Overweight children in rural Norway - public health nurses' possibilities and limitations within national guidelines.

INTRODUCTION: Globally, overweight and obesity are more prevalent in rural areas than in urban areas. The purpose of this study was to determine to what extent public health nurses in rural areas in Norway feel equipped to tackle the overweight and obesity epidemic within two sets of national guidelines: The National Guidelines for the Standardized Measurement of Height and Weight and The National Guidelines for the Prevention, Identification, and Treatment of Overweight and Obesity in Children and Adolescents. These guidelines are inspired by New Public Management (NPM) logic, which emphasises more market orientation within the public sector to obtain a more cost-effective supply of public goods. The focus is on the weighing of schoolchildren, available resources, inter-agency cooperation and the rural context. METHODS: The data were collected using a structured questionnaire among 40 public health nurses working with children in rural areas, as well as qualitative interviews with 25 informants involved in the prevention and treatment of overweight and obesity among rural children. RESULTS: The study shows that rural public health nurses worry about the lack of resources for follow-up with children with a body mass index greater than what is characterised as 'normal'. The public health nurses suggested better cooperation between different stakeholders to work around the lack of resources and at the same time be able to see the whole picture, considering that overweight and obesity are complex problems connected to different challenges. They believed that it is an advantage to see the individuals in their local surroundings, to know their family history, their leisure activities and so on. This might be easier in rural areas than in urban areas, as these areas are often more transparent. CONCLUSION: There was consensus among the public health nurses involved in this study that national guidelines for treating overweight and obesity in children with the principles of NPM, and simplifying and standardising services, adds challenges instead of solutions. Such practices also hinder the use of experience-based knowledge about both the individual and the local context. There is a need for more flexible guidelines that can easily be adapted to the local (rural) context.

Structures for collaboration and networked adaptation: Emerging themes from the COVID-19 pandemic.

The COVID-19 pandemic is a crisis that is "creeping" in its onset and "slow-burning" in its duration. It is characterized by extreme uncertainty, ambiguity, and complexity, presenting an unprecedented need for response across sectors and political-administrative levels. While there has been an explosion of research papers into the national strategies for handling the pandemic, empirical publications on the local and regional management are still scarce. This paper presents early empirical insights into key collaborative functions in Norway and Sweden, with an ambition to contribute to a research agenda focusing on the collaborative practices of pandemic crisis management. Our findings point to a set of themes that are all related to emerging collaborative structures, that fill holes in pre-established structures for dealing with crises, and that have been important for being able to effectively deal with the pandemic. At the municipal and regional levels, we see more examples of well-adapted collaborative practices than we see the wickedness of the problem causing inertia and paralysis. However, the emergence of new structures indicates a need to adapt organizational structures to the existing problem, and the duration of the current crisis allows for significant evolution of collaborative structures within the various phases of the pandemic. The lessons that can be drawn from this reveal a need for reconsideration of some of the basic assumptions of crisis research and practice, in particular the so-called similarity principle that is a cornerstone of emergency preparedness organization in many countries, including Norway and Sweden.

Exploring wait time variations in a prostate cancer patient pathway-A qualitative study.

Norwegian health authorities emphasise that all citizens should have equal access to healthcare and implement cancer patient pathways (CPPs) to ensure medical care for all patients within the same time frame and to avoid unwanted variation. Statistics regarding prostate cancer indicate longer wait times for patients from a local hospital compared to patients from a university hospital. This study describes which health system-related factors influence variations in wait times. Eighteen healthcare workers participated in qualitative individual interviews conducted using a semi-structured interview guide. Transcripts were analysed by systematic text condensation, which is a cross-case method for the thematic analysis of qualitative data. The analysis unveiled four categories describing possible health system-related factors causing variation in times spent on diagnostics for patients in the local hospital and in university hospital, respectively: (a) capacity and competence, (b) logistics and efficiency, (c) need for highly specialised investigations, and (d) need for extra consultations. Centralisation of surgical treatment necessitated the transfer of patients, with extra steps indicated in the CPP for patients transferring from the local hospital to the university hospital for surgery. The local hospital seemed to lack capacity more frequently than the university hospital. Possible factors explaining variations in wait time between the two hospitals concern both internal conditions at the hospitals in organising CPPs and the implications of transferring patients between hospitals. Differences in hospitals' capacity can cause variations in wait time. The extra steps involved in transferring patients between hospitals can lead to additional time spent in CPP.

Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway.

BACKGROUND: Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. METHODS: A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel. RESULTS: The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers. CONCLUSIONS: As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.