1
|
Linnerud S, Kvæl LAH, Bjerk M, Taraldsen K, Skelton DA, Brovold T. Feasibility of an implementation strategy for preventing falls in homecare services. Implement Sci Commun 2024; 5:79. [PMID: 39030646 PMCID: PMC11264773 DOI: 10.1186/s43058-024-00615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/10/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND Falls among older adults represent a major health hazard across the world. In 2022, the World Falls Guidelines was published, summarising research evidence and expert recommendations on how to prevent falls, but we need more knowledge on how the evidence can be successfully implemented into routine practice. In this study we used an implementation strategy co-created by healthcare providers, older adults who had fallen and researchers, to facilitate uptake of fall prevention recommendations. This current study aimed to evaluate the feasibility of this co-created implementation strategy in homecare services and provide information on the intervention and measurements for a full-scale cluster-randomized trial. METHODS This study was a single-armed feasibility study with an embedded mixed-method approach completed in two city districts of Oslo, Norway, over a period of ten weeks. The co-created implementation strategy consists of a package for implementing national recommendations for preventing falls, empowering leaders to facilitate implementation, establish implementation teams, competence improvement and implementation support. City districts established implementation teams who were responsible for the implementation. Feasibility was assessed both qualitatively and quantitatively, using focus group interviews with implementation team members and individual interviews with leaders and staff members and the Feasibility of Intervention Measure (FIM). Qualitative data were analysed using thematic analysis and the Normalisation Process Theory. RESULTS Qualitative data were collected from 19 participants: 12 implementation team members, 2 leaders and 5 staff members. 8 of the implementation team members responded to FIM. The analysis revealed four themes: 1) Fostering consensus through tailored implementation and discussions on fall prevention, 2) The importance of multi-level and interdisciplinary collaboration in fall prevention implementation, 3) Minimizing perceived time usage through utilization of existing areas for implementation activities, and 4) Reflective monitoring demonstrates the importance of facilitation and structure in the implementation strategy. For FIM, there were a high level of agreement related to how implementable, possible, doable, and easy to use the implementation strategy was. CONCLUSIONS Overall, we found the implementation strategy to be feasible to enhance uptake of fall prevention recommendations in the Norwegian homecare services. To succeed with the implementation, a dedicated implementation team should receive support through the implementation process, they should choose small implementation activities to enhance fall prevention competence and managers should possess implementation knowledge. TRIAL REGISTRATION The trial is registered in the Open Science Registry: https://doi.org/10.17605/OSF.IO/2JFHV Registered: January 11, 2023.
Collapse
Affiliation(s)
- Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway.
| | - Linda Aimée Hartford Kvæl
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Department of Housing and Ageing Research, Norwegian Social Science, OsloMet - Oslo Metropolitan University, Olavs plass, P.O. Box 4 St, N-0130, Oslo, Norway
| | - Maria Bjerk
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
| | - Dawn A Skelton
- Research Centre for Health (ReaCH), Department of Physiotherapy and Paramedicine, School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, St. Olavs plass, P.O. Box 4, N-0130, Oslo, Norway
| |
Collapse
|
2
|
Ekenes M, Oldeide O, Wehling E. Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters. BMC Health Serv Res 2024; 24:460. [PMID: 38609916 PMCID: PMC11015684 DOI: 10.1186/s12913-024-10972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 04/09/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.
Collapse
Affiliation(s)
- Maren Ekenes
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway.
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway.
| | - Olin Oldeide
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Eike Wehling
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
3
|
Brenne BA, Hedlund M, Ingstad K. Nurses' professional discretion in the purchaser-provider split in home care in Norway. J Adv Nurs 2024; 80:612-627. [PMID: 37574768 DOI: 10.1111/jan.15828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/05/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023]
Abstract
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.
Collapse
|
4
|
Linnerud S, Kvael LAH, Graverholt B, Idland G, Taraldsen K, Brovold T. Stakeholder development of an implementation strategy for fall prevention in Norwegian home care - a qualitative co-creation approach. BMC Health Serv Res 2023; 23:1390. [PMID: 38082278 PMCID: PMC10714538 DOI: 10.1186/s12913-023-10394-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The uptake of fall prevention evidence has been slow and limited in home care services. Involving stakeholders in the implementation process is suggested as a method to successfully tailor implementation strategies. The aim of this study was to develop an implementation strategy for fall prevention, targeting healthcare providers working in home care services. METHODS This study used an explorative qualitative approach in a five-step co-creation process to involve researchers, service users, and healthcare providers. The first two steps consisted of workshops. This was followed by focus group interviews and individual interviews with key informants as steps three and four. Data from the first four steps were analyzed using reflexive thematic analysis. The fifth and final step was a workshop finalizing a strategy for implementing fall prevention evidence in home health services. RESULTS Overall, our findings, resulted in an implementation strategy for fall prevention with four components: (1) Empower leaders to facilitate implementation, operationalized through what managers pay attention to regularly, resource priorities, and time spent on fall prevention, (2) Establish implementation teams, consisting of multidisciplinary healthcare providers from different levels of the organization, with formalized responsibility for implementation, (3) Tailor dual competence improvement, reflecting the need for knowledge and skills for fall prevention and implementation among healthcare providers and users, and (4) Provide implementation support, representing guidance through the implementation process. CONCLUSIONS This study advances our understanding of implementation in home care services. Implementation of fall prevention requires an implementation strategy involving a blend of essential components targeting leaders, competent healthcare providers and users, and establishing structures enhancing the implementation process.
Collapse
Affiliation(s)
- Siv Linnerud
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway.
| | - Linda Aimee Hartford Kvael
- Department of Housing and Ageing Research, Norwegian Social Science, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| | - Birgitte Graverholt
- Department of Health and Functioning, Western Norway University of Applied Sciences, P.O. Box 7030, N-5020, Bergen, Norway
| | - Gro Idland
- Agency of Health, The municipality of Oslo, N-0130, Oslo, Norway
| | - Kristin Taraldsen
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| | - Therese Brovold
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, P.O. Box 4, St. Olavs plass, Oslo, N-0130, Norway
| |
Collapse
|
5
|
Chang M, Michelet M, Skirbekk V, Langballe EM, Hopstock LA, Sund ER, Krokstad S, Strand BH. Trends in the use of home care services among Norwegians 70+ and projections towards 2050: The HUNT study 1995-2017. Scand J Caring Sci 2023; 37:752-765. [PMID: 36967552 DOI: 10.1111/scs.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Life expectancy (LE) is increasing worldwide, while there is lack of information on how this affects older individuals' use of formal home care services. AIM We aimed to decompose LE into years with and without home care services and estimate projected number of users towards 2050 in Norway for people 70 years or older. METHODS This study is based on a sample of 25,536 participants aged 70 years and older in the Trøndelag Health Study (HUNT) survey 2 (1995-1997), 3 (2006-2008), or 4 (2017-2019) linked with national data on mortality. Prevalence of home care services was standardised to the Norwegian population by age and sex. The Sullivan method was used to estimate expected years with and without home help services and nursing services for the years 1995, 2006 and 2016. Data from HUNT4 and Statistics Norway were used to estimate projected use of these services between 2020 and 2050. RESULTS During 1995-2017, the use of home help services decreased from 22.6% to 6.2% (p < 0.001), and from 6.4% to 5.5% (p = 0.004) for home nursing services. Adjusted for age and sex, the use of home help services decreased significantly over time (p < 0.001), while home nursing services were stable (p = 0.69). LE at age 70 increased from 11.9 to 15.3 years in men (p < 0.05) during 1995-2017, and from 14.7 to 17.1 in women (p < 0.05). In the same period, the expected years receiving home help decreased from 2.6 to 1.1 in men (p < 0.05), and from 4.4 to 2.1 in women (p < 0.05). The expected years receiving home nursing increased from 0.6 to 0.9 in men (p < 0.05), and from 1.3 to 1.7 in women (p < 0.05). Projected numbers of people 70+ in Norway in need of either of these services were estimated to rise from 64,000 in 2020 to 160,000 in 2050. CONCLUSION While overall life expectancy increased, the expected years receiving home help have decreased and home nursing slightly increased among the Norwegian population aged 70 years and older during 1995-2017. However, the substantial increase in the projected number of older adults using home care services in the future is an alert for the current health care planners.
Collapse
Affiliation(s)
- Milan Chang
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Icelandic Gerontological Research Institute, Reykjavik, Iceland
| | - Mona Michelet
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Vegard Skirbekk
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Ellen M Langballe
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Laila A Hopstock
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Erik R Sund
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Steinar Krokstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, NTNU Norwegian University of Science and Technology, Trondheim, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Bjørn H Strand
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
6
|
Rostad HM, Skinner MS, Wentzel-Larsen T, Hellesø R, Sogstad MKR. Modes and models of care delivery in municipal long-term care services: a cross-sectional study from Norway. BMC Health Serv Res 2023; 23:813. [PMID: 37525166 PMCID: PMC10388513 DOI: 10.1186/s12913-023-09750-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/25/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Numerous forces drive the evolution and need for transformation of long-term care services. Decision-makers across the globe are searching for models to redesign long-term care to become more responsive to changing health and care needs. Yet, knowledge of different care models unfolding in the long-term care service landscape is limited. The objective of this article is twofold: 1) to identify and characterise models of care in Norwegian municipal long-term care services based on four different modes of service delivery: Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity, and 2) to analyse whether the identified care models vary with regard to municipal characteristics, more specifically 'population size' and 'income'. METHODS We adopted a cross-sectional approach and used data from a web-based survey conducted in 2019 to identify and characterize models of care in Norwegian long-term care services, based on four modes of service delivery. The questionnaire was developed through a comprehensive review of national healthcare policy documents and previous research and amended in collaboration with a user panel. A set of questions from the questionnaire were used to create four modes of service delivery. Hierarchical cluster analysis was used to cluster the municipalities based on the mean scores of the modes to identify care models. RESULTS In total, 277 municipalities (response rate 66%) completed the survey. The four modes made it possible to identify four care models that differ on the level of Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity. Additionally, the models differed regarding municipal population size (p < 0.001) and income (p = 0.006). CONCLUSIONS We put forward a theoretical description of the variety of ways long-term care services are provided, offering a way of simplifying complex information which can assist care providers and policymakers in analysing and monitoring their own service provision and making informed decisions. This is important to the development of services for current and future care needs.
Collapse
Affiliation(s)
- Hanne Marie Rostad
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.
| | | | - Tore Wentzel-Larsen
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Centre for Child and Adolescent Mental Health (RBUP), Southern and Eastern Norway, Oslo, Norway
- Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Ragnhild Hellesø
- Centre for Care Research, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Department of Public Health Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | |
Collapse
|
7
|
Karlsen L, Mjølstad BP, Løfaldli BB, Helvik AS. Family caregiver involvement and role in hospital at home for adults: the patients' and family caregivers' perspective - a Norwegian qualitative study. BMC Health Serv Res 2023; 23:499. [PMID: 37198679 PMCID: PMC10189695 DOI: 10.1186/s12913-023-09531-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Hospital at home (HaH) provides acute healthcare services in patients' homes instead of traditional in-patient care. Research has reported positive outcomes for patients and reduced costs. Although HaH has developed into a global concept, we have little knowledge about the involvement and role of family caregivers (FCs) of adults. The aim of this study was to explore FC involvement and role during HaH treatment as perceived by patients and FCs in a Norwegian healthcare context. METHODS A qualitative study was carried out among seven patients and nine FCs in Mid-Norway. The data was obtained through fifteen semi-structured interviews; fourteen were performed individually and one as duad interview. The age of the participants varied between 31 and 73 years, and mean age of 57 years. A hermeneutic phenomenological approach was used, and the analysis was performed according to Kvale and Brinkmann's description of interpretation. RESULTS We identified three main categories and seven subcategories regarding FC involvement and role in HaH: (1) Preparing for something new and unfamiliar, including the subcategories `Lack of involvement in the decision process` and `Information overload affecting caregiver readiness`, (2) Adjusting to a new everyday life at home, including the subcategories `The critical first days at home`, `Coherent care and support in a novel situation`, and `Prior established family roles influencing the new everyday life at home`, (3) FCs` role gradually diminishes and looking back, including the subcategories `A smooth transition to life beyond hospital at home` and `Finding meaning and motivation in providing care`. CONCLUSIONS FCs played an important role in HaH, although their tasks, involvement and effort varied across different phases during HaH treatment. The study findings contribute to a greater understanding of the dynamic nature of the caregiver experiences during HaH treatment, which can guide healthcare professionals on how they can provide timely and appropriate support to FCs in HaH over time. Such knowledge is important to decrease the risk of caregiver distress during HaH treatment. Further work, such as longitudinal studies, should be done to examine the course of caregiving in HaH over time to correct or support the phases described in this study.
Collapse
Affiliation(s)
- Lillian Karlsen
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway.
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway.
| | - Bente Prytz Mjølstad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, N-7491, Trondheim, Norway
| | - Bjarte Bye Løfaldli
- The Centre for Health Innovation, Øvre Enggate 8B, Kristiansund N, N-6509, Norway
| | - Anne-Sofie Helvik
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology, Postboks 8905, Trondheim, N-7491, Norway
| |
Collapse
|
8
|
Trier EL, Haugland T, Thoresen L. Palliative enheter i de kommunale helse- og omsorgstjenestene – en kartleggingsstudie. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/tfo.8.3.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
|
9
|
Brenne BA, Hedlund M, Ingstad K. Exploring home-based care nurses' mindset for nursing practices: a phenomenological study. BMC Nurs 2022; 21:291. [PMID: 36316738 PMCID: PMC9623960 DOI: 10.1186/s12912-022-01068-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Home nursing is an essential aspect of healthcare and can address future health challenges. The nature of nursing and its practical applications are of particular interest, as nursing involves technical knowledge, rational procedures, and diverse skills. It is consequential to explore nursing practices in context to understand how nurses navigate their work. This study aimed to explore the characteristics of home care nurse practices and how nurses solve tasks in the context of nursing in home care. Methods This is an exploratory qualitative research study using a descriptive phenomenological approach. We reported following the COREQ guidelines. Fifteen in-depth interviews with nurses from four Norwegian municipalities were conducted and analysed according to stepwise inductive analysis. Results The analysis revealed three main patterns that characterise nursing practices in home care: ‘To be vigilant’, ‘To be an all-rounder’, and ‘To act with independence’. The content and distinction of these patterns are discussed through a theoretical framework of ‘clinical mindlines’. There are multiple mindlines and complex realities for home-based care nursing. The nurses displayed great sensitivity in their practice, were knowledgeable about where they focused their attention, adapted their actions to the context, and demonstrated their independence as professionals. Conclusion Nurses’ vigilance and contextual insight are critical to their practice approach and task-solving abilities. These professionals need to manage emergent organisations and exercise independence and professional judgment when adapting their work to the context of home care patients. Future health policy should not strictly be based on standardised guidelines; depending on the context, it is also appropriate to focus on nurses’ practical knowledge and the importance of mindlines.
Collapse
Affiliation(s)
- Bodil Aarmo Brenne
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
| | - Marianne Hedlund
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway ,grid.5947.f0000 0001 1516 2393Department of Social Work, NTNU, 7491 Trondheim, Norway
| | - Kari Ingstad
- grid.465487.cFaculty of Nursing and Health Science, Nord university, Pb. 93, 7601 Levanger, Norway
| |
Collapse
|
10
|
Kumlin M, Berg GV, Kvigne K, Hellesø R. Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single-case study. BMC Health Serv Res 2022; 22:1030. [PMID: 35962337 PMCID: PMC9375356 DOI: 10.1186/s12913-022-08422-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Today, the ageing population is larger than ever before, and people who are living longer with chronic illnesses and multimorbidity need support from multiple healthcare service levels. Similarly, healthcare systems are becoming increasingly specialised and fragmented. The World Health Organization has highlighted novel policies for developing integrated and person-centred services. However, patients, next of kin and health professionals face several challenges in managing healthcare during the care trajectory. Limited literature has addressed the challenges experienced by these groups. Therefore, this study aimed to identify the dilemmas and deliberations faced by patients, next of kin and health professionals during the care trajectory of elderly patients with complex healthcare needs. Method The study had a qualitative single-case design. The case was taken from a multi-case study exploring the care trajectory of elderly patients. The participants were the patient, their next of kin and the health professionals involved in the patient’s care trajectory. Data were obtained via observation and individual interviews conducted during the patient’s hospital stay and after the patient returned home. Results The dilemmas and deliberations in managing the care trajectory were divided into four main themes: the health professionals’ pursuit of appropriate and feasible healthcare services, the next of kin’s planning horizons, being the person left in limbo and reorganising the home for comprehensive healthcare. Conclusion The pursuit of a tailored and suitable healthcare service lead to a comprehensive mobilisation of and work by all actors involved. Having a comprehensive understanding of these conditions are of importance in developing an appropriate care trajectory for the elderly patient with complex need.
Collapse
Affiliation(s)
- Marianne Kumlin
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway. .,Innlandet Hospital Trust, Lillehammer, Norway. .,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Geir Vegar Berg
- Innlandet Hospital Trust, Lillehammer, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology Gjøvik, Gjøvik, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Hov R, Bjørsland B, Kjøs BØ, Wilde-Larsson B. Pasienters opplevelse av trygghet med palliativ omsorg i hjemmet. TIDSSKRIFT FOR OMSORGSFORSKNING 2022. [DOI: 10.18261/issn.2387-5984-2021-01-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
12
|
Rykkje L, Holm AL, Hem MH. Norwegian Nurses' Reflections Upon Experiences of Ethical Challenges in Older People Care: A Qualitative Thematic Analysis. SAGE Open Nurs 2021; 7:23779608211057938. [PMID: 34869863 PMCID: PMC8640321 DOI: 10.1177/23779608211057938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction Internationally, aging populations have increased needs for health care services, and often specialized care is required. However, services for older people tend to be underfunded, resulting in lack of qualified staff and poor quality care. Resource shortages lead to ethical challenges and insufficient nursing care. Therefore, quality in daily care for older people also depends upon the nurses’ ability to make complex, ethical decisions in their practice. Objectives To explore ethical challenges experienced by nurses caring for older people in clinical practice, and to provide examples of management for the challenges. Methods The data collected were written reflection notes by Norwegian continuous education students in advanced gerontology. Forty two of 83 notes were included and a thematic analysis in six steps was utilized. Findings There are three main themes: (1) meeting vulnerability, discomfort, and suffering, (2) collaboration with relatives, and (3) struggling to perform professional care. Conclusion Nurses strive to “do what is in the patients’ best interest”, and this is fostered through collaboration, professionalism, care, and presence. Nurses’ ethical competencies may develop when reflecting upon their own care performance. Building ethical competencies should be a priority in both nursing education and clinical practice. However, to improve care quality, nurses also need professional knowledge about older people care and ethical awareness should be supported by the workplace.
Collapse
Affiliation(s)
- Linda Rykkje
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
| | - Anne Lise Holm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Marit Helene Hem
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| |
Collapse
|
13
|
Rostad HM, Skinner MS, Larsen TW, Sogstad MKR. Sammenheng i kommunale helse- og omsorgstjenester – hvor mye flytter eldre mellom ulike tilbud i kommunen? TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
14
|
Skinner MS, Veenstra M, Sogstad M. Nurses' assessments of horizontal collaboration in municipal health and care services for older adults: A cross-sectional study. Res Nurs Health 2021; 44:704-714. [PMID: 34036609 DOI: 10.1002/nur.22144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 11/09/2022]
Abstract
Interprofessional and interorganizational collaboration is considered key to achieving high-quality care and positive patient outcomes, but there is limited research into how nurses working in nursing homes and home care services perceive collaboration with other municipal health and care service providers and how their assessments of collaboration vary with individual characteristics and context. The objective of this study was to map variation in nurses' assessments of horizontal collaboration with core care services for older adults, specifically nursing homes, home care services, general practitioners, the allocation office and physio- and occupational therapy services. The study draws on findings from a nationwide cross-sectional survey on posthospital care for older adults, conducted among nurses working in nursing homes and home care services in Norway (N = 3717). Nurses were asked to assess collaboration with these five services. Independent variables were workplace, age, years at current workplace, part-time work, postgraduate education, and municipality size. Statistical analyses were conducted using descriptive statistics and analysis of variance (ANOVA). A majority of nurses evaluated horizontal collaboration as good. Collaboration with the home care services was evaluated as best, while collaboration with general practitioners was evaluated as least good. The study showed that workplace and municipality size were important for nurses' assessments of collaboration. Generally, nurses in smaller municipalities evaluated collaboration as better than nurses in larger municipalities. That workplace and municipality size impact on nurses' evaluations of collaboration in municipal care services for older adults is important knowledge for leaders and policy-makers aiming to improve patient care and teamwork.
Collapse
Affiliation(s)
- Marianne S Skinner
- Centre for Care Research, NTNU-Norwegian University of Science and Technology, Gjøvik, Norway
| | - Marijke Veenstra
- Centre for Care Research, NTNU-Norwegian University of Science and Technology, Gjøvik, Norway.,Norwegian Social Research (NOVA), Oslo Metropolitan University, Oslo, Norway
| | - Maren Sogstad
- Centre for Care Research, NTNU-Norwegian University of Science and Technology, Gjøvik, Norway
| |
Collapse
|
15
|
Kumlin M, Berg GV, Kvigne K, Hellesø R. Unpacking Healthcare Professionals' Work to Achieve Coherence in the Healthcare Journey of Elderly Patients: An Interview Study. J Multidiscip Healthc 2021; 14:567-575. [PMID: 33707950 PMCID: PMC7939484 DOI: 10.2147/jmdh.s298713] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/11/2021] [Indexed: 11/23/2022] Open
Abstract
Aim Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain. Methods This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed. Results The analyses revealed three central themes in the healthcare professionals’ work to build coherence in the patients’ care trajectory: Working to manage a patient’s illness trajectory during the course of the patient’s life, working to achieve a comprehensive overall picture, and considering multiple options in a “patchwork” terrain. Conclusion Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person’s journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient’s life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient’s complex care trajectory.
Collapse
Affiliation(s)
- Marianne Kumlin
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences Elverum, Elverum, Norway.,Innlandet Hospital Trust, Lillehammer, Norway.,Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Geir Vegar Berg
- Innlandet Hospital Trust, Lillehammer, Norway.,Department of Health Sciences, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences Elverum, Elverum, Norway
| | - Ragnhild Hellesø
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
16
|
Bjornsdottir K, Ketilsdottir A, Gudnadottir M, Kristinsdottir IV, Ingadottir B. Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study. J Clin Nurs 2021; 30:1120-1131. [PMID: 33434351 DOI: 10.1111/jocn.15658] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/31/2020] [Accepted: 01/05/2021] [Indexed: 01/10/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to (1) describe the development of integrated services between hospital-based heart failure nursing services and municipally located home care nurses' services and (2) identify the benefits of this collaboration for the development of home care nursing services. BACKGROUND Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved. DESIGN A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure. METHODS Data were field notes from observations at meetings of the steering group designing the services, visits to patients' homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist. RESULTS In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients' homes. A clinical pathway was developed to assure effective assessment of patients' condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition. CONCLUSIONS The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services. RELEVANCE TO CLINICAL PRACTICE The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices.
Collapse
Affiliation(s)
- Kristin Bjornsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Audur Ketilsdottir
- Division of Clinical Services II (Cardiovascular Center, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
| | - Margret Gudnadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Inga V Kristinsdottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Brynja Ingadottir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
17
|
Sogstad M, Skinner M. Samhandling og informasjonsflyt når eldre flytter mellom ulike helse- og omsorgstilbud i kommunen. TIDSSKRIFT FOR OMSORGSFORSKNING 2020. [DOI: 10.18261/issn.2387-5984-2020-02-10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|