| 1. |
- Hedlund, M., et al.
(författare)
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The disciplining of self-help : Doing self-help the Norwegian way
- 2019
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 225, s. 34-41
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Tidskriftsartikel (refereegranskat)abstract
- We explore how Norwegian self-help groups are defined and managed to create a particular form of health system governmentality. Self-help groups are typically framed as therapeutic communities where participants define the agenda creating a space where open and equal interaction can produce individual learning and personal growth. In Norway, however, self-help groups are managed in a way that integrates them in to the health system but insulates them from clinical medicine; an approach that disciplines participants to act in a particular way in relation to the health system. We draw on the analysis of 1456 pages of public documents and websites from the National Nodal Point for Self-Help (NPSH), the organisation that manages self-help groups, and central government including individual testimonies from participants published between 2006 and 2014. We argue, drawing on Foucault, that self-help premised on lay-leadership and self-determination is at odds with the centrally defined regulation apparent in the model adopted in Norway and an example of disciplining that reinforces health system governmentality and serves the interests of the medical profession and the state. Further we propose that this illustrates the contestation between the pastoral power of medics, the National Nodal Point for Self-Help and the Ministry of Health. Our analysis of Norwegian self-help as a mechanism to create a particular form of health system governmentality helps explain the expansion of self-help and self-management within developed health systems and provides an explanation for why self-help within health systems, is typically situated adjacent to, rather than integrated into, clinical medicine.
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| 2. |
- Andersen-Hollekim, Tone E., et al.
(författare)
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Patient participation in the clinical pathway : Nurses' perceptions of adults' involvement in haemodialysis
- 2019
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Ingår i: Nursing Open. - : Wiley. - 2054-1058. ; 6:2, s. 574-582
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To develop knowledge of nurses' perceptions of participation for patients treated with haemodialysis and their next of kin.Design: A qualitative study with a hermeneutic approach.Methods: The data were collected in 2015 through focus groups with 13 nurses in Central Norway.Results: The nurses reported that patient participation ranging from non-involvement to shared decision-making was related to whether dialysis was initiated as acute or scheduled. The restrictions required in chronic haemodialysis limited participation. The next of kin were not involved. The nurses highlighted interventions on both the individual and system levels to strengthen participation.Conclusion: Dialysis units should develop strategies for participation related to individual needs and design treatment in cooperation with patients and their families, ensuring involvement early in the clinical pathway. Further research is needed on issues related to next of kin, including their desired level of involvement.
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| 3. |
- Brulin, Emma, et al.
(författare)
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An impaired learning environment : Resident physicians’ experience of the transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden
- 2023
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Ingår i: Frontiers in Psychology. - : Frontiers Media SA. - 1664-1078. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Extensive studies regarding the COVID-19 pandemic have shown negative effects on physicians-in-training. Besides a high workload, their learning environment has been affected. A quality learning environment is vital for residents’ physician’s clinical development and also their health. Nevertheless, few studies have explored this. The aim of this study was to explore resident physicians’ experiences of transition to pandemic care during the first wave of the COVID-19 pandemic in Sweden. Method: In this qualitative study, 12 Swedish resident physicians were interviewed using a semi-structured interview guide. They were interviewed between June and October of 2020 and asked to reflect on the pandemic and, more specifically, the first wave. The empirical material was analysed using qualitative content analysis. The analysis resulted in one theme and four categories. Results: The theme identified was An impaired learning environment which signifies the disruptions the resident physicians experienced during the first wave of the pandemic. The four categories, Professional role insecurity, High expectations but little influence, Stagnant clinical development, and Professional growth through experience, describe in what way the learning environment was impacted.
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| 4. |
- Brulin, Emma, et al.
(författare)
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Money talks : performance-based reimbursement systems impact on perceived work, health and patient care for physicians in Sweden
- 2023
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Ingår i: Frontiers in Psychology. - : Frontiers Media S.A.. - 1664-1078. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The study aimed to investigate in which way performance-based reimbursement (PBR) systems in Swedish healthcare services (1) subjectively impacted physicians’ work and patient care and (2) were associated with the occurrence of stress-induced exhaustion disorders among physicians.Method: The study applied a mixed-method design. Data were collected from a representative sample of Swedish physicians. In the questionnaire, respondents were asked to answer an open-ended question regarding their reflections on PBR. The answers to the open-ended question were analysed using thematic analysis. Respondents were also asked to rate the impact of PBR on their work. The association between PBR and self-rated stress-induced exhaustion disease was analysed with logistic regressions. Stress-induced exhaustion disorder was measured using the Burnout Assessment Scale.Results: Thematic analysis resulted in four themes: (1) Money talks, (2) Patients are affected, (3) Medical morals are challenged, and (4) PBR increase the quantity of illegitimate tasks. Logistic regressions showed that physicians who experienced PBR had an impact on their work and had a two-fold higher risk of stress-induced exhaustion disorder.Discussion: Our findings suggest that current reimbursement systems in Sweden play an essential role in Swedish healthcare and negatively influence physicians’ work and health. Also, current PBR impact patients negatively. No previous study has explored the potentially harmful impact of PBR on how physicians perceive work, health and patient care. Results indicate that policymakers should be encouraged to deeply review PBR systems and focus on ways that they can limit the negative impact on physicians’ work and health while meeting future challenges.
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| 5. |
- Evensen, Aud, et al.
(författare)
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Individuell læring i gruppebasert psykoedukativ kognitiv rehabilitering
- 2010
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Ingår i: Nordisk tidsskrift for helseforskning. - : UiT The Arctic University of Norway. - 1504-3614 .- 1891-2982. ; 6:2, s. 70-83
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Tidskriftsartikel (refereegranskat)abstract
- Artikkelen omhandler en kvalitativ studie om individuell læring i gruppebasert psykoedukativ kognitiv rehabilitering. Studiens formål var å få frem kunnskap om betydning av å benytte kombinasjon av individrettet og grupperettet metode i rehabiliteringsopplegg.Metode: Kvalitativ beskrivende og fortolkende studie med bruk av fokusgruppeintervjuer to år etter deltakelse i rehabiliteringsopplegget.Resultater: Gruppebasert rehabilitering var opplevd som gjensidig støtte. Rehabilitering med kognitiv tilnærming førte til oppdaging om egen lært hjelpeløshet og lavt selvbilde før rehabilitering og læring om andre måter å møte belastninger på. To år etter deltakelse på gruppebasert rehabilitering var opplegget erfart å ha betydning for selvfølelse, meningsfulle liv, mer aktivitet og mestring i hverdagen. Det er behov for mer forskning hvor opplevelse av mening og sammenheng måles og effekter av ulike rehabiliteringsmetoder sammenlignes.Konklusjon: Kombinasjonen gruppebasert rehabilitering med individuell kognitiv tilnærming hadde betydning for motivasjon, mestring og aktivt liv to år etter rehabiliteringen.
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| 6. |
- Giske, S., et al.
(författare)
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Mapping interaction quality for nursing and medical students in primary care placement in municipal emergency care units : a systematic observational study
- 2024
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Ingår i: Frontiers in Medicine. - : Frontiers Media SA. - 2296-858X. ; 11
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Primary care placement for nursing and medical students is vital for developing the competence to accommodate the increasing number of patients with multimorbid and complex conditions. Prior studies have suggested that interaction quality in primary care placement empowers learning. However, research mapping interaction quality in primary care placements in municipal emergency care units is lacking. This study aimed to systematically map interaction quality for nursing and medical students in primary care placement in two municipal emergency care units. Materials and methods: This study adopted a systematic descriptive observational design. Systematic observations (n = 201 cycles) of eight nursing students (n = 103 cycles) and six medical students (n = 98 cycles) were used to map interaction quality across six learning situations between March and May 2019. Observations were coded using the Classroom Assessment Scoring System-Secondary (CLASS-S). Data were analyzed using descriptive statistics and Spearman correlations. Results: Interaction quality is described in three domains: (I) emotional support, (II) framework for learning, and (III) instructional support, and the overall measure, student engagement. The results indicated middle-quality interactions in the emotional and instructional support domains and high quality in the framework for learning domain and student engagement. Correlations exhibited similar patterns and ranged from non-significant to strong correlations. Conclusion: The interaction qualities indicated a generally positive and supportive learning environment contributing to nursing and medical students’ learning and active participation in work tasks related to their professional roles. Thus, this new form for primary care placement for nursing and medical students in the municipal emergency care units was found to be a positive learning arena. These results may enhance nursing and medical education programs in countries with similar health services and education. Health education, supervisors, peers, and others contributing to students’ learning should recognize which interaction qualities may affect learning and how to improve quality, thus affecting supervisors’ approach to training students. While the CLASS-S showed potential for mapping interaction qualities for nursing and medical students in primary care placement in municipal emergency care units, further studies are needed to validate the CLASS-S for use in clinical placement settings.
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| 7. |
- Giske, Solveig, et al.
(författare)
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Medical students' learning experience and participation in communities of practice at municipal emergency care units in the primary health care system : a qualitative study
- 2022
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Medical education has been criticised for not adapting to changes in society, health care and technology. Internationally, it is necessary to strengthen primary health care services to accommodate the growing number of patients. In Norway, emergency care patients are increasingly treated in municipal emergency care units in the primary health care system. This study explores medical students' learning experience and how they participated in communities of practice at two municipal emergency care units in the primary health care system. Methods In this qualitative study, we collected data from March to May 2019 using semi-structured individual interviews and systematic observations of six ninth-semester medical students undergoing two-week clerkships at municipal emergency care units. The interview transcripts were thematically analysed with a social constructivist approach. A total of 102 systematic observations were used to triangulate the findings from the thematic analysis. Results Three themes illuminated what the medical students learned and how they participated in communities of practice: (i) They took responsibility for emergency care patients while participating in the physicians' community of practice and thus received intensive training in the role of a physician. (ii) They learned the physician's role in interprofessional collaboration. Collaborating with nursing students and nurses led to training in clinical procedures and insight into the nurses' role, work tasks, and community of practice. (iii) They gained in-depth knowledge through shared reflections when time was allocated for that purpose. Ethical and medical topics were elucidated from an interprofessional perspective when nursing students, nurses, and physicians participated. Conclusions Our findings suggest that this was a form of clerkship in which medical students learned the physician's role by taking responsibility for emergency care patients and participating in multiple work tasks and clinical procedures associated with physicians' and nurses' communities of practice. Participating in an interprofessional community of practice for professional reflections contributed to in-depth knowledge of ethical and medical topics from the medical and nursing perspectives.
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| 8. |
- Hagqvist, Emma, 1980-, et al.
(författare)
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Falling outside the system : Occupational safety and health inspectors’ experiences of micro-enterprises in Sweden
- 2020
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Ingår i: Safety Science. - : Elsevier B.V.. - 0925-7535 .- 1879-1042. ; 125
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Tidskriftsartikel (refereegranskat)abstract
- In this study, 11 Swedish occupational safety and health (OSH) inspectors were interviewed about their views of and experiences interacting with micro-enterprises (1-9 employees). The qualitative content analysis found one theme, “Falling outside the system”, and three subthemes, “The inspector—shaped by specific standards”, “The bureaucrat and the micro-entrepreneur—two separate worlds”, and “System faults and system changes”. According to the inspectors, the Swedish OSH regulatory system, with inspectors on the front line, neglects the specific needs, circumstances and characteristics of micro-enterprises. Therefore, we suggest revising the OSH regulatory system and following inspection methods and enforcement styles to better address the needs of micro-enterprises.
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| 9. |
- Hagqvist, Emma, 1980-, et al.
(författare)
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The Swedish HealthPhys Study: Study Description and Prevalence of Clinical Burnout and Major Depression among Physicians
- 2022
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Ingår i: Chronic Stress. - : SAGE Publications. - 2470-5470. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The study purpose was to describe the Swedish HealthPhys cohort. Using data from the HealthPhys study, we aimed to describe the prevalence of clinical burnout and major depression in a representative sample of Swedish physicians across gender, age, worksite, hierarchical position, and speciality in spring of 2021, during the third wave of the Covid-19 pandemic. Method: The HealthPhys questionnaire was sent to a representative sample of practising physicians (n = 6699) in Sweden in February to May of 2021 with a 41.3% response rate. The questionnaire included validated instruments measuring psychosocial work environment and health including measurements for major depression and clinical burnout. Results: Data from the HealthPhys study showed that among practising physicians in Sweden the prevalence of major depression was 4.8% and clinical burnout was 4.7%. However, the variations across sub-groups of physicians regarding major depression ranged from 0% to 10.1%. For clinical burnout estimates ranged from 1.3% to 14.5%. Emergency physicians had the highest levels of clinical burnout while they had 0% prevalence of major depression. Prevalence of exhaustion was high across all groups of physicians with physicians working in emergency departments, at the highest (28.6%) and anaesthesiologist at the lowest (5.6%). Junior physicians had high levels across all measurements. Conclusions: In conclusion, the first data collection from the HealthPhys study showed that the prevalence of major depression and clinical burnout varies across genders, age, hierarchical position, worksite, and specialty. Moreover, many practising physicians in Sweden experienced exhaustion and were at high risk of burnout.
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| 10. |
- Hansson, Josefine, et al.
(författare)
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A Comparative Study of Financial Support and Resilience of Self-Employed people in Sweden and Canada
- 2023
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Ingår i: <em>European Journal of Public Health</em>, Volume 33, Issue Supplement_2, October 2023. - : Oxford University Press (OUP).
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Konferensbidrag (refereegranskat)abstract
- BackgroundGlobally the COVID-19 pandemic presented major difficulties for self-employed people such as financial decline, restrictions and business closures. A plethora of financial support measures was rolled out worldwide to support them, but there is a lack of research looking at the effectiveness of the policy measures on small businesses. The aim of the study was to compare policies addressing government financial support in Sweden and Canada to get an understanding of how different governmental financial support measures enhanched self-employed people's resilience and improved their chances to manage the pandemic. In addition, individual interviews with Swedish and Canadian self-employed people were conducted to get an understanding of how they experienced the support measures and how these measures factored into their resilience during and after the restrictions had ended.MethodsWe conducted a mixed-method study encompassing document analysis and semi-structured interviews with self-employed people in Sweden and Canada. The constant comparative method guided the data analysis and documentary and interview data were analysed together. Three categories were formed: Welfare protection and effects, Self-employed well-being and Agility during COVID-19, based on their ability to represent the overall sense of the phenomena.ResultsKey results were that self-employed people in both countries unable to telework, were less resilient during the pandemic due to financial problems, restrictions and lockdowns, and that this negatively affected their well-being.ConclusionsPotential future policy responses in Sweden and Canada to support self-employed people during crises or adversity should consider the diversity among small businesses and tailor programmes towards viable businesses in greatest need of support, such as those in businesses unable to telework.Key messages • Self-employed people in Sweden and Canada unable to telework, were less resilient during the pandemic due to financial problems, restrictions and lockdowns. • Future policy responses to support self-employed people during adversity should tailor programmes towards viable businesses in greatest need of support.
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