Individuelle behovsvurderinger eller standardiserte tjenestetilbud?

Øydgard, Guro Wisth

doi:10.18261/issn.2387-5984-2018-01-04

Cited by 20 publications

(10 citation statements)

References 15 publications

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“…37 Combined with an increase in government regulations and a tightening of overall resources, each municipality’s flexibility in developing and allocating services has become constrained. 38 In addition, the reduced variation between municipalities can be a result of benchmarking: municipalities trying to adapt to the allocation level of other municipalities by comparing publicly available municipal data. 36 …”

Section: Discussionmentioning

confidence: 99%

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study

Burrell,

Rostad,

Wentzel-Larsen

et al. 2024

Health�Serv�Insights

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The international policy of active ageing emphasises activities and social relations for long-term care recipients, for example through adult day care. Knowledge about who are allocated such services is, however, sparse. We aimed to investigate characteristics that contribute to determine allocation of adult day care for care recipients with and without dementia. This study selected all 250 687 individuals who received long-term care services on 31 December 2019 from the Norwegian Register for Primary Health Care. We added municipal level data from the Municipality-State-Reporting register and a national survey. Multilevel analyses comparing allocation of adult day care services to other services found that municipal clustering was around 20%. Care recipients who lived alone had higher odds of receiving adult day care, while the odds of receiving adult day care decreased as age increased. Disability level and gender were also significantly associated with allocation of adult day care, but in different directions for different user groups. As the unrestricted revenues of municipalities increased, the odds of allocating adult day care to people without dementia decreased. Other municipality characteristics did not significantly impact the allocation of adult day care. In conclusion, individual characteristics were more influential in allocation of adult day care than municipality characteristics, and the results uncovered clear differences between care recipients with and without dementia.

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Section: Discussionmentioning

confidence: 99%

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study

Burrell,

Rostad,

Wentzel-Larsen

et al. 2024

Health�Serv�Insights

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“…An ethnographic study demonstrated that institutional guidelines govern the practices of case managers (purchasers) and determine which services will be available to patients. Therefore, case managers play an active role in making assessments to adapt patients' needs to the existing hierarchy of needs (Oydgard, 2018). If the purchaser formulates more general instructions and includes time for additional tasks by recognizing that unforeseen needs can arise, nurses' use of discretion will be acknowledged, and they will be able to address acute and unforeseen events.…”

Section: Discussionmentioning

confidence: 99%

Nurses' professional discretion in the purchaser‐provider split in home care in Norway

Brenne

Hedlund

2023

Journal of Advanced Nursing

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AimTo explore how nurses' professional discretion is operationalized in home care services that follow a purchaser–provider organization in Norway.DesignA qualitative descriptive study.MethodsSemi‐structured interviews with open‐ended questions were used, and data were collected from in‐depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six‐step analysis was used to analyse the empirical data.ResultsThe analysis yielded two main themes, namely ‘The purchaser's instructions: facilitating and constraining care’ and ‘Professional discretion meets the purchaser–provider organisation of healthcare,’ with five associated codes.ConclusionNurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion.ImpactThe purchaser–provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by ‘New Public Management,’ such as the purchaser–provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy‐makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust.ImplicationsThis study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.

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“…Derved kan et menneske ikke betragtes som skarpt afgraenset fra omgivelserne, men må betragtes som en del af et menneskes 'personhed', og det Leibling kalder en 'social, interaktiv hukommelse' (Leibing, 2006:246,253,259-261 (Kröger, 2005). I de seneste årtier har de pårørendes rolle aendret sig på ny; i dag inddrages de pårørende i stor udstraekning som partnere i varetagelse af pleje-og omsorgsopgaver, og de forventes at spille en aktiv rolle (Navne & Wiuff, 2011;Øydgard, 2018 hvoraf to var gruppeinterview med deltagelse af en beboer, en pårørende og en medarbejder. Graden af deltagelse og observation har varieret fra moderat til aktiv deltagelse afhaengig af situationen (Spradley, 1980:58-62) og er dokumenteret i daglige feltnoter.…”

Section: Indledningunclassified

Når omsorgen udliciteres:

Felding¹,

Schwennesen²

2019

TFSS

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Originalartikel Når omsorgen udliciteresEn analyse af den konfliktfyldte omsorgstrojka mellem mennesker med demens, pårørende og plejepersonale på et plejehjem i Danmark Felding, Simone Anna; Schwennesen, Nete (2019). 'Når omsorgen udliciteres: En analyse af den konfliktfyldte omsorgstrojka mellem mennesker med demens, pårørende og plejepersonale på et plejehjem i Danmark' i Tidsskrift for Forskning i Sygdom og Samfund, nr. 30, Vi undersøger i denne artikel den saerlige relation, der opstår mellem mennesker med demens, deres pårørende og plejepersonalet, når demensramte flytter på plejehjem -det vi kalder en omsorgstrojka. Når demensramte flytter på plejehjem, er det ikke bare de fysiske rammer, der skiftes ud, der sker også et skift i de naere relationer, hvorigennem mennesket med demens lever sit liv. I denne artikel ser vi naermere på den ambivalente og ofte konfliktfyldte omsorgstrojka, der opstår mellem demensramte, deres pårørende og plejepersonale og de nye former for forbundethed, der opstår igennem denne relation. Vores analyse tager udgangspunkt i feltarbejde foretaget på en demensafdeling på et dansk plejehjem, vi kalder Frydendal, hvor der gentagelsesvist opstod konflikter mellem plejepersonale og pårørende.Konflikterne handlede ofte om, hvordan der bedst kunne drages omsorg for beboerne. Hvor begge parter ønskede det bedste for beboeren, var der ofte en grundlaeggende uenighed, i for-

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Individuelle behovsvurderinger eller standardiserte tjenestetilbud?

Abstract: En institusjonell etnografi om kommunale saksbehandleres oversettelse fra behov til vedtak Judgements for the individual service user or standardized service?An institutional ethnography on local government administrators' transition from requirements to decisions.

Cited by 20 publications

References 15 publications

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study

Allocation of Adult Day Care Services to Different User Groups: A Register-Based Cross-Sectional Study

Nurses' professional discretion in the purchaser‐provider split in home care in Norway

Når omsorgen udliciteres:

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