Muligheter og begrensninger i sykepleierens handlingsrom når sykehjemspasientens sykdomstilstand forverrer seg

The purpose of this chapter is to highlight the experiences of nurses working in nursing homes when it comes to detecting changes in a patient’s condition at an early stage, so that treatment can be initiated as early as possible. How do nurses experience their sphere of action, their opportunities and their limitations to detect changes at the earliest stage possible? Studies show that nurses experience this sphere of action as very limited. These limitations show most clearly when there is only one nurse on duty. In this situation, keeping track of all patients and their needs is particularly demanding and difficult, especially if other employees are untrained. With one exception, all informants feel that it is their responsibility if something goes wrong, and several say that it gives them a bad conscience to know that patients have suffered unnecessarily on their guard. The informants indicate that their working lives have changed significantly after the introduction of the coordination reform. The scope of both academic and organizational tasks has increased. The patients are sicker, which means that nurses are given more as well as more complicated and time-consuming tasks that only nurses have the competence to perform. All informants agree that this is both positive and negative. It is positive because the assignments are more varied, interesting and relevant to their specific professional competence. It is negative partly because not enough positions have been created relative to the increased workload and partly because nurses have a greater responsibility, especially when there is only one nurse on duty. This happens relatively often due to high levels of sick leave and vacant positions. Several of the informants say that a redistribution of work tasks between the various occupational groups could help to expand their sphere of action in order to give them more time to attend to their specific tasks.

Ledelse av profesjonalisert velferd i et paradoksteoretisk perspektiv

Despite an increased focus on the professionalisation of welfare leadership, leadership challenges in the healthcare sector and child welfare services are an unexplored area. This chapter deals with welfare leadership, and attention is directed at the nature of these challenges and how paradox theory can be used to describe and explain them. This chapter shows that the framework and conditions of welfare leadership are often contradictory and that demands and expectations are often characterised by paradoxes. Major reforms have been implemented in Norway in recent years, and increased quality, expanded expertise and stronger leadership have been among the focus areas. Many leaders in the healthcare sector and child welfare services increasingly experience conflicting and intersecting governance requirements, and everyday leadership is characterised by complexity, uncertainty and stress. Leaders in complex, contradictory and quotidian conditions experience challenges in the areas of managerial discretion and broader leadership competence. Finally, the author discusses the need for leaders to develop competence in handling dilemmas by acquiring training in paradoxical thinking and handling complexity.

Utfordringer i tverrfaglig samarbeid. Kommunal helse- og omsorgstjeneste samt kommunalt barnevern

This chapter on the challenges of interdisciplinary co-operation between Municipal Health/Social Care and Child Protection respectively is based on the directives of public authorities that interactions often challenge interdisciplinary co-operation. The research studies on which we based the discussion indicate that there are several challenges associated with this form of co-operation. The discussion has its basis in the social constructivist perspective, where the focus is on the implications of the ontologies and epistemologies for interdisciplinary co-operation. Further, the discussion shows that interdisciplinary co-operation challenges the hierarchy of knowledge and user participation within the services. The chapter argues that interdisciplinary co-operation has, to some extent, the potential for further knowledge development.

Utøvelse av kunnskapsbasert praksis i sykehjem

Evidence-based practice (EBP) is one of the core skills in nursing, and it has received increased attention in official documentation and parliamentary announcements. The objective of this chapter is to develop knowledge about how EBP can be employed in nursing homes. The chapter is based on the experiences of nursing students during their project work on health promotion and prevention in a nursing home. The data are based on 18 students’ written evaluations of their practical studies, a focus group discussion with 4 of these 18 nursing students, and individual interviews with 4 leaders conducted in 2018. This study shows that both the leaders of the nursing homes and the students themselves acknowledge the need for occupational practice to be evidence-based. Resistance experienced by the nursing home staff may be a barrier to the application of EBP. The students experienced the project work as an opportunity to immerse themselves in a specific and well-defined theme using EBP tools.

Kunnskap om barns kollektive ansvarserfaringer og implikasjoner for tjenesteutøvelse i barnevernet

A major goal of the Child Welfare Services is to provide the best possible support to children in challenging life situations, including cross-cultural children, in Norway. However, there is inadequate knowledge about cross-cultural children’s responsibility taking and its implications for service delivery in Norwegian municipalities. This chapter discusses the importance of increased knowledge of the responsibility-taking practices of cross-cultural children for Municipal Child Welfare Service workers’ service delivery. The authors based the chapter on literature from studies on responsibility-taking experiences of children from Peru, Norway and other countries outside Europe. The literature indicates that many children have responsibilities to work and contribute to the sustenance of their families. Often, the children experienced feelings of identity, belonging and pride in mastering work roles. It is, therefore, difficult to understand the practices of these children as destructive parentification. On the contrary, the expectation that children provide for the upkeep of their families often attracts the destructive parentification label in European countries. Also, we argue that nuanced understanding of cross-cultural children’s responsibility-taking practices and identities may equip Child Welfare Services workers with competence that may enable them to provide the best possible support to cross-cultural children in Norway.

Utøvelse av ledelse i kommunale sykehjem – handlingsrommets betydning

Leaders of municipal nursing homes face challenges when they seek to secure a balance between the quality demands of authorities and the services they provide. In this chapter, we present a qualitative study on the leadership challenges in the municipal nursing homes. The aim is to develop knowledge on leadership challenges and the managerial discretions leaders employ to address the challenges. We interviewed seven middle-level leaders in five nursing homes in three medium-sized Norwegian municipalities using semi-structured interviews. The study revealed challenges connected to temporal nursing home placements made permanent, the time-consuming nature of the search for substitute workers, and the need to improve worker attitudes towards substitute workers’ experience-based knowledge. Attitude change is necessary because different forms of knowledge have different statuses in the nursing homes. The study shows that the leaders seek to meet the challenges connected to nursing home placements by establishing teams of professionals, while they try to persuade the Specialist Health Services to take over the responsibilities for the patients in transition. To meet the substitute worker challenge, the leaders use subjective managerial discretions to develop different strategies, including establishing substitute worker bases, substitute worker lists and delegation of substitute worker search. The leaders promote attitude change by stressing the importance of the substitute workers’ experience-based knowledge in both formal and informal contexts and implementing concrete competence measures. The study indicates that leaders who use subjective managerial discretions save time that they employ to create a balance between different leadership functions. The use of managerial discretions by leaders may affect the learning and organizational changes in nursing homes.

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.

Kulturell trygghet for den samiske pasienten i møter med helsevesenet

This chapter focuses on how nurses should act towards Sámi patients in order to promote cultural safety in meetings with the healthcare system. The method applied is a secondary analysis of interviews of 12 persons, as well as participatory observations. The findings show that there still are barriers between health personnel and Sámi patients due to the historic legacy and lack of knowledge. The barriers can be linguistic challenges, different understandings of an illness’s causes and authority distance due to the notion of the Sámi as inferior human beings.

Kompetansebegrepets uklarhet i møte med barnevernets komplekse handlingsrom

Background: Governmental documents must provide guidance and knowledge for social workers with a focus on child care. They must describe legislative changes, meet employee expectations and evaluate any reforms. To do so, it is important that the language and use of any concepts are interpreted in the same way. One of the terms used by the government in Norway is the word ‘competence’, which intends to describe to employees in social care services their tasks. The purpose of this chapter is to highlight challenges related to governmental use of the concept of the word ‘competence’. The term is used frequently, in the assumption that there is a common and equal interpretation of the word. Method: This study is a text analysis of relevant governmental documents published from 2014. The purpose of this method is to create structured data out of the documents. Theory: The study applies the perspectives of hermeneutics and phenomenology, combined with the organizational theories by Skau (2017) and Røvik (2007). Result: We have three findings concerning the term ‘competence’. The first is that the term is barely defined. The second is that the term is used without a proper structure. The third is that there are few governmental documents that are aimed specifically at child health care workers. Conclusion: This study shows that the term ‘competence’, which is used frequently in various contexts, lacks proper definition. This may lead to confusion and misunderstanding with respect to governmental directions and intents versus professional job execution amongst employees at social care services in Norway.

Sjuksköterskans kärnkompetenser

The overall aim of this chapter is to introduce different competencies that are considered as pivotal for good nursing care. This is motivated as skilfulness in such competences can contribute to how professionals manage their responsibilities and take actions as professionals. Therefore, the chapter is not presented as a study. Rather, it has a theoretical approach focusing on the description of six core competencies in nursing, i.e., patient-centred care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. These core competencies have been developed and described by the QSEN Institute (Quality and Safety Education for Nurses). Therefore, they are reflected on in relation to an understanding of nursing as an autonomous profession with a theoretical basis in caring science. This will not only shed light on nurses’ competencies but also contribute insights into the understanding of challenges and opportunities related to nurses’ domains of actions.