Personaer for å styrke hjemmedialysepasientens rolle i innovasjonsprosessen

Bakgrunn: Det er et mål at minst 30 prosent av dialysepasienter skal benytte hjemmedialyse. Tett oppfølging fra spesialisthelsetjenesten er vesentlig for å øke pasientenes trygghets- og mestringsfølelse i hjemmebehandlingen. Utgangspunktet for studien var en nyrepoliklinikk der sykepleiernes rutiner og støtteverktøy ikke ga rom for å kunne få opp andelen pasienter med hjemmedialyse. En digital oppfølgingsløsning skulle pilottestes. Formålet var å få innsikt i hvilken nytteverdi løsningen hadde, og hvordan den måtte videreutvikles for å møte sykehusets og pasientenes behov. Hensikt: I innovasjonsprosessen fikk sykepleierne ved poliklinikken en aktiv rolle i pilotprosjektet, mens pasientperspektivet var vanskeligere å få frem grunnet pasientenes helsetilstand. Vi ønsket derfor å undersøke hvordan personaer kunne utvikles for å tydeliggjøre pasientenes behov og forholdet mellom pasientene og helsetjenesten. Vi ønsket også å bidra til mer brukersentrering når teknologi for oppfølging av hjemmebehandling utvikles. Metode: Studien vår er en eksplorativ, kvalitativ og longitudinell casestudie, hvor casen var å prøve ut den digitale oppfølgingsløsningen. Vi samlet inn data gjennom intervjuer, observasjoner og workshoper med pasienter og sykepleiere ved nyrepoliklinikken, ansatte på sykehus og i hjemmesykepleien samt leverandøren. Tematisk analyse av data fra casen la grunnlaget for å utvikle personaer, som senere ble presentert for nyresykepleierne for validering. Resultat: Våre resultater viser stor variasjon i pasientenes behov for oppfølging og metoder for å mestre hverdagen med hjemmedialyse. Disse varierte behovene møtes av sykepleierne, som bruker mye tid på kommunikasjon, logistikk og tilrettelegging for å sikre best mulig behandlingsetterlevelse. De utviklede personaene tar hensyn til dette samspillet. Konklusjon: Bruk av personaer har vært kritisert fordi det kan føre til at man i mindre grad bringer reelle brukere inn i prosessen. I denne studien har vi imidlertid benyttet personaer nettopp fordi muligheten til å bringe svært syke pasienter aktivt inn i innovasjonsprosessen har vært begrenset. Personaer kan i stor grad illustrere samspillet mellom sykepleiere og pasienter og de valgene pasientene tar. I videre arbeid med personaer bør også andre aktører enn pasienten beskrives, som hjemmesykepleien og de pårørende.publishedVersio

Clinical placement education during the coronavirus disease 2019 pandemic shapes new nurses: A qualitative study

Background - Many newly qualified nurses experience transition challenges because they feel unprepared for the reality of the nursing profession owing to the theory-practice gap. Transition challenges amongst newly qualified nurses have profound consequences for the nursing profession and patient care. A detailed and nuanced understanding of the complexity in transition-related challenges during extraordinary conditions like the coronavirus disease 2019 pandemic is needed for newly qualified nurses to remain in the nursing profession. Objective - This study explored the experience of newly qualified nurses entering the nursing profession who had their clinical placement education missed, shortened, or substituted since they had to serve as health care assistants during the coronavirus disease 2019 pandemic. Design - An exploratory and descriptive study design was used. Settings - Workplaces for newly qualified nurses. Participants - A purposive sample of 10 newly qualified Norwegian nurses working in various clinical placement nursing settings were included. Methods - Data were collected in April and May 2022 via individual interviews conducted via Zoom. Thematic analysis was applied to identify themes. Triangulation was employed to ensure trustworthiness. Findings - Three major themes emerged: relational aspects of nursing, practical aspects of nursing, and inadequacies in the pedagogical plan of teaching and learning. The themes indicate that the limited or suspended clinical placement education during the pandemic affected the competence of newly qualified nurses. Conclusions - During the coronavirus disease 2019 pandemic, clinical placement education for student nurses was limited or suspended owing to safety concerns. The short clinical placement durations affected the competence of newly qualified nurses, as they lacked exposure to real-world patient care scenarios as in non-pandemic times. Furthermore, our findings indicate that newly qualified nurses’ clinical placement experiences provide important knowledge and insight for educators in terms of education and support for future student nurses going into situations with short clinical placement hours. The conclusion highlights the implications of the findings and recommendations and the need for further support and education for newly qualified nurses after the pandemic

Trust-based service innovation of municipal home care. A longitudinal mixed methods study

Background: In Scandinavia, various public reforms are initiated to enhance trust in the healthcare services and the public sector in general. This study explores experiences from a two-step service innovation project in municipal home care in Norway, coined as the Trust Model (TM), aiming at developing an alternative to the purchaser-provider split (PPS) and enhancing employee motivation, user satisfaction, and citizen trust. The PPS has been the prevalent model in Norway since the 1990s. There is little empirical research on trust-based alternatives to the PPS in health- care. The overall objectives of this study were to explore facilitators and barriers to trust-based service innovation of municipal homecare and to develop a framework for how to support the implementation of the TM. Methods: The TM elements were developed through a comprehensive participatory process, resulting in the deci- sion to organize the home care service in small, self-managed and multidisciplinary teams, and trusting the teams with full responsibility for care decisions and delivery within a limited area. Through a longitudinal mixed methods case study design a) patients’ expressed values and b) factors facilitating or preventing the service innovation process were explored through two iterations. The first included three city districts, three teams and 80 patients. The second included four districts, eight teams and 160 patients. Results: The patient survey showed patients valued and trusted the service. The team member survey showed increased motivation for work aligned with TM principles. Both quantitative and qualitative methods revealed a series of facilitators and barriers to the innovation process on different organizational levels (teams, team leaders, system). The key message arising from the two iterations is to keep patients’ values in the centre and recognize the multilevelled organizational complexity of successful trust-based innovation in homecare. Synthesizing the results, a framework for how to support trust-based service innovation was constructed. Conclusions: Trust-based innovation of municipal homecare is feasible. The proposed framework may serve as a tool when planning trust-based innovation, and as a checklist for implementation and improvement strategies. Further research is needed to explore the validity of the framework and its replicability in other areas of healthcare

Exploration of ethical issues in the implementation of digital monitoring technologies in health care services

The study is based on a research and innovation project on adoption and use of digital monitoring in municipal care services. The evolving use of technology is considered to meet future challenges in health and care services. However, the use of technological solutions in this context has also led to several challenges, and in this study, we focus on the ethical consequences of using welfare technology. Implementation projects are particularly relevant in this context because different stakeholders with different interest, values, assumptions need to collaborate closely and build integrated solutions to make such projects successful. Furthermore, it is a challenge to predict future consequences of using emerging technologies and we argue that ethical assessments must be part of the implementation process

Sosiale mediers rolle i jobbsøkingsprosessen : #Facebook #LinkedIn #Instagram #Snapchat #Twitter

Sosiale medier er ikke lenger bare en del av den private sfære, men også noe bedrifter bruker aktivt til å promotere seg. Blant annet ser man store muligheter ved bruk av sosiale medier for en rekke HR-funksjoner, inkludert rekruttering. Det vi imidlertid vet mindre om, er arbeidssøkers bruk av sosiale medier i jobbsøking. Denne studien studerer potensielle arbeidstakeres bruk av sosiale medier i jobbsøking. Vi har intervjuet 20 økonomistudenter fra Norge og Canada om deres antakelser om, syn på og praksis rundt bruk av sosiale medier i jakten på sin fremtidige arbeidsgiver. Resultatene viser at informantene i denne studien ikke bruker sosiale medier aktivt i sin orientering om aktuelle arbeidsgivere. Allikevel ser det ut til at eksponering gjennom sosiale medier indirekte påvirker potensielle arbeidstakeres oppfatning av ulike bedrifter. Sosiale medier ser ut til å være mest hensiktsmessig som en del av arbeids­giveres merke­varebygging for arbeidsgivere (employer branding)-strategi. Rekruttering kan derfor ikke sees på i snever forstand

Exploration of ethical issues in the implementation of digital monitoring technologies in municipal health care services

The study is based on a research and innovation project on adoption and use of digital monitoring in municipal care services. The evolving use of technology is considered to meet future challenges in health and care services. However, the use of technological solutions in this context has also led to several challenges, and in this study, we focus on the ethical consequences of using welfare technology. Implementation projects are particularly relevant in this context because different stakeholders with different interest, values, assumptions need to collaborate closely and build integrated solutions to make such projects successful. Furthermore, it is a challenge to predict future consequences of using emerging technologies and we argue that ethical assessments must be part of the implementation process

Therapists’ experience of video consultation in specialized mental health services during the COVID-19 pandemic: Qualitative interview study

Background: As part of political and professional development with increased focus on including service users within mental health services, these services are being transformed. Specifically, they are shifting from institutional to noninstitutional care provision with increased integration of the use of electronic health and digitalization. In the period from March to May 2020, COVID-19 restrictions forced rapid changes in the organization and provision of mental health services through the increased use of digital solutions in therapy. Objective: The aim of this study was to develop and advance comprehensive knowledge about how therapists experience the use of video consultation (VC). To reach this objective, we evaluated therapists’ experiences of using VC in specialized mental health services in the early phase of COVID-19 restrictions. The following questions were explored through interviews: Which opportunities and challenges appeared when using VC during the period of COVID-19 restrictions? In a short-term care pathway, for whom does VC work and for whom does it not work? Methods: This study employed a qualitative approach based on an abductive strategy and hermeneutic-phenomenological methodology. Therapists and managers in mental health departments in a hospital were interviewed via Skype for Business from March to May 2020, using a thematic interview guide that aimed to encourage reflections on the use of VC during COVID-19 restrictions. Results: Therapists included in this study experienced advantages in using VC under circumstances that did not permit face-to-face consultations. The continuity that VC offered the service users was seen as a valuable asset. Various negative aspects concerning the therapeutic environment such as lack of safety for the most vulnerable service users and topics deemed unsuitable for VC lowered the therapists’ overall impression of the service. The themes that arose in the data analysis have been categorized in the following main topics: (1) VC—“it’s better than nothing”; (2) VC affects therapists’ work situation—opportunities and challenges in working conditions; and (3) challenges of VC when performing professional assessment and therapy on the screen. Conclusions: Experiences with VC in a mental health hospital during COVID-19 restrictions indicate that there are overall advantages to using VC when circumstances do not permit face-to-face consultations. Nevertheless, various negative aspects in the use of VC lowered the therapists’ overall impression of VC. Further qualitative research is needed, and future studies should focus on service users’ experiences, cocreation between different stakeholders, and how to scale up the use of VC while ensuring that the service provided is appropriate, safe, and available

Implementation of eHealth Technology in Community Health Care: the complexity of stakeholder involvement

Background: The implementation of any technology in community health care is seen as a challenge. Similarly, the implementation of eHealth technology also has challenges, and many initiatives never fully reach their potential. In addition, the complexity of stakeholders complicates the situation further, since some are unused to cooperating and the form of cooperation is new. The paper’s aim is to give an overview of the stakeholders and the relationships and dependencies between them, with the goal of contributing this knowledge to future similar projects in a field seeing rapid development. Methods: In this longitudinal qualitative and interpretive study involving eight municipalities in Norway, we analysed how eHealth initiatives have proven difficult due to the complexity and lack of involvement and integration from stakeholders. As part of a larger project, this study draws on data from 20 interviews with employees on multiple levels, specifically, project managers and middle managers; healthcare providers and next of kin; and technology vendors and representatives of the municipal IT support services. Results: We identified the stakeholders involved in the implementation of eHealth community health care in the municipalities, then described and discussed the relationships among them. The identification of the various stakeholders illustrates the complexity of innovative implementation projects within the health care domain—in particular, community health care. Furthermore, we categorised the stakeholders along two dimensions (external– internal) and their degree of integration (core stakeholders, support stakeholders and peripheral stakeholders). Conclusions: Study findings deepen theoretical knowledge concerning stakeholders in eHealth technology implementation initiatives. Findings show that the number of stakeholders is high, and illustrate the complexity of stakeholders’ integration. Moreover, stakeholder integration in public community health care differs from a classical industrial stakeholder map in that the municipality is not just one stakeholder, but is instead comprised of many. These stakeholders are internal to the municipality but external to the focal actor, and this complicating factor influences their integration. Our findings also contribute to practice by highlighting how projects within the health care domain should identify and involve these stakeholders at an early stage. We also offer a model for use in this context

Towards successful digital transformation through co-creation: a longitudinal study of a four-year implementation of digital monitoring technology in residential care for persons with dementia

Background: Implementation of digital monitoring technology systems is considered beneficial for increasing the safety and quality of care for residents in nursing homes and simultaneously improving care providers’ workflow. Co-creation is a suitable approach for developing and implementing digital technologies and transforming the service accordingly. This study aimed to identify the facilitators and barriers for implementation of digital monitoring technology in residential care for persons with dementia and wandering behaviour, and explore co-creation as an implementation strategy and practice. Methods: In this longitudinal case study, we observed and elicited the experiences of care providers and healthcare managers in eight nursing homes, in addition to those of the information technology (IT) support services and technology vendors, during a four-year implementation process. We were guided by theories on innovation, implementation and learning, as well as co-creation and design. The data were analysed deductively using a determinants of innovation framework, followed by an inductive content analysis of interview and observation data. Results: The implementation represented radical innovation and required far more resources than the incremental changes anticipated by the participants. Five categories of facilitators and barriers were identified, including several subcategories for each category: 1) Pre-implementation preparations; 2) Implementation strategy; 3) Technology stability and usability; 4) Building competence and organisational learning; and 5) Service transformation and quality management. The combination of IT infrastructure instability and the reluctance of the IT support service to contribute in co-creating value with the healthcare services was the most persistent barrier. Overall, the co-creation methodology was the most prominent facilitator, resulting in a safer night monitoring service. Conclusion: Successful implementation of novel digital monitoring technologies in the care service is a complex and time-consuming process and even more so when the technology allows care providers to radically transform clinical practices at the point of care, which offers new affordances in the co-creation of value with their residents. From a long-term perspective, the digital transformation of municipal healthcare services requires more advanced IT competence to be integrated directly into the management and provision of healthcare and value co-creation with service users and their relatives