAIT (23%) and Q-FAAM (13%) at week 6, with some increases at week 12 (50% and 46%). Muscle strength, JPS and jump performance were inconclusive. At 6 weeks, 50% had return to sport, increasing to 95% at 12 weeks. By week 12, 12 participants (36%) had incurred a re-sprain. Conclusions: Recurrence rates are high and align with previous reports. Our initial results suggest that sensorimotor outcomes seem to recover up to 12 weeks post LAS, but time to recovery varies considerably across these outcomes. Recruitment is ongoing; future analysis will examine key predictors of CAI.3 [ABSTRACT FROM AUTHOR]

Objective: The aim of our study was to gain insight into how practitioners in mental health care support people with severe psychiatric disabilities in setting and pursuing personal goals that are meaningful to them. Method: We conducted focus groups with 36 mental health practitioners in Norway and interpreted the data by using reflexive thematic analysis. Results: Four themes emerged from the analysis: (a) active collaboration to understand what is meaningful to the individual, (b) being nonjudgmental during the process of goal setting, (c) helping individuals break goals into smaller goals and steps, and (d) allowing time for the process of trying to achieve goals. Conclusions and Implications for Practice: Although goal setting is central to the Illness Management and Recovery program, practitioners perceive the work as quite demanding. To succeed, practitioners need to acknowledge goal setting as a long-lasting and shared process, not as a means to an end. As people with severe psychiatric disability often need help in goal setting, practitioners should play an important role in supporting them in setting goals, making plans for achieving them, and taking actual steps in that direction. Impact and Implications: Goal setting is a shared process where true collaboration is needed. Practitioners should monitor an individual's ambitions and goals even when they face increasing demands to treat individuals quickly, cheaply, and efficiently. If practitioners let financial and administrative priorities dictate their clinical practice, there is a risk that they will become less responsive to individuals' ambitions, rush to set goals too quickly, and not really attend to where individuals are. [ABSTRACT FROM AUTHOR]

Fibromyalgia is a contested illness with unknown aetiology and poorly understood development. The present aim is to explore the pre-diagnostic illness trajectory narrated by individuals recently diagnosed with fibromyalgia (FM). Individual interviews about the course of the illness were conducted with seven women and three men (age from early 20s to 50s) who had recently been diagnosed with FM. A narrative analysis of what the interviewees told and how the stories were narrated was conducted. The findings are expressed by three storylines. "Strenuous life and alerted body preluding illness" displays a difficult, unsupported life and bodily sensitivity to stimuli. "Recurrent pains unfolding to become a lasting and complex illness" describes individuals pushing themselves to meet social obligations until they come to a full stop. "Diagnosed but still uncertain presence and future" portrays satisfaction with finally being diagnosed with FM and being supported by others, but still there are no solutions as to do about it. The three storylines portray a long, winding trajectory of suffering starting before the onset of illness, and unfolding illness gradually becoming persistent and overwhelming. Finally, a diagnosis of FM is arrived at, but how the situation will evolve is uncertain. [ABSTRACT FROM AUTHOR]

The aims of this study are to examine the one-year trajectory of sleep problems, identify clinical correlates, and describe subjective experiences related to persistent sleep problems during recovery from substance use disorders (SUD). This study builds on a sequential mixed method design. The quantitative component features data from a prospective longitudinal study of 127 poly-SUD patients in the Stavanger area in Norway, while the qualitative component describes a thematic analysis of interviews with 16 persons from this study still experiencing sleep problems after at least one year of abstinence. The prevalence of sleep problems at baseline for the whole cohort was 79%. Among the 59 patients who were abstinent after one year, N = 20 (33.9%) had moderate and N = 11 (18.6%) had severe sleep problems. Persistent sleep problems were associated with psychological distress and were experienced as a major challenge in the struggle to stay drug free. Establishing daily routines related to work, school, and care for children were coping strategies for participants with persistent sleep problems. Persistent sleep problems are often overlooked in a clinical setting. Based on our findings, these issues pose a major challenge in the struggle to stay drug free. For patients with psychological distress, and lack of responsibilities that established daily routines, sleep difficulties may result in increased risk of drug use episodes that result in relapse. These results argue that screening and evidence-based methods for insomnia and sleep health-programs should be commonplace adjunct intervention for patients with SUDs. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the recovery of physical function, health related quality of life (HRQoL), and pain for people following hip fracture for the initial 12 months, and to examine whether postoperative outcome measures of physical function, HRQoL, and pain can predict physical function at 3 and 12 months. Design: A prospective single‐center observational study, as part of the HIPFRAC trial. Settings: One hospital with two associated municipalities in Norway. Subjects: 207 participants with hip fracture included in the study (140 participants transferred to a short‐term nursing home placement and 67 transferred directly home at discharge from hospital). Method: Outcome measures were Short Physical Performance Battery (SPPB), Timed Up & Go (TUG), Stair climbing test (SC), Numeric Rating Scale (NRS) for pain at rest and in activity, and EQ‐5D‐5L index and health score. Data were analysed by repeated measures of variance and multivariate regression analyses. Results: There were statistically significant improvements in physical function (SPPB total score and TUG), NRS‐pain in activity, and HRQoL (EQ‐5D‐5L) from hospital discharge to 3‐month follow‐up for the whole cohort and the two groups (p < 0.001). However, the largest improvements occurred within the first 3 months. Further statistically significant improvements occurred between 3 and 12 months (p < 0.05). The strongest predictors of physical function at 3 and 12 months post‐fracture were physical function (SPPB) at hospital discharge and pre‐fracture requirement of a walking aid. Conclusion: The recovery of physical function, HRQoL, and pain in participants after hip fracture indicates gradual improvements during the initial 12‐month follow‐up, with the largest improvements within the first 3 months. [ABSTRACT FROM AUTHOR]

Purpose: Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach: The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings: Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value: The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems. [ABSTRACT FROM AUTHOR]

To study the feasibility of a structured conversation tool (ICIT) in Norwegian general practice. A structured conversation tool with elements from Cognitive Behavioral Therapy (CBT) was developed for use at the encounter in general practice to increase patient's self-coping ability and the GPs management and sick leave assessment in patients with MUPS. Eight GPs received training and used the ICIT on 49 patients with MUPS. The physicians were gathered into two focus groups. The interviews were recorded on tape, transcribed, and analyzed with systematic text condensation. The aim of our study was to examine any benefit and the feasibility of the ICIT in general practice. The physicians found the ICIT helpful to sort out, clarify and concretize the patients' issues. They felt less fatigued as patients took on a greater responsibility for their own recovery and reported a greater satisfaction and better management with the patients. A salutogenic approach gave the physicians greater insight into their patients' lives and their issues, opening for new treatment options and aiding in recovery. By focusing on the patient's potential capabilities despite their medical condition, some physicians experienced that patients on sick leave returned to work quicker. The GPs in this study reported that the ICIT was helpful in consultations with patients due to unspecific medical conditions and facilitated a sense of competence for the physician. GPs need communication skill training for integrated treatment and sick leave assessment for patients with Medically Unexplained Physical Symptoms (MUPS). •The GPs experienced that the structured conversation tool was beneficial in structuring, clarifying, and substantiating the patient's problems. •The GPs experienced a greater insight into their patients and their issues, opening new treatment options and aiding in recovery. •The GPs experienced patients' quicker recovery and returns to work by starting immediate treatment using the conversation tool. [ABSTRACT FROM AUTHOR]

Peer recovery services (PRS) in Norwegian municipalities fill a gap in available care in mental health care and/ or substance abuse treatment. In this qualitative study, we interviewed six peer recovery workers (PRWs). Our aim was to explore how the PRWs understood their competences as vital for carrying out the work in PRS. Through a thematic analysis, we found themes the PRWs recognize as important in their recovery competence. The findings can be of practical relevance to those aiming to develop more recovery oriented mental health distress and substance abuse services. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore and describe staff working in a Norwegian supportive housing site's experiences with promoting social community participation for residents with co-occurring problems. The research question addressed was: how does residential support staff experience promoting social community participation for residents with co-occurring problems? Design/methodology/approach: Nine residential support staff participated in qualitative interviews. All interviews were recorded and transcribed verbatim. The transcripts were analysed using Braun and Clarke's approach to thematic analysis. Findings: The analysis process resulted in two themes: "It is all about economics" and "Who will pay for it?" Practical implications: Regarding the Nordic welfare system, the need for a redistribution of financial resources in health services is discussed. The authors recommend that further studies explore people outside the regular health-care system perspectives on how they can contribute to making community inclusion a reality for persons experiencing co-occurring problems. Originality: This study provides a nuanced understanding of how financial resources can impede or support efforts and opportunities to promote community inclusion for residents experiencing co-occurring problems. [ABSTRACT FROM AUTHOR]

Aim: To measure change in service user involvement in secure mental health units, before and after the implementation of recovery‐oriented practice. Design: Quasi‐experimental study pretest–posttest design with non‐equivalent comparison groups. Methods: Data were collected from May 2018 to December 2019 in four medium‐/high‐security units in Norway. Two intervention units that implemented recovery‐oriented practice were compared with two comparison units that did not. Data were obtained using anonymous questionnaires at baseline and at 6‐month follow‐up. For intervention units, data were also obtained at a 12‐month follow‐up to measure sustainability of improvements over time. Twenty inpatients ('patients'; intervention group: 10, comparison group: 10) and 141 members of frontline staff ('service providers'; intervention group: 92, comparison group: 49) participated at baseline. Mann–Whitney U‐tests and independent sample t‐tests were applied at the group‐level to analyse changes in mean scores in groups. Results: Among patients in the intervention units, findings indicated no improvements after 6 months, but significant improvements after 12 months in terms of patients' opportunities to participate in formulating their individual care plans, to influence decision‐making about therapy and to receive information about complaint procedures. Opportunities to participate in discussions about medication and treatment regimens did not improve. After 6 months, service providers in the intervention units reported an increase in democratic patient involvement, patient collaboration and management support, but not in carer involvement and assisted patient involvement. The improvements in democratic patient involvement and management support were sustained over time. No changes were found in the comparison groups. Conclusion: The patients and the service providers reported a higher degree of service user involvement after implementing recovery‐oriented practice. Specific work is needed to ensure patients' involvement in all domains. Impact: The findings are encouraging with respect to the potential to increase empowerment in a restricted setting through the implementation of recovery‐oriented practice. [ABSTRACT FROM AUTHOR]

Background: The Recovery Knowledge Inventory (RKI) was developed to operationalise the recovery construct and in turn contribute to moving mental health services towards recovery‐oriented practice. This study validated the RKI in a sample of Norwegian mental health care practitioners and examined mental health workers' knowledge of and attitudes towards patient recovery. Methods: The RKI was translated into Norwegian and tested on 317 mental health workers from 7 primary and 22 specialised mental health care units within a defined geographical area of Norway. Results: Psychometric challenges to the RKI were observed and called into question the previously proposed four‐factor structure. The findings of the scale revealed that the study sample scored significantly lower than a comparable sample in a previous study, suggesting that the Norwegian mental health workers have relatively low orientation towards recovery. This finding was especially applicable to the reduction of symptoms and treatment, which the respondents perceived as essential for recovering from mental illnesses and substance abuse disorders. Conclusions: To operationalise the recovery construct, the development of a measure such as the RKI needs further attention. For psychiatric practice to be moved in a more recovery‐oriented direction, consensus on what constitutes well‐functioning recovery must be reached by patients, practitioners and researchers alike. [ABSTRACT FROM AUTHOR]

Colorectal cancer affects a large number of people aged ≥80 years. Little is known about how they manage after discharge from hospital. The aim of this study was to explore the experiences of individuals aged ≥80 years recovering from surgery for colorectal cancer, and the challenges they may encounter after discharge from hospital. Data were collected between January and March 2016 through in-depth interviews with ten participants approximately one month after surgery. Inductive thematic analysis was employed to analyse the data. The COREQ checklist was used in reporting this study. Two themes were identified: Managing the recovery from CRC surgery, and Insufficient follow-up from the healthcare services after CRC surgery. The findings indicate that older people treated for colorectal cancer manage surprisingly well after discharge despite challenges in their recovery; however, there are seemingly areas of improvement in their follow-up healthcare. [ABSTRACT FROM AUTHOR]

Purpose: Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach: The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings: Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value: The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems. [ABSTRACT FROM AUTHOR]

Purpose: Guided by narrative theory and by use of a narrative-in-action approach, the aim of this study was to explore how mental health recovery unfolds through individuals' engagement in everyday activities. Method: Data were created through participant observations with four individuals while doing everyday activities, and analysed through a narrative, interpretive approach. Findings: The findings show how mental health recovery involves unique and open-ended processes of narrative meaning-making, which unfold through an interplay between everyday activities, places and persons. Discussion: Based on these findings, we discuss how we may understand and support mental health recovery as collective processes. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to explore child sexually abused survivors' experiences of dental treatment in order to obtain a deeper understanding of them as dental patients. Methods: Data were drawn from qualitative semi‐structured interviews with 16 adult informants recruited from four different Centres against Sexual Abuse in Norway. Data analysis was developed according to the principles of grounded theory suggested by Charmaz. Results: A conceptual framework was generated, and a core concept was constructed from the informants' reports of their experiences of dental treatment: Preparing for attack and recovering from battle based on four main categories: (a) Expecting danger, (b) Battling anxiety, (c) Reliving abuse and (d) Struggling with the aftermath. Conclusions: The analyses increase the understanding of how child sexual abuse survivors prepare before—battle during—and recover after dental treatment. This study revealed child sexual abuse survivors' experiences of extensive anxiety, triggered by sensory stimuli such as sensations, movement, muscles, touch, sight, sound, smell and taste, associated with dental procedures per se, but also sensory stimuli similar to previous traumatic experiences. The findings suggest that child sexual abuse survivors' dental anxiety is primarily trauma‐driven and possibly being one of the long‐term effects of child sexual abuse. This may be an important contribution to the understanding of CSA survivors and should affect the approach of clinicians treating dental patients with such a history. [ABSTRACT FROM AUTHOR]

Mental health issues among young people have received increasing attention in Norway as more are diagnosed with and report mental health problems. In this study, we focus on the personal and social recovery processes of young people with mental health difficulties. The aim of the study was to explore how young people and parents experience collaboration with a community-based mental health outreach team around recovery processes, using a narrative analysis. Three topics from the findings are discussed: relationships and collaborations built on the service user's goals, closeness and distance in professional helping relationships, and comprehension of professionalism. [ABSTRACT FROM AUTHOR]

Purpose: Recovery for residents who experience co-occurring problems and live in supported housing takes place in everyday contexts. This study aims to explore residents' self-reported recovery and quality of life and examine the relationships between these factors and issues in supported housing. Design/methodology/approach: A cross-sectional study was conducted at 21 supported housing sites in six cities across Norway. A total of 104 residents (76 men and 28 women) responded to measures of recovery (Recovery Assessment Scale – Revised), life satisfaction (Manchester Short Assessment of Quality of Life), affect (single items), staff support (Brief INSPIRE) and sense of home (single items). Findings: Linear regression analyses indicated associations between recovery and staff support (B = 0.01, 95% CI = 0.01-0.02, ß = 0.39), housing satisfaction (B = 0.15, 95% CI = 0.07-0.22, ß = 0.38), sense of home (B = 0.23, 95% CI = 0.14-0.32, ß = 0.49) and satisfaction with personal economy (B = 0.11, 95% CI = 0.05-0.17, ß = 0.33). Similarly, associations were found between life satisfaction and staff support (B = 0.03, 95% CI = 0.02-0.04, ß = 0.46), housing satisfaction (B = 0.63, 95% CI = 0.46-0.80, ß = 0.60), sense of home (B = 0.65, 95% CI = 0.42-0.87, ß = 0.51) and satisfaction with personal economy (B = 0.34, 95% CI = 0.19-0.50, ß = 0.39). Originality/value: The findings imply that core issues in supported housing, namely, staff support, housing satisfaction, sense of home and satisfaction with personal economy, are associated with recovery and quality of life. [ABSTRACT FROM AUTHOR]

Social factors seem to play an important role in people's recovery processes, yet little attention has been given to such aspects in relation to early psychosis. In this study, we explored how young adults with first episode psychosis experienced relationships inside and outside the mental healthcare services related to their early recovery processes. We interviewed ten young adults who had been in contact with an early detection team for psychosis. The analysis involved thematic and reflexive team-based methods and drew on hermeneutic–phenomenological perspectives. We identified two themes concerning relationships with professionals: 1) being seen as a unique person with preferences and 2) getting help when you are lost. We came across three additional themes, this time, in relation to family and friends: 3) supportive family networks, 4) they cannot understand everything, and 5) different kinds of friendships. Our findings revealed that people both within and outside mental healthcare services were seen as essential (for better or worse) and often played complementary roles. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore quality of life (QOL) during the first year of recovery after stroke in North Norway and Central Denmark. Method: Individual in-depth interviews with 11 stroke survivors were performed twelve months after stroke onset. An interpretative, inductive approach shaped the interview process and the processing of data. Results: We found that QOL reflected the individuals' reconstruction of the embodied self, which was identified by three intertwined and negotiating processes: a familiar self, an unfamiliar self, and a recovery of self. Further, we found that reconstruction of the embodied self and QOL could be framed as an ongoing and interrelated process of "being, doing, belonging and becoming". Enriching social relations, successful return to work, and continuity and presence in professional support during recovery enhanced the experience of QOL. Fatigue and sustained reduced function hindered participation in meaningful activities and influenced the perceived QOL negatively. Conclusions: The two countries differed in descriptions of continuity and support in the professional follow-up during the recovery process, influencing the degree of encouragement in reconstructing the embodied self. Reconstruction of the embodied self is a means of understanding stroke survivors' QOL during the first year of recovery, supporting an individualized and tailored rehabilitation practice. [ABSTRACT FROM AUTHOR]

This study explores the lived experience of hospitalisation from the perspective of people with a mental health disorder. This hermeneutic‐phenomenological study, which forms part of a larger qualitative serial inquiry, uses a participatory research design, with analysis inspired by interpretative phenomenological analysis. Fourteen participants were interviewed twice: first during hospitalisation and then again 3 months following hospital discharge. Findings are reported from the entire interview data set. Our findings suggest that mental health hospitalisation is a contradictory experience for patients. On one hand, our study participants experienced the hospital as a place where it is alright to be vulnerable, while on the other hand participants experienced hospitalisation as a burden of everyday stigma and signs of depersonalisation. We conclude that it is important to recognise that patients in need of inpatient treatment for mental illnesses are, in fact, people first and foremost. More reflective practice can be developed by shifting the focus to recovery‐oriented practices to and open dialogue‐based approaches. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore aspects that promote and challenge long‐term ICU patients' inner strength and willpower. Background: Considerable research has been devoted to ICU patients' experiences; however, research on long‐term ICU patients is limited. Studies in a health‐promoting perspective focusing on long‐term ICU patients' inner strength and willpower are scarce. Design: A qualitative, hermeneutic‐phenomenological approach, using in‐depth interviews. Methods: Seventeen long‐term Norwegian ICU patients were interviewed once, at 6–18 months after ICU discharge. The consolidated criteria for reporting qualitative research was used (Data S1). Results: The lived experience of the phenomenon "inner strength and willpower" and what promotes and challenges this phenomenon in long‐term ICU patients were represented by four main themes and nine subthemes. Promoting aspects comprised of two main themes and five subthemes: (a) "No doubt about coming back to life" with subthemes; "Strong connectedness to life; feeling alive and present," "Meaning and purpose; feeling valuable to somebody." (b) "How to ignite and maintain the spark of life," with the subthemes: "Practical solutions, coping skills from previous life experiences," "Provocative and inspiring experiences" and "Vivid dream experiences that ignite the willpower." Two main categories and four subcategories represented challenging aspects: (a) Exhaustion, weakness and discomfort; subthemes; "Physical challenges" and "Mental discomfort" and (b) "Tiring delusions," subthemes; "Living in the worst horror movie" and "Feeling trapped." Conclusion: This study expands on previous studies by providing insights about what promotes and challenges long‐term ICU patients' inner strength and willpower during their recovery trajectory. Relevance to clinical practice: Insights into the variety of long‐term ICU patients' experiences during the recovery trajectory are important for ICU nurses to support and facilitate ICU patients' inner strength and willpower. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to explore embodiment as a meaning‐making experience in the daily life of Norwegian adults living with joint hypermobility syndrome/Ehlers‐Danlos syndrome, hypermobility type (JHS/EDS‐HT). The work of Drew Leder and his distinction between bodily dis‐ and dys‐appearance contributes to the description and analysis of individuals' bodily experiences of living with this chronic illness. Methods: An explorative and qualitative design was applied to in‐depth interviews with seven participants. The theoretical framework was phenomenological, and the method of analysis was thematic, involving descriptive and interpretative approaches. Results: Participants' bodily experiences were closely connected to a timeline viewing their illness in the past, the present and from future perspectives. The following central themes emerged from the data: (a) visible to invisible signs of a former body; (b) standing up and falling down of a present body; and (b) future thoughts of an inner and outer body. Conclusions: The study found that living with JHS/EDS‐HT revealed complex experiences of having flexible bodies and restricted lives. Our findings also showed a meaning‐making process of embodied experiences that evolved over time, as well as a sliding transition from social to personal dys‐appearance. In the course of time, a bodily disruptions in social interactions comes to the fore, with invisible symptoms such as pain and fatigue. Individual bodily suffering determines the existence of hope or hopelessness regarding recovery from this condition. [ABSTRACT FROM AUTHOR]

Hope is a pivotal part of recovery in a broad range of health conditions, including those relating to the field of mental health and substance abuse. People who experience co-occurring mental health and substance-use problems are often bound to use services that are not suited to their needs. In this study, our aim is to explore how service users experience barriers to help and assistance, and to determine the manner by which these barriers may influence their experiences of hope. Data were collected through in-depth interviews with nine participants, and these were analyzed using a thematic approach. This analysis produced the following three overarching themes: "battles with bureaucracy"; "distance, disempowerment, and de-individualization"; and "no clean slates." [ABSTRACT FROM AUTHOR]

Aims and objectives: To describe breast cancer (BC) survivors' experiences of participating in a 2‐day educational programme (Breast Cancer School, BCS) and their critical reflection on information received during and after adjuvant treatment. The following research questions guided the study. How do BC survivors experience their participation in an educational programme? How do BC survivors experience the information trajectory during and after adjuvant treatment? Background: BC is the most prevalent cancer among women in Norway. BC survivors have a substantial need for information about the disease, treatment and recovery. During the past few years, BC treatment in Norway has changed from inpatient‐ to outpatient‐based treatment. Oncology nurses and oncologists are obliged to provide patients and their families with information, which has necessitated reorganisation of the procedures for providing information. New arenas such as the Breast Cancer School (BCS) offer the opportunity to learn from experts and fellow patients. Design: Qualitative, descriptive design. Methods: Focus groups with 20 BC survivors after having participated in the BCS were used to enable critical reflection. The COREQ checklist was followed to ensure rigour in the study. Results: Two themes emerged from qualitative analysis: Balancing between the need for and the fear of information and Moving from a safe structure to lonely recovery. We identified differences between BC survivors in diversity, uniqueness and need for information. Continuity and expert knowledge provided by a primary oncology nurse and oncologists were highlighted as important. Conclusion: The study reveals the need for information tailored to each BC survivor's unique needs. The BC survivors expressed both the need for and the fear of information. BCS takes both a systematic and individual approach to provide expert information, dialog and the opportunity to meet with fellow patients. The transition from the structure of the treatment to lonely recovery after the most intensive treatment was perceived as unsafe and challenging. BC patients' experiences must be continuously valued and used to improve educational programmes, care and treatment. Oncology nurses play an important part in the information chain and continuity. Relevance to clinical practice: This study highlights the importance of including BC survivors in the design and evaluation of educational programmes. The provision of information and supportive care with continuity between oncology nurses and oncologists through the trajectory of treatment and care is crucial. [ABSTRACT FROM AUTHOR]

Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a 'perspective from above'. In this perspective, the readers are learning about psychosis in the professional's language and from the author's viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a 'perspective from within'. Here, the readers are learning about psychosis from the patients' own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon's writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients' own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness. [ABSTRACT FROM AUTHOR]

The impact of stress on health can depend on factors such as frequency, heightening of stress during a given period or the presence of one or a few repeated hassles of psychological importance. The aim of this study was to gain a deeper understanding of how adult women experience and cope with daily hassles after sexual abuse. Ten interviews were analysed using the grounded theory method. The theoretical model of 'protecting armor in daily life' emerged. The aftermath of sexual abuse related coping with daily stress can be understood as a three‐phase process: (1) avoiding and escaping—coping after experiencing sexual abuse; (2) accepting and disclosing—starting a process of recovery; and (3) reconciling and repossessing—living with the experience in the present. The model contributes to a deeper understanding of the everyday life of women who have experienced sexual abuse. Increased knowledge of coping behaviours that can be used to deal with daily hassles may also serve as a tool for health professionals, other helpers and family to help these women rebuild a good life. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aims to describe surgically treated lung cancer patients' experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs. Background: Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients' supportive care needs after being discharged from hospital. Design: This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ). Methods: The information about 14 patients' experiences was collected from semi‐structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis. Results: The main theme of the study, "Longing to get back on track with their lives", consisted of four categories: "Burdened with problems related to postoperative symptoms and treatment", "Struggling for the needed support", "A pendulum between being in need of support and being independent", and "Striving to adapt to a new way of life". The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle. Conclusions: The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients' discharge by including them and their caregivers in the discharge planning. Relevance to clinical practice: Knowledge of patients' perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning. [ABSTRACT FROM AUTHOR]

Introduction: Pharmacological interventions are viewed as central to clinical work with people diagnosed with bipolar disorder. But what is the meaning of medicine? How do clinicians view the role of medication in recovery processes in bipolar disorder? The aim of this study was to explore the perspectives of experienced therapists regarding the role of medicine in the treatment of people with bipolar disorder. Methods: In a Norwegian specialist mental health care setting, we conducted 12 semi‐structured individual interviews with experienced therapists and analysed the resulting transcripts using a team‐based thematic analysis method. Findings: We identified four themes: (a) the bedrock of therapy; (b) an imperfect answer and a dangerous tool; (c) the hallmark of insight; and (d) negotiating medicine, negotiating meaning. Conclusion: We relate our findings to the shortcomings of the dominant medical model and argue that a recovery perspective can be a helpful tool for counsellors and psychotherapists in understanding the meaning of medicine for people with bipolar disorder. [ABSTRACT FROM AUTHOR]

Few studies address the many challenges that are faced by staff and patients in the inpatient mental health context. In particular, there is a lack of research that explores first-hand patient experiences in order to establish what treatment practices best assist patient recovery and what are the barriers to these practices. This qualitative study, which utilises a user-involved research framework, collaborates with a co-researcher patient group throughout the study. Fourteen patients, all of whom had been in inpatient treatment for at least three weeks, were recruited to the study. Study participants were interviewed in-depth in the period September 2016 to March 2017. Data underwent a thematic analysis that was inspired by interpretative phenomenological analysis. A core theme of the findings was the importance of being recognised as a whole person, and the patient–professional relationship was regarded as a fundamental factor in fostering recovery, with two underlying themes: (i) a need to have one's self-identity recognised and supported, and (ii) an experience of ambivalence between needing closeness and distance. This study suggests ways nurses can give priority to interpersonal interactions and relationships with hospitalised patients over task-oriented duties, highlighting the need for nurses to balance patient competing needs for both closeness and distance. [ABSTRACT FROM AUTHOR]

Traditionally, there has been a sharp division between 'personal' and 'clinical' recovery. What role, then, might therapy play in personal recovery? To explore how female adult trauma survivors experience working towards recovery after participation in trauma-specific group therapy, we carried out semi-structured qualitative interviews with 13 clients one year after their completion of a stabilization group approach. A hermeneutic-phenomenological approach was used to analyze interview transcripts. After therapy, the participants consolidated and continued their positive processes of change. Experiences from therapy gave rise to personal recovery processes that were categorized into two main themes: "tapping into pre-therapy resources" and "using therapy-related resources." Therapy might play an important role in personal recovery through helping clients to rediscover and utilize existing resources, as well as being a source of new resources. The participants were active agents in this recovery, putting their therapies to use in the context of their daily living. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore two research questions: how do people with concurrent substance abuse and mental health disorders (concurrent conditions) experience and describe meaningful activities? And how do meaningful activities influence the recovery process?Design/methodology/approach This qualitative study uses an explorative and interpretive design in a phenomenological-hermeneutic approach. Transcribed interviews are analysed using a phenomenological-hermeneutic method for researching lived experience. The study was submitted to the Norwegian Center for Research Data where it was approved (Case No. 54661).Findings Structural analysis resulted in three overarching themes: achieving a positive identity through actions and feeling worthwhile; physically outside but inside the norms of society, and idleness, isolation, and obstacles on the road to recovery. Meaningful activities, considered a cornerstone in the recovery process, vary widely and are primarily described in social contexts, thereby confirming the significance of social aspects of recovery in addition to recovery as an individual journey. The findings also show that experiencing meaningful activities contributes to recovery capital and the development of recovery-promotive identities.Research limitations/implications The study consisted of a small sample size, recruited at one location which served as a primary research limitation.Practical implications This paper provides insights for health care practitioners and health care decision makers regarding the importance of meaningful activities viewed through a recovery perspective.Originality/value Few studies to date have used a comprehensive approach to describe the influence of experiencing meaningful activities on the recovery process. [ABSTRACT FROM AUTHOR]

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

Background: Total knee arthroplasty is experienced as a painful procedure, and pain after surgery seems to be the most limiting factor for early mobilisation. Physical exercise is of utter importance for avoiding complications such as persistent pain and functional limitations. A fast‐track pathway aims at improving patient outcome, and patients are now discharged 2–3 days after surgery. Little is known about how the patients cope with pain, exercise or daily activities at home. Aim: To explore the experience of patients undergoing total knee arthroplasty in a fast‐track pathway during the first 2 weeks after surgery. Design: Qualitative design. Methods: Three focus group interviews, including 13 patients from two different units of an orthopaedic department in central Norway, were conducted from May to June 2015. The interviews were analysed using Malteruds` method of systematic text condensation. Findings: The main finding was the patients' determination and ability to cope at home. The fast‐track pathway seemed to enable patients to take an active role in own self‐care. The patient's coping capacity was strengthened by education, knowledge and predictability. Four main areas related to coping emerged after discharge. First, the majority of patients expressed that it was good to come home and take responsibility for their own rehabilitation. Second, prerequisites for feeling secure after returning home were highlighted. Third, the patients seemed empowered by sharing experiences with others. Fourth, postoperative pain was prevalent in many patients after discharge, but the patients seemed prepared by information provided in the fast‐track pathway. Conclusion: The fast‐track pathway released coping skills and resources among the patients. The expectation of, and preparation for early discharge made the patients feel confident when discharged few days after surgery. The patients expected to take great responsibility for their own rehabilitation process. [ABSTRACT FROM AUTHOR]

Abstract: Recovery is a crucial concept in the mental health field. The research of recovery is split into the categories of personal, social and clinical recovery. The purpose of this study was to explore the fragmented concept of recovery in light of assertive community treatment (ACT) in Norway. The study has a mixed methods design with a pragmatic approach. The Questionnaire about the Process of Recovery and open‐ended questions posed to 70 participants from 12 ACT teams in Norway, gathered by the “Users interview users” method, are combined with interviews or focus groups with eight of these participants. Surprisingly those under a community treatment order (CTO) report the highest degree of personal recovery. The qualitative material shows that the service users interpreted the concept of recovery differently than researchers and professionals. The ACT service users highlighted three important elements: flexible treatment, medication and access to a car. They emphasized the necessity for basic needs to be met in order to experience a meaningful recovery process, and these basic needs may be of even greater importance to those under CTOs. Their experiences should imply a greater emphasis on securing basic needs such as secure housing, sounder finances and access to the normal benefits offered by society. [ABSTRACT FROM AUTHOR]

Background: Post-infectious fatigue syndrome (PIFS), also known as post-viral fatigue syndrome, is a complex condition resulting in physical, cognitive, emotional, neurological, vocational and/or role performance disabilities in varying degrees that changes over time. The needs for health care resources are high, and costly, as is the economic burden on the affected individuals. Many factors may impact the trajectory, and frequently PIFS develops into a chronic condition. Health professionals lack understanding and knowledge, which results in delayed diagnosis, lack of recognition, appropriate treatment, support and practical help. The aim of our study was to explore, from the perspective of persons who had lived with PIFS for four years following an outbreak of Giardia l. induced enteritis, factors that may have impacted their illness trajectory and how these factors had played a role during different phases.Methods: In this retrospective exploratory qualitative study a group of 26 affected adults between 26 and 59 years old were selected for in-depth interviews. A maximum variation sample was recruited from a physician-diagnosed cohort of persons with PIFS enrolled at a tertiary outpatient fatigue clinic. The interviews were audio-recorded, transcribed verbatim and subjected to qualitative content analysis.Results: Unhelpful and helpful factors were associated with the healthcare system, health professionals and the affected persons were experienced as having an impact on the trajectory. External impacting factors which are related to the health care system, providers and the social security system are misdiagnosis, trivialization of symptoms, unhelpful advice, delayed diagnosis and lack of appropriate help. Internal impacting factors related to the affected individuals were lack of knowledge, overestimating functional capacity, assuming the condition will pass, ignoring body signals and denial. A model of impacting factors in each phase of the trajectory is presented.Conclusion: Unmet needs may result in unnecessary disability and high societal and personal costs. Enhanced knowledge of impacting factors in each phase of the trajectory may contribute to more timely and tailored health care services and less use of health services. Increased functional capacity, improved health and ability to work or study may reduce the societal costs and the economic burden for the affected individuals. [ABSTRACT FROM AUTHOR]