Social dignity in community-based mental health services

Background: An essential element of community-based mental health services is the relationship between service users and mental health workers. This thesis explores how service users’ personhood and intrinsic human value are recognised or at risk in those relationships. There is focus on “Recovery” and “Ethics of caring”, and the concept “Social dignity” is used as a perspective. Purpose: The overall purpose was to explore mental health service users’ experience-based knowledge about being recognised, and to describe and suggest how this knowledge was and could be foundation for mental health workers’ knowledge and clinical work. In Paper I, the aim was to explore how service users describe and make sense of their encounters with other people. Paper II described service users’ understanding of being in relationships with professionals and how these relationships limited or enhanced recovery. Paper III aimed to reveal and express knowledge about meanings of recognition of clients’ personhood and intrinsic value as human beings, based on mental health workers’ lived experiences of long-term relationships with clients. And Paper IV explored examples of mental health workers’ processes of development and learning. Method: Project A: “Dignity in everyday life” and project B: “Focus on experience-based knowledge” are based on phenomenological hermeneutical lifeworld research. In project A, 11 service users were interviewed about their experiences of being recognised and how they would like to be recognised, and “Interpretative Phenomenological Analysis” with focus on analysis of singular cases guided the analysis. In project B, 8 experienced mental health workers participated in multi stage focus groups (four sessions) to develop knowledge about what is involved in recognising service users in community-based mental health services. “Interpretative analysis of lifeworld” and “Phenomenological hermeneutical method for researching lived experience” guided the analysis. Findings: Recognition depended on experiences of being valued and significant, and that the service user’s participation in the relationship was acknowledged by the mental health worker. The service users lived in a “struggle to be me” and a “struggle to be recognised”, and experiences of being in relationships in which they were recognised were a great relief (Paper I). The struggle to be recognised was a dilemma between on the one hand being open and risking to lose the right to be a narrator in his or her life; and on the other to protect own identity and risk being isolated and alone. Opportunities to be open and trusting in relationships with mental health workers were found to be related to factors which contribute to recovery (Paper II). Mental health workers’ modes of “being”, give opportunities for service users to be open and trusting. Being in relationship with the aim to promote dignity led to enhanced self-respect for service users as well as mental health workers (Paper III). Openness and indecisiveness were important factors for developing practical wisdom, and processes of development and change were nurtured by re-evaluation of experiences, thus contributing to develop and maintain dignity promoting practices (paper IV). Conclusion: Integrating service user’s experience-based knowledge as a foundation for mental health workers’ knowledge and clinical work depends on health workers being open to and impressed by the service user in each present moment; allowing service users to be narrators in own life; and awareness that services users’ perspectives and experiences represent a unique insight that needs to be valued. The main aim for dignity promoting practices is not primarily to induce development or change in the service user, rather to recognise and value him or her in his or her present state. By being in relationship with the service user, the mental health worker can acknowledge the service user as an active agent and demonstrate to him or her that his or her life is significant. Openness and trust can be nurtured by acknowledging the service user’s personal struggle; by understanding withdrawal and speaking to internal voices (as well as other “symptoms”) as human experiences rather than merely signs of illness; and by recognising the person’s intrinsic human value. Bearing this in mind, mental health workers need to engage in ongoing development processes towards openness, as it is in the present moment in each encounter that the services may succeed or fail

Hvor fort vokser neglene dine?

Hva er en persons gjennomsnittlige neglevekst? Finnes det noen faktorer som vil påvirke din neglevekst? For eksempel er det kjent at det finnes forskjeller mellom kjønnene og at ting forandres i menneskekroppen når den eldes. Hensikten var å finne ut av om det var en forskjell i negleveksten mellom unge og gamle eller mellom gutter og jenter. 15 personer fikk sine negler målt tre ganger hver femte dag. Utvalget bestod av fem jenter og fem gutter i  alderen 17år, og fem voksne i alder over 40. Ut fra resultatene kunne det ikke påvises noen forskjell mellom gutters og jenters neglevekst. Mellom de unge og voksne ble det derimot funnet en signifikant forskjell. De unges negler vokste fortere enn de voksnes

Developing a culture of pride, confidence and trust: enhanced collaboration in an interdicisplinary team

Background: Collaborative work is an inherently complex phenomenon. This article explores elements that enhance collaboration and argues that collaboration – understood as evolving processes whereby social entities actively and reciprocally engage in joint activities aimed at achieving a common goal – has not been given sufficient attention in the relevant Norwegian reforms. The Norwegian government implemented the Coordination Reform in January 2012, the aim of which was to provide a sustainable and high-quality health service (Ministry of Health and Care Services, 2012 ). This article uses the term ‘collaboration reform’ as this is the literal meaning of the Norwegian title Samhandlingsreform, and because collaboration seems to describe the aim of the reform better than coordination. Aim: To explore how facilitated processes enhance collaboration in an interdisciplinary team, and discuss how the findings inform issues of collaboration between hospitals and municipal health services. Methods: The design was a cooperative inquiry, that is, a participatory and shared approach to research that aims to facilitate understanding of a shared experience by virtue of cycles of action and reflection. Findings/results: Taking part in facilitated processes gave the team members added awareness about their work, made them more able to handle complex situations and gave them confidence in their own competence and that of their and colleagues. The processes also gave team members opportunities for enhanced sharing and a broader agenda, to notice and detect, and to create a story about who we are and what we do. Conclusions: Trusting and knowing each other is a foundation for collaborative work. The facilitated processes provided structure and direction, addressed power imbalances and kept the focus goal-centred. Cross-boundary collaboration between hospitals and municipal health services could improve with an awareness of collaboration as an evolving process involving reciprocity between social entities and participation in joint activities aiming at achieving a shared goal. Formal guidelines and agreements on a local basis could help promote joint responsibility for patients’ best interest. Implications for practice: Provision of integrated and coordinated services for patients can be improved by social entities engaging in joint activities There is a need for facilitated networks across boundaries in the health services Collaboration may improve with greater focus on the processes of sharing tasks and responsibilities Knowledge about cooperating partners is crucial to optimise provision of integrated and coordinated services for patient

Developing a culture of pride, confidence and trust: enhanced collaboration in an interdisciplinary team

Background: Collaborative work is an inherently complex phenomenon. This article explores elements that enhance collaboration and argues that collaboration – understood as evolving processes whereby social entities actively and reciprocally engage in joint activities aimed at achieving a common goal – has not been given sufficient attention in the relevant Norwegian reforms. The Norwegian government implemented the Coordination Reform in January 2012, the aim of which was to provide a sustainable and high-quality health service (Ministry of Health and Care Services, 2012 ). This article uses the term ‘collaboration reform’ as this is the literal meaning of the Norwegian title Samhandlingsreform, and because collaboration seems to describe the aim of the reform better than coordination. Aim: To explore how facilitated processes enhance collaboration in an interdisciplinary team, and discuss how the findings inform issues of collaboration between hospitals and municipal health services. Methods: The design was a cooperative inquiry, that is, a participatory and shared approach to research that aims to facilitate understanding of a shared experience by virtue of cycles of action and reflection. Findings/results: Taking part in facilitated processes gave the team members added awareness about their work, made them more able to handle complex situations and gave them confidence in their own competence and that of their and colleagues. The processes also gave team members opportunities for enhanced sharing and a broader agenda, to notice and detect, and to create a story about who we are and what we do. Conclusions: Trusting and knowing each other is a foundation for collaborative work. The facilitated processes provided structure and direction, addressed power imbalances and kept the focus goal-centred. Cross-boundary collaboration between hospitals and municipal health services could improve with an awareness of collaboration as an evolving process involving reciprocity between social entities and participation in joint activities aiming at achieving a shared goal. Formal guidelines and agreements on a local basis could help promote joint responsibility for patients’ best interest. Implications for practice: Provision of integrated and coordinated services for patients can be improved by social entities engaging in joint activities There is a need for facilitated networks across boundaries in the health services Collaboration may improve with greater focus on the processes of sharing tasks and responsibilities Knowledge about cooperating partners is crucial to optimise provision of integrated and coordinated services for patient

Orientation in expected and unexpected landscapes – a case study of a newly established municipal healthcare unit

Background: This article examines how staff delivering care (two groups of healthcare workers and leaders) in a newly established unit worked to sustain required performance levels through changes and disruptions. It highlights discrepancies between plans for the unit (work as imagined) and reality in the unit (work as done). Aim: The aim of this article is to explore the experiences of persons in the workplace in response to discrepancies between work as imagined and work as done. Methods: Case study methodology is used to give attention to context and complexity, to gain a deepened understanding of the topic and to unveil contradictions and commonalities. The data material includes notes, pictures and soundtracks, and was analysed using qualitative content analysis. Results: The findings show discrepancies between the plans and practical reality. Staff responses to these are presented as ‘being left to oneself’ ‘moving to new positions’ and ‘walking together’. Conclusion: The healthcare system consists of multiple interactive systems and subsystems. People working at the micro level need to deliver care under expected and unexpected conditions. For a workplace culture to be effective, staff need to experience being part of a community they can be proud of, as well as being acknowledged as persons contributing to that community. Involvement in decision making and opportunities to verbalise challenges make it possible for staff to make a map that fits the landscape, and thus make better plans for patient care. Implications for practice: Engagement in a project initiated by staff can provide direction for work and better quality of care A resilient healthcare system depends on health workers having the opportunity to develop as persons and be part of a community Changes in healthcare systems are demanding for both leaders and staff, and it takes time and effort to build resilient systems and culture

Staying on track in changing landscapes: mapping complex projects in health services

Background: Projects initiated to transform and develop health services have to account for a variety of complex factors. There is a need to develop methods to handle this complexity, and in this article we present a flexible and adaptable framework for mapping projects that focus on involvement of persons receiving care and other stakeholders, with an integrated support structure. The method also considers elements in the local context. Aims: To present examples of project mapping, and to explore how the process can enhance quality in complex projects in healthcare services. Methods: The project mappings have been co-designed in processes of deliberate dialogue between the authors of this article, with involvement from other researchers and stakeholders. A three- dimensional version of project mapping was developed, and further refined by introducing a two-dimensional version and testing the framework in various settings such as a project leader course and the 2018 Enhancing Practice Conference in Basel. Analysis continued through the whole process as preliminary ideas were discussed and documented. We reflected, wrote notes, talked to people, took part in workshops that included a variety of creative methods, and did a qualitative content analysis of key findings to develop themes. Results: The examples of project mapping show that the process of mapping is as important as the map itself. The maps are flexible and can be combined. Project mapping can contribute to quality in projects by helping project facilitators and participants to stay on track. It can also enable co-creation and guide facilitation processes. Conclusion: Engaging in mapping processes represents an approach that can contribute to a shift in thinking and help even out power imbalances between project participants, as well as influencing the working culture in a health service. Mapping can facilitate transformation of practice while simultaneously creating new knowledge about that transformation

Staying on track in changing landscapes: mapping complex projects in health services

Background: Projects initiated to transform and develop health services have to account for a variety of complex factors. There is a need to develop methods to handle this complexity, and in this article we present a flexible and adaptable framework for mapping projects that focus on involvement of persons receiving care and other stakeholders, with an integrated support structure. The method also considers elements in the local context. Aims: To present examples of project mapping, and to explore how the process can enhance quality in complex projects in healthcare services. Methods: The project mappings have been co-designed in processes of deliberate dialogue between the authors of this article, with involvement from other researchers and stakeholders. A three- dimensional version of project mapping was developed, and further refined by introducing a two-dimensional version and testing the framework in various settings such as a project leader course and the 2018 Enhancing Practice Conference in Basel. Analysis continued through the whole process as preliminary ideas were discussed and documented. We reflected, wrote notes, talked to people, took part in workshops that included a variety of creative methods, and did a qualitative content analysis of key findings to develop themes. Results: The examples of project mapping show that the process of mapping is as important as the map itself. The maps are flexible and can be combined. Project mapping can contribute to quality in projects by helping project facilitators and participants to stay on track. It can also enable co-creation and guide facilitation processes. Conclusion: Engaging in mapping processes represents an approach that can contribute to a shift in thinking and help even out power imbalances between project participants, as well as influencing the working culture in a health service. Mapping can facilitate transformation of practice while simultaneously creating new knowledge about that transformation

Older people living at home : experiences of healthy ageing

AIM: The purpose of this study was to investigate how old persons perceived their life to be, how they viewed the ageing process and their need of health care and societal support. BACKGROUND: The purpose of WHO's Healthy Ageing strategy and development of age-friendly environments is to support physiological and psychosocial changes in old persons by facilitating basic needs. Interventions to operationalize these needs in older people living at home are often developed from a professional perspective and to a small extent involves the perceptions, experience and expectations of the older persons. METHOD: This qualitative study has an explorative design using focus group discussions to collect data. In all, 34 persons between 69 and 93 years of age participated in seven group discussions. The interviews were analyzed using inductive manifest content analysis. FINDINGS: The main results suggest that most old persons enjoyed life and wished it to continue for as long as possible. Important was to sustain networks and to feel useful. Unexpected changes were described as threats and the need to use health care services was associated with illness and being dependent. The result is presented in three categories with sub-categories: 'Embracing life', 'Dealing with challenges' and 'Considering the future'