The challenges of primary health care nurse leaders in the wake of New Health Care Reform in Norway

© The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.e. The Creative Commons Public Domain Dedication waiver applies to the data made available in this article, unless otherwise stated.Background: The local municipality, whose management style is largely inspired by the New Public Management (NPM) model, has administrative responsibilities for primary health care in Norway. Those responsible for health care at the local level often find themselves torn between their professional responsibilities and the municipality’s market-oriented funding system. The introduction of the new health care reform process known as the Coordination Reform in January 2012 prioritises primary health care while simultaneously promoting a more collaborative and multidisciplinary approach to health care. Nurse leaders experience constant cross-pressure in their roles as members of the municipal executive team, the execution of their professional and administrative duties, and the overall political aims of the new reform. The aim of this article is to illuminate some of the major challenges facing nurse leaders in charge of nursing homes and to draw attention to their professional concerns about the quality of nursing care with the introduction of the new reform and its implementation under NPMinspired municipal executive leadership. Method: This study employs a qualitative design. In-depth interviews were conducted with 10 nurse leaders in 10 municipalities, with a phenomenological-hermeneutic approach used for data analysis and interpretation. Result: Findings highlighted the increasingly complex challenges facing nurse leaders operating in the context of the municipality’s hierarchical NPM management structure, while they are required to exercise collaborative professional interactions as per the guidelines of the new Coordination Reform. The interview findings were interpreted out of three sub-themes 1) importance of support for the nurse leader, 2) concerns about overall service quality, and 3) increased tasks unrelated to nursing leadership. Conclusion: The priorities of municipal senior management and the focus of the municipality’s care service need clarification in the light of this reform. The voices of those at the frontlines of the caring services need to be heard as the restructuring of the caring services may have implications both for funding allocation and for the quality of patient care

Retarder in larger concrete construction in cold clima

Varmeutviklingen i betong avgjøres mye av sement sammensetningen. Sementen er sammensatt av forskjellige klinker som har mye å si for varmeutviklingen, ettersom de har forskjellige energiutvikling og reaksjonshastighet når de kommer i kontakt med vann. Pozzolan er et stoff som kan brukes til å erstatte en vis mengde av sementen, som flygeaske som gir en reduksjon i varmeutviklingen og har mindre innvirkning på betongen egenskaper er ofte brukt i Norge. Varmeutviklingen i betongen spiller direkte inn på størrelsen til temperaturgradienten. Når herdetemperaturen blir for høy kan det bli for stor forskjell mellom kjernen (spenning) og overflaten (strekk) slik at det dannes riss og kvaliteten på betongen blir dårligere. Målsetningen i denne oppgaven er å kartlegge om bruk av retarderende stoffer kan gi en redusere varmeutviklingen i betongen ved bruk av Norcem Standard FA sement. Dette i forbindelse med vindmølleparken som skal bygges i Åndstadblåheia som det var først planlagt å bruke Norcem Standard FA sement. Litteraturstudiet omfatter hydratiseringsgrad, hastighetsfunksjon, modenhetsprinsippet og varmeutvikling. Det praktiske arbeid som ble gjort i forbindelse med oppgaven var blanding av reseptene, konstruksjon av herdekasser og kobling av målepunkter for temperaturmålingene og det ble tatt trykkfasthet prøver for hver blanding. Det er gjort noen enkle beregninger av stigningstallet til varmeutviklingen og teoretisk maksimum temperaturer i blandingene som ble brukt. Ved måling av temperaturutviklingen i herdekassene ble det laget grafer som viser temperaturutviklingens forløp og hvordan ytre romtemperatur kan påvirke temperaturen i herdingsprosessen. Simuleringsprogramet Hett 97 er brukt til å simulere forskjellige konstruksjoner for å kartlegg temperaturutviklingen i større konstruksjoner. Dette for å kunne sammenligne med oppnådd temperatur i herdekassene og beregnet temperature

Current status of rehabilitation activity and the new health care reform in Norway

The purpose of this study is to analyse the current activities of Norwegian ambulatory rehabilitation teams at a time when the field of rehabilitation is set for major changes with the recent introduction of the new pro-rehabilitation Coordination Reform. The content of the all logged consultations of four ambulatory teams belonging to one of the four regional health authorities was analysed in terms of municipality population size and, where possible, the age-distribution of the patients. Consultations were coded into one of four main codes, i.e. 'investigation and diagnostics; treatment and practical training; consultation, collaboration and training; and auxiliary measures'. A total of 2992 consultations were registered for period 2009–2012, with the far majority of consultations involving patients aged =67 years, and the elderly under-represented in especially the smaller municipalities. Analysis showed differential rehabilitation activity towards the elderly in the two rehabilitation teams which registered the far majority of consultations, which were also concentrated in only three of the 18 sub-codes. Provision of rehabilitation seems to lack an overall coordinating strategy. The kind and level of rehabilitation any given elderly person is entitled to, by and large, depends on the place of residence of the patient

Antologiens sentrale begreper og perspektiver

This chapter provides an overview of key concepts and theoretical perspectives used in the anthology and points out fundamental challenges in the practice of professional welfare. ‘Competence’ and ‘knowledge’ often have different meanings, and there is a need for increased awareness of the understanding of these concepts. This chapter highlights how the managerial discretion, learning, system blindness, power executing and paradoxes may cause tensions and how these in turn may inhibit the realization of required changes. Internal or external job recruitment may have an impact on managers’ freedom to act. To raise the quality and competence within the professional welfare services, it is necessary to be aware of the unique and multi-faceted challenges in the field

Hvordan få til nytenkning i kommunale sykehjem?

Journal home page at https://www.nsf.no/fg/geriatri-og-demens/tidsskriftet-geriatrisk-sykepleie

Dopamine agonist serum concentrations and impulse control disorders in Parkinson's disease

Background and purpose: Impulse control disorders (ICDs) are common among Parkinson's disease patients using dopamine agonists. We wanted to determine whether ICD patients have higher dopamine agonist serum concentrations than those without any sign of ICD. Methods: Patients who used either pramipexole or ropinirole depot once daily were screened for ICDs using the validated Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease–Rating Scale. Those who scored above the cut-off for one or more of the four defined ICDs (gambling, compulsive sexual behavior, compulsive shopping, and binge-eating) were compared in a case–control study to patients who scored zero points (no evidence of ICD) on the same items. They were examined clinically and evaluated using relevant scales. Three blood samples were taken on the same day: before daily dose, and then 6 and 12 h later. Results: Forty-six patients were included: 19 ICD-positive and 27 controls. Ropinirole serum concentrations 6 h after daily intake (Cmax) were higher in the case group compared to the control group, as was the daily ropinirole dosage. No differences were observed in serum concentrations, dosage or total drug exposure for pramipexole. Disease duration and length of dopamine agonist treatment was significantly longer among ICD patients for ropinirole, but not for pramipexole. Conclusions: The use of pramipexole may in itself confer high ICD risk, whereas ICDs among ropinirole users depend more on serum concentration and drug exposure. The pharmacokinetic properties of ropinirole make it challenging to predict its effects on patients, which supports the need for therapeutic drug monitoring to reduce risk of ICD

Green Plants in the Red: A Baseline Global Assessment for the IUCN Sampled Red List Index for Plants

Plants provide fundamental support systems for life on Earth and are the basis for all terrestrial ecosystems; a decline in plant diversity will be detrimental to all other groups of organisms including humans. Decline in plant diversity has been hard to quantify, due to the huge numbers of known and yet to be discovered species and the lack of an adequate baseline assessment of extinction risk against which to track changes. The biodiversity of many remote parts of the world remains poorly known, and the rate of new assessments of extinction risk for individual plant species approximates the rate at which new plant species are described. Thus the question ‘How threatened are plants?’ is still very difficult to answer accurately. While completing assessments for each species of plant remains a distant prospect, by assessing a randomly selected sample of species the Sampled Red List Index for Plants gives, for the first time, an accurate view of how threatened plants are across the world. It represents the first key phase of ongoing efforts to monitor the status of the world’s plants. More than 20% of plant species assessed are threatened with extinction, and the habitat with the most threatened species is overwhelmingly tropical rain forest, where the greatest threat to plants is anthropogenic habitat conversion, for arable and livestock agriculture, and harvesting of natural resources. Gymnosperms (e.g. conifers and cycads) are the most threatened group, while a third of plant species included in this study have yet to receive an assessment or are so poorly known that we cannot yet ascertain whether they are threatened or not. This study provides a baseline assessment from which trends in the status of plant biodiversity can be measured and periodically reassessed

Corporate performance in recessions : the effects of capital structure and growth

The purpose of this study is to analyze how recessions affect the impact of prior growth and capital structure on corporate performance. Using multiple regression analysis on financial statement data from the period 2000-2012 we were able to investigate this on a large sample of Norwegian firms. Splitting our performance construct into profitability and growth, our results show that i) recessions negate the positive effects of prior growth on growth that rapidly growing firms experience in non-recessionary years; ii) recessions induce a negative non-linear effect of prior growth on profitability, which particularly affects fast-growing firms; iii) recessions exacerbate the negative effect of high leverage found in non-recessionary years; iv) recessions induce an increasingly negative effect of leverage on profitability, and v) there is little evidence of an interaction effect between capital structure and growth on corporate performance in our sample. In sum, our findings indicate that both prior growth and high leverage can have substantial negative impact on firm performance in recessions. The thesis includes a brief investigation of potential causal mechanisms behind the negative effects we observe. We find support for a removal of creditors and investors’ intertemporal productivity indifference during recessions, and that industry affiliation and credit constraints provide important channels for recessionary impact. Lastly we provide directions for future research that can expand on our exploratory study.nhhma