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Aim: To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser–provider organization in Norway. Design: A qualitative descriptive study. Methods: Semi‐structured interviews with open‐ended questions were used, and data were collected from in‐depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six‐step analysis was used to analyse the empirical data. Results: The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser–provider organisation of healthcare,' with five associated codes. Conclusion: Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion. Impact: The purchaser–provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser–provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy‐makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust. Implications: This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses. [ABSTRACT FROM AUTHOR]

Standards developed by standard-setting organisations (SSOs) – sometimes labelled private rulemaking – are part of larger practices of governance in most societies yet are underinvestigated from a policy process perspective. Utilising and developing the multiple streams approach (MSA), this article investigates a policy process moving between government and the SSO Standards Norway (SN). The study finds standardisation by SSOs to be an ambiguous institutional arrangement. Strong institutional barriers in theory did not work as such in the case investigated. This article argues that the differentiation between responsibility for process (SN) and content (committee) makes the standardisation process vulnerable. The concept of "institutional deficit" is introduced to describe a potential mismatch between SSOs producing policy in a government-like institution, but where the SSOs are not capable of taking responsibility for policies in a government-like way. This article finds the adjusted MSA useful in this potentially least likely case. [ABSTRACT FROM AUTHOR]

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Background: The documentation of goals and outcomes of nutrition care in Electronic Health Records is insufficient making further exploration of this of particular interest. Identifying common features in documentation practice among Scandinavian dietitians might provide information that can support improvement in this area. Aims: To explore the associations between clinical dietitians' self‐reported documentation of patients' goals and outcomes and demographic factors, self‐reported implementation of the systematic framework the Nutrition Care Process 4th step (NCP) and its associated terminology, and factors associated with the workplace. Methods: Data from a cross‐sectional study based on a previously tested web‐based survey (INIS) disseminated in 2017 to dietitians in Scandinavia (n = 494) was used. Respondents were recruited through e‐mail lists, e‐newsletters and social media groups for dietitians. Associations between countries regarding the reported documentation of goals and outcomes, implementation levels of the NCP 4th step, demographic information and factors associated with the workplace were measured through Chi‐square test. Associations between dependent‐ and independent variables were measured through logistic regression analysis. Results: Clinically practicing dietitians (n = 347) working in Scandinavia, Sweden (n = 249), Norway (n = 60), Denmark (n = 38), who had completed dietetic education participated. The reported documentation of goals and outcomes from nutrition intervention was highly associated with the reported implementation of NCP 4th step terminology (OR = 5.26; p = 0.009, OR = 3.56; p = 0.003), support from the workplace (OR = 4.0, p < 0.001, OR = 8.89, p < 0.001) and area of practice (OR = 2.02, p = 0.017). Years since completed dietetic training and educational level did not have any significant associations with documentation practice regarding goals and outcomes. Conclusion: Findings highlight strong associations between the implementation of the NCP 4th step terminology and the documentation of goals and outcomes. Strategies to support dietitians in using standardized terminology and the development of tools for comprehensive documentation of evaluation of goals and outcome are required. [ABSTRACT FROM AUTHOR]

The coexistence of IFRS and non-IFRS standards has proven challenging at the national level. We utilise a multi-mode standardisation perspective that recognises the interplay of committees, market players, and the government to examine multi-standard financial reporting in Norway and focus on two parallel efforts that introduced proposals to base the national accounting standards on the IFRS for SMEs. In our case, the jurisdictional tensions stem from the broad remit of the government to regulate financial reporting and the ambiguous legal standing of the national standards and of the standard setter. Comparability is often cited as one of the central aims of standardisation in financial reporting. Consequently, how different players utilise the concept is of interest. We find that the scope of comparability that the standards aim to achieve is not given sufficient consideration. The feedback provided with regard to the proposals underscores that the scope of comparability is important for the users of the standards. They focus on the most likely comparisons that are made and want to maintain a national focus and comparability across similar types of companies and industries. They do not regard the standardisation efforts and proposed elimination of standards and options as necessarily beneficial for comparability. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore how nurses use standardised care plans as a new recording tool in municipal health care, and to identify their thoughts and opinions. Background: In spite of being an important information source for nurses, care plans have repeatedly been found unsatisfactory. Structuring and coding information through standardised care plans is expected to raise the quality of recorded information, improve overviews, support evidence‐based practice and facilitate data aggregation. Previous research on this topic has mostly focused on the hospital setting. There is a lack of knowledge on how standardised care plans are used as a recording tool in the municipal healthcare setting. Design: An exploratory design with a qualitative approach using three qualitative methods of data collection. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods: Empirical data were collected in three Norwegian municipalities through participant observation and individual interviews with 17 registered nurses. In addition, we collected nursing records from 20 electronic patient records. Results: Use of standardised care plans was influenced by the nurses' consideration of their benefits. Partial implementation created an opportunity for nonuse. There was no consensus regarding how much information to include, and the standardised care plans could become both short and generic, and long and comprehensive. The themes "balancing between the old and the new care planning system," "considering the usefulness of standardised care plans as a source of information" and "balancing between overview and detail" reflect these findings. Conclusions: Nurses' use of standardised care plans was influenced by the plans' partial implementation, their views on usefulness and their personal views on the detail required in a care plan. Relevance to Clinical Practice: The structuring of nursing records is a fast‐growing trend in health care. This study gives valuable information for those attempting to implement such structures in municipal health care. [ABSTRACT FROM AUTHOR]

Commensuration—the transformation of different qualities into a common metric—has recently received increased scholarly attention. While mostly studied at the meso- or macroscale, this article extends the focus to microscale commensuration. Based on fieldwork in a Norwegian emergency medical service, the article analyses how nurses rated patients' pain intensity on a scale from zero to ten. While nurses were instructed to score pain by combining patients' self-report with their own 'objective' assessment, the article finds that their actual assessments relied almost solely on the latter. After exploring nurses' objections against the use of self-report, the article reconstructs the principles, methods and beliefs underlying nurses' 'objective' approach to pain scoring. In so doing, the article demonstrates how a fundamental aspect of human experience was filtered through nurses' professional gaze—to the advantage of some patients and the disadvantage of others. The article also advances theorising on microscale commensuration, thus providing guidance for future studies of how the world is transformed through the everyday production of numbers. • Uses ethnography to unpack the situated logic of triage nurses' pain assessments. • Deepens our knowledge of how and why nurses assess patients differently from patients. • Frames pain assessment as a form of commensuration. • Extends studies of commensuration to include microscale number production. • Advances theorising on microscale commensuration. [ABSTRACT FROM AUTHOR]

This article draws on ethnographic data from a Norwegian emergency primary care clinic ( EPCC) to explore nurses' discretionary application of guidelines. Specifically, it analyses nurses' discretionary use of the Manchester Triage System ( MTS) when performing face-to-face triage, that is, assessing the urgency of patients' complaints. The analysis shows how nurses assessed patients at odds with MTS prescriptions by collecting supplementary data, engaging in differential diagnostic and holistic reasoning, relying on emotion and intuition, and allowing colleagues and patients to influence their reasoning. The findings also show how nurses' reasoning led them to override guidelines both overtly and covertly. Based on this evidence, it is argued that nurses' assessments relied more on internalised 'triage mindlines' than on codified triage guidelines, although the MTS did function as a support system, checklist and system for supervisory control. The study complements existing research on standardisation in nursing by providing an in-depth analysis of nurses' methods for navigating guidelines and by detailing how deviations from those guidelines spring from their clinical reasoning. The challenges of imposing a managerial logic on professional labour are also highlighted, which is of particular relevance in light of the drive towards standardisation in modern healthcare. [ABSTRACT FROM AUTHOR]

In this article, we explore some notable differences between long-term residential care (LTRC) facilities in Canada and Norway. Through the analysis of mealtimes and activities, we show that the observed Norwegian facility follows more routinized, ritualized, and collectivistic organizational formats than the Canadian facility. As well, the medicalized nature of Norwegian LTRC contributes to a greater degree of conformity in ideas and ideals relative to Canadian facilities. We did not observe the same conformity to the patterns and demands of the nursing home organization in the Canadian facility; it appeared to be less driven by and dependent on ideas and procedures from the outside. Consequently, the Canadian facility seemed to be more apt at satisfying the varied social needs of residents. However, lower staffing levels in Canadian LTRC may limit opportunities for collective activities and communal life, while higher staffing levels and a higher level of formal competence in Norway may enhance personalized medical care. Based on observations and research experiences from other Norwegian and Canadian facilities, we think it is possible that greater differences might exist between Canadian facilities with regard to the quality and content of care. Equity for residents in general might be better maintained within and between Norwegian facilities, while services and quality of care may vary significantly in Canada. Facilities in Norway are, in short, more standardized and homogenous; the difference in content and quality tends to be relatively similar from facility to facility. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to illuminate the development of standardisation of relatives' participation at the time of death in the Palliative Medical Unit and to explore if the implementation of standardisation brought palliative care more in line with its ideology., Methods: A registration form was developed and utilized by the Palliative Medical Unit nurse in charge of the patient and family to register to what extent relatives participated at the time of death. The study consists of two data sets named evaluation 1 and 2. Evaluation 1 includes data collected during the period 01.11.1995-31.12.1999, representing 73% of all deaths (N = 244). Evaluation 2 includes data collected during the period 01.01.2003-31.12.2009, representing 71% of all deaths (N = 400). The data was analysed in SPSS, covering primarily the frequency of participation and correlation between evaluation 1 and evaluation 2., Results: Relatives are more often present at the moment of death, while nurses are less present at this moment. Additionally, Palliative Medical Unit nurses use more time to inform and discuss relatives' participation in pre and post-mortem care, as well as making agreements with relatives after death occurs., Conclusion: Important premises for successful standardisation are fostering Palliative Medical Unit nurses' knowledge about various aspects of pre and post-mortem care through regular evaluation and an educational programme providing staff with necessary time, awareness and skills. In addition nurses also require sufficient amount of time in the clinic., (Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.)