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An Inclusive Society Enriches Us All - Employers´ Attitudes and Inclusion of People with Intellectual Disabilities in Competitive Employment
No full textVPL39
A Social Educator’s Milieu Therapeutic Approach to School Refusal
No full textBachelor i vernepleie, deltid
Fakultet for helse- og sosialvitskap / Institutt for velferd og
deltaking / VPD390 BacheloroppgåveVPD39
CONFIDENCE IN PRONE POSITION: Intensive Care Nurse's Assessments, Interaction, and Competence in Prone Positioning
No full textMaster i Intensivsykepleie
Fakultet for helse- og sosialvitenskap
Veileder: Ingrid Lindaas
26.05.25Bakgrunn: Bukleie er en etablert behandlingsmetode for pasienter med alvorlig
respirasjonssvikt, men prosedyren oppleves ofte som krevende for intensivsykepleiere.
Kunnskap om hvordan intensivsykepleiere erfarer og håndterer bukleie i praksis er
avgjørende for å styrke pasientsikkerheten og faglig kvalitet.
Hensikt: Å undersøke hvilke erfaringer intensivsykepleiere har med pasienter i bukleie.
Metode: Studien er en kvalitativ metasyntese basert på fire fagfellevurderte artikler.
Metasyntesen er gjennomført med utgangspunkt i Malteruds oversettelse av Noblit og Hare
sin metaetnografiske metode. Funnene er fortolket gjennom utvikling av
tredjeordensbegreper.
Resultat: gjennom studien identifiserer fem tredjeordensbegreper: Strukturert skjønn,
Trygghetskurven, Etisk manøvrering, Klinisk samspillkompetanse og Taus kunnskap. Disse
begrepene belyser hvordan intensivsykepleiernes erfaringer preges av en kontinuerlig
utvikling av faglig trygghet og dømmekraft i møte med bukleie. Kompetanse utvikles i et
samspill mellom erfaring, refleksjon, samarbeid og organisatorisk støtte.
Konklusjon: Bukleie oppleves som en kompleks og belastende prosedyre som utfordrer
intensivsykepleierens tekniske, etiske og kliniske kompetanse. For å sikre trygg
gjennomføring bør opplæring og praksis legge til rette for refleksjon, erfaringsdeling og
tverrfaglig samhandling.
Nøkkelord: intensivsykepleie, bukleie, erfaringer, metasyntese, pasientsikkerhet, klinisk
vurderingSPE59
Crossing the distance: The why – the how – and the outcomes of cross-industry innovation
No full textIndustry crises and the global sustainability challenge place demands on small and medium-sized enterprises (SMEs). To survive a crisis, SMEs are often forced to respond. With limited resources available, economic concerns are high on the agenda when making decisions and laying down a strategy to navigate immediate and long-term considerations. First, SMEs often begin by cutting costs and shaving off any non-essential parts of the business, but as time passes more drastic measures are likely to emerge to remain profitable. The path of least resistance can be to utilise what they already possess but in a different industry. In short, they can explore the possibility of innovating across industry lines. However, this process is often fraught with hidden obstacles, perhaps most noticeably in tacit industry structures that catch the SMEs unaware.
The thesis aims to build on this challenge by exploring the role of crossindustry innovation (CII) – wherein competence or technology from one industry may find a home in another industry – in SMEs that have decided to explore opportunities in a different industry. As such, the thesis departs from an overarching framework of open innovation to the subfield of CII. CII is still an emerging concept within the innovation literature, with more attention needed to address CII in SMEs. As such, the thesis draws on and connects CII to different strands of literature, most notably open innovation, dynamic capabilities, SME growth, organisational resilience, and sustainable repositioning. These aspects form a foundation for answering research questions about why SMEs do CII, how dynamic CII capabilities influence this endeavour, the importance of contextual factors, how intermediaries can facilitate CII in SMEs and the potential role of CII in sustainability transitions.
The thesis consists of three papers, wherein one is based on a quantitative survey with SMEs targeted to assess the impact of CII on growth, and the other two consist of qualitative interviews with (primarily) SMEs. The first qualitative paper explores how SMEs engage in CII in response to a major industry crisis to develop CII capabilities and resilience. The second qualitative article examines the prospect of using CII for sustainable repositioning in SMEs, which can be aided by industrial cluster facilitation. The low oil prices between 2014 and 2018 severely affected Norway’s oil and gas industry. This provided the contextual frame for the qualitative papers, in particular, as all the interviews and a majority of the survey respondents hail from Western Norway, a region heavily dependent on the oil and gas industry.
Central contributions from the thesis indicate positive outcomes for SMEs that engage in CII, as CII leads to both organic and acquired growth in SMEs. Further, assuming strong CII capabilities pertaining to strategy and mindset, and the ability to identify and seize CII opportunities, CII can result in more resilient SMEs able to absorb and adapt to crises. The thesis also positions CII as a path for incumbent SMEs to undergo sustainable repositioning. Industrial clusters can assist SMEs in this process and contribute to lowering the high initial costs of CII. This has the potential to result in the tandem development of SMEs and clusters along a sustainability transition trajectory, wherein these lower-level entities function as agents for system-level change.
These contributions have multiple implications at both the managerial and policy level. For example, practitioners should be aware of the potential gain of doing CII, and which organisational aspects to focus on to achieve success. Policy initiatives may be directed towards facilitating interaction points between different industries and reducing industry boundaries by making industry norms more transparent. This is especially important for SMEs with limited resources, where obtaining a match between perceived and realisable CII opportunities matters greatly. CII can further contribute to aligning economic and environmental concerns, providing an option for SMEs seeking sustainable development, through skill retention and knowledge continuity, as opposed to larger economic compromises. Policies should recognise that clusters can play a vital role in this, as their mandate offers room to guide SMEs interested in CII.
The work is carried out at Western Norway University of Applied Sciences and belongs to the doctoral programme in Responsible Innovation and Regional Development.acceptedVersio
Korleis kan ein barnehagelærar arbeide med inkludering i ein fleirkulturell barnehage?
No full textBACH301BACHD40
Understanding depiction in tactile Norwegian sign language interpreting
No full textInterpreting settings involving tactile signed languages (TSLs) require the conveyance of information from visual and auditory channels into the tactile modality. A TSL is defined as a tactile adaptation of a visual signed language (SL), primarily used by deaf signers who experience vision loss later in life. In these adaptations, some signs are produced on the body of both interlocutors, creating a larger signing space that is more easily accessible through the tactile modality. We refer to TSL signs produced on the body of the interlocutor as “TSL haptices”. Moreover, one distinctive feature of visual SLs is depiction, where signs visually represent meaning by “demonstrating” a referent or event. Depiction also exists in TSLs, though its use has received limited study, particularly in the context of interpretation. As a result, this paper aims to: i) investigate how interpreters mediate depicting structures in interpreting settings involving Tactile Norwegian Sign Language (TNTS), ii) describe how depiction is expressed on the bodies of interpreters and deafblind individuals, and iii) provide a model that defines the various types of “haptices” found in TNTS interpreting.publishedVersio
Malnutrition in those with dementia
No full textBachelorutdanning i sykepleie Fakultet for helse- og sosialvitenskap / Instituttet for helse- og omsorgsvitenskap / Høgskulen på Vestlandet / Campus HaugesundSYKH39
From relief to dignity: Palliative Care for COPD Patients
No full textBachelor i sykepleie HVL/Helse og sosialvitenskapSYKH39
Skill-mix change and task shifting for musculoskeletal disorders in primary care: From framework development and workforce training to opportunities for service improvement
No full textBackground
Changing demographics and increasing complexity of patients presenting to primary care, along with a limited supply of healthcare professionals, are putting new demands on existing models of care and new ways of organising primary care are therefore needed. Healthcare in Norway and the United Kingdom (UK) operates within a reality of funding restraints and for it to remain effective task shifting and skill-mix review have been promoted and implemented as key mechanisms for change. For primary care to function well it is imperative that the limited workforce is used effectively. Whilst it is possible to redistribute tasks between different health professionals, the extent to which this can solve a growing problem remains uncertain.
Norway and the UK both have publicly funded national healthcare systems and share a context of high societal cost and loss of health-related quality of life associated with musculoskeletal disorders. A significant proportion of the workload seen in primary care is from musculoskeletal problems, and it is therefore important to look at the potential of skill-mix change and task shifting to improve this area of healthcare. Task shifting in primary care has taken place in Norway and the UK over several years. Whilst the two countries share a reported shortage of General Practitioners (GPs), there are differences to the structure of post-graduate specialisation and career pathways for allied health professionals working in primary care. These different contexts can offer insights around the utility of policydriven changes to address shared challenges.
In this thesis I explore how skill-mix change and task shifting for musculoskeletal disorders in primary care can give opportunities for service improvement, informed by research in England and in Norway. Study I took place in England where we developed a national musculoskeletal core capability framework for first point of contact practitioners. The framework was informed by Study II, which explored the opinions of patients in England about what they want and expect from their GP and other first point of contact healthcare professionals when seeking help with a suspected musculoskeletal disorder. In Study III we evaluated the utility of a postgraduate university module designed for workforce development of allied health professionals, and explored the perceptions of students (physiotherapists, paramedics, and dietitians) and their clinical mentors. Finally, in Study IV we looked at the current model of care for patients with musculoskeletal disorders in Norwegian primary care, from the viewpoint of GPs and physiotherapists.
Methodological points of departure
The studies included in this thesis employ a range of methods. Study I was a multifaceted process, it included a modified three-round Delphi study with a multiprofessional panel of 41 experts nominated through 18 national professional and patient organisations, and a wider online survey. Study II was a qualitative study including four focus groups and we analysed the data through deductive thematic analysis. In Study III we used a qualitatively driven mixed-method approach that included empirical material from online surveys and individual interviews, and Study IV was a qualitative interview study. In studies III and IV we used a reflexive and creative method to explore the empirical material.
The four studies have different methodological points of departure, which illustrates my serendipitous journey through this doctoral project. Studies I and II have constructivist underpinnings but lack an explicit alignment with any identified theoretical framework. Study III combines qualitative and quantitative methods to allow a flexible theoretical framework where realist and constructivist concerns are synergistically combined. Study IV departs from a social constructivist theoretical foundation. In both studies III and IV we use Lipsky’s theories on street-level bureaucracy as a theoretical lens, a theory that shows how professionals implement public policy in their work. In Study IV we also draw upon a Foucauldian perspective on mechanisms of power and institutional structures.
Findings
Study I produced a framework that contains 105 outcomes within 14 capabilities, separated into four domains: person-centred approaches; assessment, investigation and diagnosis; condition management, intervention and prevention; service and professional development. The framework is now being used by practitioners, commissioners, and education and training providers. Findings from Study II enabled the patient perspective to be included in the framework and identified these key concerns and priorities: the problem and its impact; the management of the problem; the practical questions; the future.
Study III included empirical material from 27 online survey responses and eight interviews. Participants perceived the utility of the module, titled Allied Health Professionals First Contact Practice in Primary Care, to be influenced by personal circumstances, professional identity, and mentoring experience, and that profession-specific competence typically fall short of the capabilities required for the primary care gatekeeper role. Our findings can inform and guide postgraduate training for healthcare professionals moving into first point of contact roles in primary care, as well as employers that implement public policy at the street level. Our study can also guide policymakers, who in their endeavour to improve public services must allow autonomous practitioners to interpret and show discretion in their meetings with patients, but also offer clear guidelines, job descriptions, and roadmaps.
Study IV included interviews with five GPs and 11 physiotherapists (eight of whom were also Manual Therapists) in Norway. Our analysis discovered a complex discourse about skill-mix in primary care, where attitudes towards task shifting were influenced by financial considerations, task preferences, and perceptions of competence. Competition and cooperation coexist between the professions, and both alliances and rivalries are fostered by the apparent gradual blurring of the lines between historical hegemony and new models of care. In a context where task shifting is challenged by established practice there were examples of deviations from evidence-based practice and the Choosing Wisely principles, which indicate that GPs and physiotherapists must balance the roles of patient advocate, gatekeeper, and homo economicus. Additionally, it appeared that the management of patients with musculoskeletal disorders is fragmented and to an extent reflects a supply-driven system.
Conclusions and future perspectives
This PhD project advances our knowledge around the potential of task shifting and skill-mix change in primary care, specifically concerning musculoskeletal health. Development and implementation of national capability frameworks are used to guide the direction of travel for system change, and NHS England state that all adults in England will be able to see a musculoskeletal first contact physiotherapist by 2024. Post-qualification educational and professional development initiatives, along with implementation of new roles and accompanying roadmaps, seek to align the required competences and capabilities on the one side with the role requirements on the other.
Friction can develop when the boundaries of professional scope of practice for different professions expand, and this can have detrimental effects at both the system level and at the street-level of patient-healthcare professional interaction. Our studies point out opportunities for improving musculoskeletal primary care, in terms of offering the right care at the right time, by developing better collaboration between healthcare professionals. However, such improvements are contingent on addressing the political and economic foundations upon which healthcare systems rest, and for professional bodies and individual healthcare professionals to reduce protectionism over established boundaries of professional practice.acceptedVersio
When ignorance creates distance: Healthcare professionals' challenges in encountering palliative patients with substance use disorders
No full textBachelor i sykepleie
Fakultet for helse- og sosialvitenskap/institutt for helse og omsorgsvitenskapSYKH39