VIDEOCARE: Decentralised psychiatric emergency care through videoconferencing

BACKGROUND: Today the availability of specialists is limited for psychiatric patients in rural areas, especially during psychiatric emergencies. To overcome this challenge, the University Hospital of North Norway has implemented a new decentralised on-call system in psychiatric emergencies, by which psychiatrists are accessible by videoconference 24/7. In September 2011, the new on-call system was established in clinical practice for patients and health staff at three regional psychiatric centres in Northern Norway. Although a wide variety of therapies have been successfully delivered by videoconference, there is limited research on the use of videoconferenced consultations with patients in psychiatric emergencies. The aim of this study is to explore the use of videoconference in psychiatric emergencies based on the implementation of this first Norwegian tele-psychiatric service in emergency care. METHODS/DESIGN: The research project is an exploratory case study of a new videoconference service in operation. By applying in-depth interviews with patients, specialists and local health-care staff, we will identify factors that facilitate and hinder use of videoconferencing in psychiatric emergencies, and explore how videoconferenced consultations matter for patients, professional practice and cooperation between levels in psychiatric care. By using an on-going project as the site of research, the case is especially well-suited for generating reliable and valid empirical data. DISCUSSION: Results from the study will be of importance for understanding of how videoconferencing may support proper treatment and high-quality health care services in rural areas for patients in psychiatric emergencies

Managing Everyday Life: A Qualitative Study of Patients’ Experiences of a Web-Based Ulcer Record for Home-Based Treatment

Chronic skin ulcers are a significant challenge for patients and health service resources, and ulcer treatment often requires the competence of a specialist. Although e-health interventions are increasingly valued for ulcer care by giving access to specialists at a distance, there is limited research on patients’ use of e-health services for home-based ulcer treatment. This article reports an exploratory qualitative study of the first Norwegian web-based counselling service for home-based ulcer treatment, established in 2011 by the University Hospital of North Norway (UNN). Community nurses, general practitioners (GPs) and patients are offered access to a web-based record system to optimize ulcer care. The web-based ulcer record enables the exchange and storage of digital photos and clinical information, by the use of which, an ulcer team at UNN, consisting of specialized nurses and dermatologists, is accessible within 24 h. This article explores patients’ experiences of using the web-based record for their home-based ulcer treatment without assistance from community nurses. Semi-structured interviews were conducted with a total of four patients who had used the record. The main outcomes identified were: autonomy and flexibility; safety and trust; involvement and control; and motivation and hope. These aspects improved the patients’ everyday life during long-term ulcer care and can be understood as stimulating patient empowerment

Opportunities of personal connected care technology to children and youth with disabilities

Objective: Children and youths with disabilities have different needs and resources, and many need life-long assistance from several care services. Personal connected care technology (PCCT) can be a useful tool, and make users more independent, safe and able to manage daily activities. This article explores the organizational prerequisites for successful implementation of PCCT in municipalities. Material and methods: Based on a qualitative study in four Norwegian municipalities testing PCCT for the user group, 16 professionals were interviewed. They represented different sectors, service levels and positions, as well as The Norwegian Labour and Welfare Administration (NAV), which provides assistive technology. A thematic analysis is used. Results: Organizational prerequisites from a user perspective, a facilitating perspective and management perspective must be taken into account, for implementation of PCCT. The individual user’s resources and needs has to be examined and customized. It is also important to define roles and responsibilities of the service providers. Stakeholders, including executive level, must be involved, and cross-sectorial cooperation achieved. Conclusion: Implementing PCCT is complex. However, with knowledge and efforts to organizational preconditions at the user-, facilitator- and management level, technology can be established as a sustainable tool in municipality services for children and young people with disabilities

Mellom deltakelse og beskyttelse: Aksjonsforskningens mulighetsrom for barn og unge

Å gi barn og unge mulighet til deltakelse i forskning om temaer som angår deres liv og levekår er viktig. Samtidig innebærer forskning med mindreårige deltakere særskilte forskningsetiske og metodiske utfordringer. De har rett til beskyttelse, og deres integritet må ivaretas. Det kan oppstå et spenningsforhold mellom barns og unges deltakelse og deres rett til beskyttelse, særlig i forskning om sensitive tema. Dette spenningsforholdet bunner i en dualisme i synet på barn som kompetente på den ene siden og sårbare på den andre. Artikkelen drøfter hvordan aksjonsforskning som metodisk tilnærming kan fremme barns og unges medbestemmelse og deltakelse, og samtidig ivareta deres integritet. Med utgangspunkt i en barndomssosiologisk forståelsesramme, drøftes aksjonsforskningens mulighetsrom med eksempler fra en studie om en internettbasert selvhjelpsgruppe for ungdom med psykisk syke foreldre. Ved å belyse tre av aksjonsforskningens særtrekk, (1) deltakerorienterte prosesser, (2) nær forskerrolle samt (3) forskning for endring, argumenterer vi for at aksjonsforskning er velegnet til å imøtekomme barns og unges deltakelse og samtidig ivareta deres integritet i forskning om sensitiv tematikk

The symbolic affordances of a video-mediated gaze in emergency psychiatry

While mental illness is a significant health challenge worldwide, the availability of specialists is limited, especially in rural areas and for psychiatric emergencies. Although tele-psychiatry, via real-time videoconferencing (VC), is used to provide consultative services in areas that lack psychiatrists, there are a paucity of studies on the use of VC for psychiatric emergencies. We examine how VC matters for patient involvement and professional practice in the first Norwegian emergency tele-psychiatric service. Through a decentralised on-call system, psychiatrists are accessible 24/7 by telephone and VC for patients and nurses in regional psychiatry centres. Based on 29 interviews with patients, psychiatrists and nurses, this article addresses how participation is fostered by VC, and how it may change the social dynamics of therapeutic emergency encounters. We identified four contributions of the ‘video-mediated gaze’ in the therapeutic encounter including those of the: (1) immediacy of assessment, (2) increased transparency, (3) sense of access to the ‘real’ expert, and (4) fostering of the patient's ‘voice’ in therapeutic decisions. These VC inflections of the therapeutic encounter are a mix of the pragmatic (1 and 2) and the symbolic (3 and 4), assembling in these contexts to foster patient-centeredness. With a sociological approach to video-conferenced emergency psychiatry, the identification of symbolic affordances adds necessary nuances to the application of new technologies into fragile therapeutic communication

Study protocol: Health talk Norway

Abstract This paper is a study protocol. "Health tal

How Do Children Make Sense of their Parent's Mental Health Difficulties:A Meta-Synthesis

Children of parents who experience mental health difficulties (COPE-MHD) consistently demonstrate numerous negative outcomes, including risks of intergenerational continuity of mental health difficulties (MHD). Numerous studies have analysed the experiences and understanding of parents’ MHD from the perspective of COPE-MHD. This metasynthesis aims to capture, across available literature, the way in which COPE-MHD make sense of their parent’s MHD and how this perception impacts their life. For inclusion in the review, research articles were required to be published in peer-reviewed journals, apply qualitative methods of data collection and analysis and report on the direct accounts of COPE-MHD regarding their understanding or experience of their parents’ MHD. Five electronic databases were used; Academic Search Complete, CINAHL, MEDLINE, PsycINFO and Child Development and Adolescent Studies. Fourteen studies were included. Analysis produced three overarching themes. The findings illustrate children’s sophisticated biopsychosocial conceptualisation of the cause and process of their parent’s MHD. It also highlights how they utilise this understanding to manage the day-to-day concerns associated with their parent’s experience of MHD. Clinical implications highlight a need for services working with children, parents and families to more frequently enquire about parents’ MHD and to consider the outcomes of such enquiry in the psychological formulation of children and young peoples’ mental health and development. Limitations and recommendations for future research are presented