BackgroundIn Norway, elder care is primarily a municipal responsibility. Municipal health services strive to offer the ‘lowest level of effective care,’ and home healthcare services are defined as the lowest level of care in Norway. Municipalities determine the type(s) of service and the amount of care applicants require. The services granted are outlined in an individual decision letter, which serves as a contract between the municipality and the home healthcare recipient. The purpose of this study was to gain insight into the scope and duration of home healthcare services allocated by municipalities and to determine where home care recipients live in relation to home healthcare service offices.MethodsA document analysis was performed on data derived from 833 letters to individuals allocated home care services in two municipalities in Northern Norway (Municipality A = 500 recipients, Municipality B = 333 recipients).ResultsIn Municipality A, 74% of service hours were allotted to home health nursing, 12% to practical assistance, and 14% to support contact; in Municipality B, the distribution was 73%, 19%, and 8%, respectively. Both municipalities allocated home health services with no service end date (41% and 85% of the total services, respectively). Among recipients of “expired” services, 25% in Municipality A and 7% in Municipality B continued to receive assistance.ConclusionsOur findings reveal that the municipalities adhered to the goal for home care recipients to remain at home as long as possible before moving into a nursing home. The findings also indicate that the system for allocating home healthcare services may not be fair, as the municipalities lacked procedures for revising individual decisions. Our findings indicate that local authorities should closely examine how they design individual decisions and increase their awareness of how long a service should be provided.

BackgroundThe 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 NPM-inspired municipal executive leadership.MethodThis 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.ResultFindings 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.ConclusionThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-016-0187-x) contains supplementary material, which is available to authorized users.

Opptrappingsplanen introduserer begrepet psykisk helsearbeid i kommunene. Det innebaerer et bedre og mer helhetlig behandlingstilbud, og det vektlegges også en bedring av levekår, boforhold, arbeid, aktivitet og sosial inkludering. Fra 1997 til 2008 har det skjedd en oppbygging av det psykiske helsearbeidet i kommunene. Oppbyggingen er gjennomført med midler knyttet til Opptrappingsplanen for Psykisk Helse (1). I denne prosessen er de psykiatriske dagsentrene blitt en del av de kommunale tjenestene som nå er innlemmet i en samlet kommunal helse og omsorgstjeneste. Med et ekstra tilskudd på over 24 milliarder over åtte år, ønsket Stortinget å bedre behandlingstilbudene for personer med psykiske lidelser (2). Målet var å sikre et helhetlig og sammenhengende behandlingsnettverk. Psykiatriske dagsenter er en del av dette behandlingsnettverket, der dagsentrenes formål er å tilby sosialt felleskap og meningsfylte aktiviteter for brukere med psykiske lidelser.Dagsentrene drives ut fra ulik ideologi og det er forskjellig struktur og innhold på de forskjellige dagsentrene. Tilbudet er frivillig og brukerne kan komme innom uten fast avtale og vaere med i aktiviteter sammen med andre. Slik blir dagsenteret en viktig møteplass der brukerne kan få tilbud om støttesamtaler etter avtale. Dagsentrene kan dermed vaere viktige arenaer for hjelp og støtte. I følge psykiatrisk sykepleier Robberstad (3) vil det for en del brukere vaere mest naturlig å få fotfeste i grupper og aktiviteter sammen med andre. Både Stortingsmelding nr. 25 (2), Opptrappingsplan for Psykisk Helse (1) og Veileder for Psykisk Helsearbeid i kommunehelsetjenesten (4) fokuserer på at mennesker trenger meningsfylte aktiviteter og et sosialt fellesskap i hverdagen. Sosiolog og arbeidsforsker Alm Andreassen (5), forskerne Lundemark og Winter Jensen (6) viser at enkelte mestrer å vaere i et tilrettelagt arbeide, men noen faller utenfor og trenger et lavterskeltilbud på psykiatriske dagsenter slik psykiatrisk sykepleier Langeland (7) påpeker. Dagsentrene er viktige støttespillere i oppbyggingen av menneskers nettverk i følge psykiater Dalgard (8), sykepleier og sosiolog Lillestø & sosiolog Hansen (9) og psykiatrisk sykepleier Robberstad (3).Vi ønsket med denne studien å finne ut hvordan sykepleiere som arbeider på psykiatriske dagsentra erfarer sin rolle og funksjon. Det er gjort få forskningsstudier om dette temaet bortsett fra den psykiatriske sykepleieren Robberstads (3) studie som er gjort for 15 år siden der hun studerte innholdet i psykiatriske dagsentra i Norge. Fordi vi har valgt et sykepleieperspektiv i forskningen vår, har vi tatt utgangspunkt i det professor og psykiatrisk sykepleier Martinsen (10) skriver om omsorg. Hun skriver at omsorg er et grunnbegrep i sykepleien. Omsorg er et moralsk begrep og en grunnleggende verdi for livsførsel i relasjoner gjennom praktisk arbeid. Moral har med kvaliteten i de mellommenneskelige forhold å gjøre, og moral har med hvordan man er tilstedet i relasjonen. Martinsens omsorgsbegrep er universelt og gjør seg gjeldende ...

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IntroductionParticipating in a community with other retired individuals to increase life quaøity can be possible for the older persons. Cultural and ethnical background is important for their social identity.ObjectiveTo identify what the informants think is important in their surroundings in order to extend their healthy life period.Study designA structured questionnaire developed by the OCIN network.MethodsNineteen elderly women aged 75 years or more were interviewed. This regional survey is a pilot study in Norway. The data were collected during 2 periods, in 2009 and 2010. The data are analyzed using a result scheme prepared by the network OCIN.ResultsOur findings show that this is a group of elderly women that are concerned with promoting their own health. The participants wish to take care of themselves, so they do not become a burden for society and the local authorities.ConclusionsThe findings of this study suggest that participation in the local context is important for promoting health and well-being among elderly in all ethnicities. For the Sami elderly, this is particularly important because meeting equal-minded people helps them maintain their Sami identity. In the Sami culture and among the Sami elderly, it is important to be “strong” and “healthy”. Due to these norms, the elderly Sami women try to live with their illnesses and are less eager to go to the doctor when they are seriously ill.