Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic: results from a comparative international study.

BACKGROUND: The COVID-19 pandemic led to huge and rapid changes in general practice in Norway as in the rest of Europe. This paper aims to explore to what extent the COVID-19 pandemic changed the work tasks and organization of Norwegian general practice. MATERIAL AND METHOD: We analysed data from the Norwegian part of the international, cross-sectional PRICOV-19 study, collecting data from general practice via an online self-reported questionnaire. We included 130 Norwegian general practices, representing an estimated 520 Norwegian general practitioners (GPs). All Norwegian GPs were invited to participate. In the analyses, we focused on items related to the use of alternatives to face-to-face consultations, changes in the workload, tasks and delegated responsibilities of both the GPs and other personnel in the GP offices, adaptations in routines related to hygiene measures, triage of patients, and how the official rules and recommendations affected the practices. RESULTS: There was a large and significant increase in the use of all forms of alternative consultation forms (digital text-based, video- and telephone consultations). The use of several different infection prevention measures were significantly increased, and the provision of hand sanitizer to patients increased from 29.6% pre-pandemic to 95.1% since the pandemic. More than half of the GPs (59.5%) reported that their responsibilities in the practice had increased, and 41% were happy with the task shift. 27% felt that they received adequate support from the government; however, 20% reported that guidelines from the government posed a threat to the well-being of the practice staff. We found no associations with the rurality of the practice location or size of the municipalities. CONCLUSION: Norwegian GPs adapted well to the need for increased use of alternatives to face-to-face consultations, and reported a high acceptance of their increased responsibilities. However, only one in four received adequate support from the government, which is an important learning point for similar situations in the future.

Migration and health: exploring healthy ageing of immigrants in European societies.

AIM: The aim is to identify important factors for immigrants' health and well-being and for their use (or non-use) of primary health care (PHC) and other non-specialised services, and for possible ways that PHC can support healthy ageing of immigrants. BACKGROUND: Older persons are an increasing share of the immigrant population in the global north, frequently in contact with various forms of health services, (PHC services most of all. Consequently, PHC services are in a particularly unique position to support healthy ageing of immigrants. METHODS: The position paper builds on five international, multi-professional and cross-disciplinary small group discussions as well as an international workshop early summer. During the discussions and the workshop, topics were arrived at as to factors related to the health situation of older immigrants, their needs, and health-seeking behaviour, and to how PHC professionals could support healthy ageing in immigrants. Those main topics in turn guided search for relevant research literature and informed the selection of the main research questions of this paper. FINDINGS: Several factors, in addition to culture and cultural differences, are important to for PHC professionals and decision-makers to take into consideration in encounters with older immigrants. The socio-economic position of the older immigrant and close relatives, inter-generational relationships within the immigrant communities, country-specific factors in the host country like health care expenditure, and communication skills in health professionals are all examples of factors playing an important role regarding the health and health-seeking behaviour of older immigrants.

Practices and Strategies of Health Professionals during the COVID-19 Pandemic-Between Limitations and Opportunities.

The COVID-19 pandemic was declared as such in March 2020 [...].

Scandinavian Nurses' Use of Social Media during the COVID-19 Pandemic-A Berger and Luckman Inspired Analysis of a Qualitative Interview Study.

There is a knowledge gap about nurses' use of social media in relation to and during the COVID-19 pandemic, which demands the upholding of a physical distance to other people, including patients and their relatives. The study aims to explore how nurses in the Scandinavian countries used social media for professional purposes in relation to the first 15 months of the COVID-19 pandemic. Qualitative, semi-structured interviews with 30 nurses in three Scandinavian countries (Denmark, Norway, and Sweden) were conducted. Thematic analyses were made, methodically inspired by Braun and Clarke, and theoretically inspired by Berger and Luckmann's theory about the construction of social reality. The Standards for Reporting Qualitative Research (SRQR) checklist was used. The results showed that social media was a socialisation tool for establishing new routines in clinical practice. Virtual meeting places supported collective understandings of a specific COVID-19 'reality' and 'knowledge' amongst nurses, with the pandemic bringing to the fore the issue of e-professionalism among nurses relating to their clinical practice. However, social media and virtual education were not commonly used in patient contacts. Further, nurses attempted a re-socialisation of the public to proper COVID-19 behaviour through social media. Moreover, blurred boundaries between acting as a private individual and a professional nurse were identified, where ethics of the nursing profession extended to nurses' private lives.

How is leadership experienced in joy-of-life-nursing-homes compared to ordinary nursing homes: a qualitative study.

BACKGROUND: Nursing homes are under strong pressure to provide good care to the patients. In Norway, municipalities have applied the 'Joy-of-Life-Nursing-Homes' (JoLNH) strategy which is based on a health-promoting approach building on the older persons' resources. Meanwhile job satisfaction is closely related to less intention to leave, less turnover and reduced sick leave. The knowledge about adjustable influences related with job satisfaction might help nursing home leaders to minimize turnover and preserve high quality of care. This study explores leadership in Norwegian nursing homes with and without implementation of JoLNH: How does leadership influence the work environment and how is leadership experienced in JoLNH compared to ordinary Nursing Homes? METHOD: We used a qualitative approach and interviewed 19 health care personnel working in nursing homes in two Norwegian municipalities. The analysis was conducted following Kvale's approach to qualitative analysis. RESULTS: The main categories after the data condensing were [1] the importance of leadership, and [2] the importance of leadership for the work environment in a municipality with (a) and without (b) an implementation of the JoLNH strategy. CONCLUSIONS: The health care personnel in the municipality with an implementation of JoLNH emphasize that the leader's influence may lead to increased motivation among the staff and better control of changes and implementation processes. Our findings may indicate that the employee from a JoLNH municipality experience a more trustful relationship to the leader.

Nurses' use of social media during the COVID-19 pandemic-A scoping review.

BACKGROUND: During the COVID-19 pandemic, nurses stand in an unknown situation while facing continuous news feeds. Social media is a ubiquitous tool to gain and share reliable knowledge and experiences regarding COVID-19. The article aims to explore how nurses use social media in relation to the COVID-19 pandemic. METHOD: A scoping review inspired by Arksey and O'Mally was conducted by searches in Medline, CINAHL, Academic Search Complete and Web of Sciences. Empirical research studies investigating nurses' use of social media in relation to COVID-19 were included. Exclusion criteria were: Literature reviews, articles in languages other than English, articles about E-health, and articles investigating healthcare professionals without specification of nurses included. Articles, published in January-November 2020, were included and analysed through a thematic analysis. The PRISMA-ScR checklist was used. RESULTS: Most of the eleven included studies were cross-sectional surveys, conducted in developing countries, and had neither social media nor nurses as their main focus of interest. Three themes were identified: 'Social media as a knowledge node', 'Social media functioned as profession-promoting channels' and 'Social media as a disciplinary tool'. Nurses used social media as channels to gain and share information about COVID-19, and to support each other by highlighting the need for training and changes in delivery of care and redeployment. Further, social media functioned as profession-promoting channels partly sharing heroic self-representations and acknowledgment of frontline persons in the pandemic, partly by displaying critical working conditions. Finally, nurses used social media to educate people to perform the 'right 'COVID-19' behaviours in society. CONCLUSION: This review provided snapshots of nurses' uses of social media from various regions in the world, but revealed a need for studies from further countries and continents. The study calls for further multi-methodological and in depth qualitative research, including theoretically framed studies, with a specific focus on the uses of social media among nurses during the pandemic.

"Joy of life" in nursing homes. Healthcare personnel experiences of the implementation of the national strategy. A qualitative study with content analysis of interviews.

BACKGROUND: Nursing homes are under strong pressure to provide good care to the residents. In Norway, municipalities have applied the 'Joy-of-Life-Nursing-Home' strategy to increase a health-promoting perception that focuses on the older persons` resources. Implementations represent introducing changes to the healthcare personnel; however, changing one's working approaches, routines and working culture may be demanding. On this background, we explored how the 'Joy-of-Life-Nursing-Home' strategy is perceived by the employees in retrospective, over a period after the implementation and which challenges the employees experience with this implementation. METHOD: We used a qualitative approach and interviewed 14 healthcare personnel working in nursing homes in one Norwegian municipality, which had implemented the 'Joy-of-Life-Nursing-Home' strategy. The analysis was conducted following Kvale's approach to qualitative content analysis. RESULTS: The main categories were: (a) the characteristics of care activities before implementations of 'Joy-of-Life-Nursing-Home', (b) how 'Joy-of-Life-Nursing-Home' influenced the care activities, and (c) challenges with the implementation of 'Joy-of-Life-Nursing-Home'. Some of the informants spoke well about the implementation concerning the care quality stating "to see the joy in the eyes of the resident then I feel we have succeeded". For informants who experienced resistance toward the implementation, they felt it was too much to document, it was too complicated, and the requirements were too many. CONCLUSIONS: Quality of care seems to have increased after the implementation, as perceived by the informants. Nevertheless, the fact that the informants seemed to be divided into two different groups related to their main perspective of the implementation is concerning. One group has positive experiences with the implementations process and the benefits of it, while the other group focuses on lack of benefits and problems with the implementation process. To understand what facilitates and hinders the implementation, research on contextual factors like work environment and leadership is recommended.

Informal use of restraint in nursing homes: A threat to human rights or necessary care to preserve residents' dignity?

Use of restraint in nursing homes is highly controversial and fundamentally transgresses human rights and freedom of movement and choice. While different forms of formal restraint use in nursing homes are broadly delineated, the use of informal restraint is less understood. The aim of this article is to identify different kinds of informal restraint, and how staff use informal restraint under which circumstances. This article illuminates informal restraint use based on an ethnographic study in four nursing homes in the Western part of Norway. We have identified five different forms of informal restraint use which are as follows: (1) diversion of residents' attention; (2) white lies; (3) persuasion and interpersonal pressure; (4) offers and finally (5) threats. These different forms of informal restraint are actions by staff against residents' will, limiting residents' freedom of movement and their personal preferences. In addition, we have identified 'grey-zone restraint' which comprises actions by staff towards residents which lie in-between formal and informal restraint. The use of informal restraint can be explained by institutional circumstances such as location, architecture and institutional collectivist constraints in relation to care work. Moreover, and paradoxically, informal restraint can be explained as a consequence of neo-liberal policies with establishment of extended premises for freedom of movement and practices of resident preferences in nursing homes. Informal restraint practices call into question whether these practices are compatible with fundamental human rights and the preservation of residents' dignity.

The establishment and functioning of the PRIMORE (European PRImary care MultiprOfessional REsearcher network) Project.

There is a need for multiprofessional comprehensive studies to better understand the relationship between design and provision of primary care and long-term care and health outcomes. The PRIMORE (PRImary care MultiprOfessional REsearcher network) project aims at bringing together researchers with different backgrounds and from a wide range of professional groups within the fields of primary care research and long-term care research to develop and share knowledge for the benefit of research on municipal health and care services, and eventually, the quality of municipal health and care in Europe. Main activities of the project will be network development, capacity building, providing a platform where multiprofessional primary care research activities can take place and publishing position papers.

A mixed method study of an education intervention to reduce use of restraint and implement person-centered dementia care in nursing homes.

BACKGROUND: People living with dementia in nursing homes are most likely to be restrained. The primary aim of this mixed-method education intervention study was to investigate which factors hindered or facilitated staff awareness related to confidence building initiatives based on person-centred care, as an alternative to restraint in residents with dementia in nursing homes. The education intervention, consisting of a two-day seminar and monthly coaching sessions for six months, targeted nursing staff in 24 nursing homes in Western Norway. The present article reports on staff-related data from the study. METHODS: We employed a mixed-method design combining quantitative and qualitative methods. The P-CAT (Person-centred Care Assessment Tool) and QPS-Nordic (The General Nordic questionnaire for psychological and social factors at work) instruments were used to measure staff effects in terms of person-centred care and perception of leadership. The qualitative data were collected through ethnographic fieldwork, qualitative interviews and analysis of 84 reflection notes from eight persons in the four teams who facilitated the intervention. The PARIHS (Promoting Action on Research Implementation in Health Services) theoretical framework informed the study design and the data analysis. Six nursing homes were selected for ethnographic study post-intervention. RESULTS: Qualitative data indicated increased staff awareness related to using restraint - or not- in the context of person-centered care. A slight increase in P-CAT supported these findings. Thirteen percent of the P-CAT variation was explained by institutional belonging. Qualitative data indicated that whether shared decisions of alternative measures to restraint were applied was a function of dynamic interplay between facilitation and contextual elements. In this connection, the role of the nursing home leaders appeared to be a pivotal element promoting or hindering person-centered care. However, leadership-staff relations varied substantially across individual institutions, as did staff awareness related to restraint and person-centeredness. CONCLUSIONS: Leadership, in interplay with staff culture, turned out to be the most important factor hindering or promoting staff awareness related to confidence building initiatives, based on person-centered care. While quantitative data indicated variations across institutions and the extent of this variation, qualitative data offered insight into the local processes involved. A mixed method approach enabled understanding of dynamic contextual relationships. TRIAL REGISTRATION: The trial is registered at Clinical Trials gov. reg. 2012/304 NCT01715506.

Marketization in Long-Term Care: A Cross-Country Comparison of Large For-Profit Nursing Home Chains.

This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.

Prescriptive or Interpretive Regulation at the Frontlines of Care Work in the "Three Worlds" of Canada, Germany and Norway.

This paper examines the tension between macro level regulation and the rule breaking and rule following that happens at the workplace level. Using a comparative study of Canada, Norway, and Germany, the paper documents how long-term residential care work is regulated and organized differently depending on country, regional, and organizational contexts. We ask where each jurisdiction's staffing regulations fall on a prescription-interpretation continuum; we define prescription as a regulatory tendency to identify what to do and when and how to do it, and interpretation as a tendency to delineate what to do but not when and how to do it. In examining frontline care workers' strategies for accomplishing everyday social, health, and dining care tasks we explore how a policy-level prescriptive or interpretive regulatory approach affects the potential for promising practices to emerge on the frontlines of care work. Overall, we note the following associations: prescriptive regulatory environments tend to be accompanied by a lower ratio of professional to non-professional staff, a higher concentration of for-profit providers, a lower ratio of staff to residents and a sharper division of labour. Interpretive regulatory environments tend to have higher numbers of professionals relative to non-professionals, more limited for-profit provision, a higher ratio of staff to residents, and a more relational division of labour that enables the work to be more fluid and responsive. The implication of a prescriptive environment, such as is found in Ontario, Canada, is that frontline care workers possess less autonomy to be creative in meeting residents' needs, a tendency towards more task-oriented care and less job autonomy. The paper reveals that what matters is the type of regulation as well as the regulatory tendency towards controlling frontline care workers decision-making and decision-latitude.

Study protocol for a multicenter investigation of reablement in Norway.

BACKGROUND: Reablement is a promising new rehabilitation model, which is being implemented in some Western countries to meet current and future needs for home-based services. There is a need for further investigation of the effects of reablement among community-dwelling adults in terms of clinical and economic outcomes. This study will investigate the effectiveness of reablement in home-dwelling adults compared with standard treatment in terms of daily activities, physical functioning, health-related quality of life, coping, mental health, use of health care services, and costs. METHODS/DESIGN: The study is a multicenter controlled trial. In total, 44 Norwegian municipalities will participate, including eight municipalities as a control group. For three municipalities with two zones, one will be assigned to the control group and the other to the intervention group. The experimental group will be offered reablement and the control group standard treatment. The sample will comprise approximately 750 participants. People will be eligible if they are home-dwelling adults, understand Norwegian, and have functional decline. Participants will be assessed at baseline, and after 10 weeks, 6 months, and 12 months. The primary outcome will be activity and participation measured by the Canadian Occupational Performance Measure. Physical functioning will be measured by the Short Physical Performance Battery and health-related quality of life by the European Quality of Life Scale. Coping will be measured by the Sense of Coherence questionnaire and mental health by the Mental Health Continuum Short Form. Costs will be generated based on registered working hours in different professions. Data analyses will be performed according to intention to treat. Univariate analysis of covariance will be used to investigate differences between the groups at baseline and the end of intervention. The data will be organized into two levels using a multilevel structure, i.e., individuals and municipalities, which will be analyzed using linear mixed-effects models. The working hours data (panel data) will be analyzed with random mixed-effects regression models. The cost-effectiveness of reablement will be evaluated according to the incremental cost-effectiveness ratio and uncertainty will be explored via the bootstrap method. DISCUSSION: The findings will make an important contribution to knowledge of rehabilitation approaches for community-dwelling adults. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on October 24, 2014, identifier: NCT02273934 .

Understanding public elderly care policy in Norway: A narrative analysis of governmental White papers.

How the general public in Norway conceives being an older adult and the meaning of chronological age has changed over the last few decades. As narratives of aging may be identified in the Norwegian mass media and in the population at large, dominant narratives may also be identified in policy documents, such as government health policy papers. This article explores a narrative analytical framework based on stories, subtexts, and counterstories; it argues that such narratives are characterized as much by what is unsaid as by what is said, and as much by choice of words and word combinations as by explicit messages. Culture strongly influences the conception of a likely future (what will be) and an envisioned future (what ought to be) regarding aging and geriatric care in Norway, as expressed in the public policy papers. The public policy story is discussed as both a story continuously developing, where later health policy papers relate to and comment on earlier documents, and as a story characterized by a measure of cultural incoherence. Some recent government documents dealing with professional geriatric care will serve as material for a narrative analysis.

Context and uncertainty in narratives: stories of sickness among the Beja of Northeastern Sudan.

The present paper deals with the parents' narratives of sickness and misfortune of their children among the Beja people in the Red Sea Hills, Northeastern Sudan. Drawing on fieldwork focusing parents' health-seeking behavior related to child sicknesses through 1993-95, and combining participant observation and interviews, the aim is firstly to elucidate how markers of uncertainty is a pronounced trait of Beja sickness narratives, inviting listeners to actively engage in the stories, adding to a still scarce but growing literature on narration and uncertainty. Secondly, it aims at relating this narrative style to wider contexts of Beja culture and society, a type of analysis seldom undertaken within the field of medical anthropology. It is argued that although some facets of the lives of Beja people have changed since the time of the fieldwork, the changes are not pronounced and have not changed the cultural environment so as to make the analysis and conclusions of this paper less valid.

Living a meaningful life with chronic pain from a nursing perspective. Narrative approach to a case story.

This paper is a case story discussing the experience of chronic pain from the perspective of the sufferer and suggests ways of improving the use of this perspective in nursing care. A narrative approach is adopted and the analysis was based on content analysis. A condensation of meaning-units revealed a variation in subthemes: the body in pain, striving to preserve self and self-fulfilment. The extent to which living a meaningful life is possible seems to depend on several complex factors, including a person's belief system, life experiences, personal resources, the meaning of pain and the extent to which nurses understand the overall situation. This story might indicate that nociceptive pain can be less important than pain that reduces long-term life quality. A better understanding of living with chronic pain based on cognitive-behavioural techniques could be linked to the information drawn from the narrative and used to improve nursing practice.