Assessing Integration in Value Chains - Assessing enablers and disablers of integration in different sectors

Organizations currently face increasing and ever-changing demands from their environments, which forces them to continuously aim to improve their value chain. This increasing requirement of their environments, together with the demand for greater product/service adjustments requires more flexible and adaptable value streams. Success criteria for organizations are the ability to respond quickly to demands from interested parties and, more importantly, the ability to adjust to future needs, which requires that they control the integration between different actors and units in today's complex organizations. Organizations within the health sector and the automobile, service and craft sectors encounter different challenges, but must all aim for an adaptable and efficient value chain that delivers the best quality for the patient or customer. Despite many years of research on the topic of integration, and the many different terms and definitions that exist, researchers continue to call for more research on the topic to develop a more thorough and consistent understanding of it. Given this inconsistency within the field, the aim of this research is to provide clarification and a holistic understanding of the cross-functional integration in a value chain. By raising five research questions, this PhD thesis contributes to an increased understanding of the topic of integration by studying what enables and disables integration, and which mechanisms are used to facilitate integration in five different organizations within different sectors in Norway. The case-studies in examining the value-adding element of the value chain are a hospital, two mass producers, a service provider and a craft producer, all of which are in Norway. The research data are based on semi-structured interviews with selected persons from different levels within the companies, as well as on observations, document reviews and participation in meetings. Based primarily on operation management and organization theory, the main purpose of this thesis is to extend existing knowledge identifying the enablers and disablers of integration within the value chain for different sectors. The research supports what is claimed by the literature, namely that integration is a complex and multidimensional concept in which the output of a process is dependent on the relationship between many different mechanisms such as management support, culture, facility and layout, formalization and standardization, measurements and rewards, information systems, and consensus integration. The research data support what researchers emphasize, namely that management plays an important role in achieving integration. Furthermore, cultural factors such as functional silo thinking and trust in or compliance with standards are identified as having an impact on other mechanisms such as consensus integration and formalization, as well as standardization. One less obvious finding regards the fact that functional silos were experienced at organizations with very different sizes and layouts. Even the smallest partitions were identified as contributing in the creation of functional silo thinking amongst employees. Even though some of the organizations dedicated some effort into transferring the overall strategy down to functional measures, the research data nevertheless indicated a mismatch between the overall goal and the functional focus. The literature cautions that unaligned bonuses could contribute to the creation of functional silos, as is supported by this research. Another objective of this thesis is to build knowledge about what type of facilitators are used within the different organizations and how the use of these facilitators differs or is similar within different sectors. Based on both the theoretical and empirical findings on what is perceived to affect integration in value chains and what has been done to facilitate integration, a framework for maturity mapping of integration is suggested. This assessment framework provides guiding statements and questions to enable a rating of the degree of integration of the value chain, and further suggests a relationship between the mechanisms. This relationship framework is intended to act as a guide for practitioners who seek to improve the integration of their value chain by taking actions on one or more mechanisms and who need to determine what possible mechanisms could be influenced by this action(s). Hence, this framework may contribute as guidance for practitioners who struggle to achieve an integrated value chain. The results of this thesis provide several contributions to existing research. Firstly, this thesis provides supplementary theoretical insight into the topic of integration by providing an improved clarification of the topic. Unlike much research that focusses on integration within one single value chain, this dataset provides data from a broader set of sectors: a craft producer, two mass producers, a hospital and a financial service provider. Moreover, while earlier research is to a large extent based on surveys, this study offers empirical results from five case studies and responds to the call for more empirical studies. The practical contribution of this thesis is an increased understanding of what employees within different value chains experience as contributing to or hindering integration. Furthermore, for practitioners within similar types of organizations, this thesis may contribute new insights which enablers, disablers and facilitators may consider if they aim to enhance value-chain integration. Finally, the framework that is proposed within this thesis may assist practitioners in evaluating the degree of integration of their value chain and further provide guidance on how possible actions may influence value-chain integration

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Denne masteroppgaven er en dokumentanalyse av fire av skolens styringsdokumenter, oppgaven tar for seg generell del av Lk06, overordnet del av L20, gjeldende opplæringslov samt forarbeidet til ny opplæringslov. Oppgavens grunnlag er problemstillingen «I hvilken grad erkjennes tilpasningsbehovet for elever innenfor autismespekteret i et utvalg av den norske skolens styringsdokumenter?». I tillegg har forskningsspørsmålene «I hvilken grad erkjennes de tilpasningsbehov elever med autismespekterdiagnoser kan ha utbytte av, herunder; Behov for struktur og forutsigbarhet, tilpasninger knyttet til organisering av skoledagen, mulighet til sosial ferdighet-, og kommunikasjonsstrening, og individualisering av tilpasninger til en mangfoldig gruppe? Hvordan legger skolens styringsdokumenter opp til å sikre en opplevelse av å være inkludert? Erkjennes arbeid med atferd som en del av tilretteleggingen for elever med autisme? Hva er konsekvensene av manglende tilrettelegging? Og hvordan kan man arbeide med utfordrende atferd og ekskludering?» vært drivende for prosjektet. Det har vært avgjørende for meg å kartlegge tilpasningsbehovet til elever med autismespekterforstyrrelser, samt se det i lys av hvordan og i hvilken grad de samme behovene er erkjent i generell og overordnet del av de to siste læreplanene, gjeldende opplæringslov og forarbeidet til ny opplæringslov. Dette er en kvalitativ studie som tar for seg elever med autismespekterforstyrrelser, hva som kan være deres tilpasningsbehov og hvordan disse behovene blir ivaretatt i skolens styringsdokumenter. Datagrunnlaget for denne oppgaven er en dokumentanalyse av overordnet og generell del av de to siste læreplanene, gjeldende opplæringslov og forarbeidet til ny opplæringslov. Dokumentene er blitt analysert gjennom en hermeneutisk begrepsanalyse, der nøkkelbegreper fra faglitteraturen har blitt ettersøkt, analysert og tolket i styringsdokumentene. Funnene for dette prosjektet er drøftet i lys av mitt teoretiske perspektiv, opp mot de forskningsspørsmål og den problemstillingen som er valgt for denne oppgaven.This master's thesis is a document analysis of four of the school's governing documents, the thesis deals with the general part of Lk06 and L20, the current iteration of the Education Act as well as the preparation for the new Education Act. This assignment is based on the governing question "To what extent is the need for adaptation recognized for students on the autism spectrum in a selection of the Norwegian school's governing documents?". In addition, the research questions "To what extent are the adaptation needs recognized that pupils with autism spectrum diagnoses can benefit from, including; Need for structure and predictability, adaptations related to the organization of the school day, the possibility of social skills and communication training, and individualization of adaptations to a diverse group? In what way does the school's governing documents plan to ensure an experience of being included? Is behavioral training recognized as part of the provision for pupils with autism? What are the consequences of a lack of facilitation? And how can you work with challenging behavior and exudation?" has been a driving force for the project. It has been crucial for me to map the adaptation needs of students with autism spectrum disorders, as well as see it in relation to, how and to what extent the same needs are recognized in the general part of the last two curricula, the current iteration of the Education Act and the preparation for the new Education Act. This is a qualitative study that looks at pupils with autism spectrum disorders, what their adaptation needs might be and how these needs are taken care of in the school's management documents. The data basis for this thesis is a document analysis of the general part of the last two school curriculums, the current Education Act and the preparation for the new Education Act. The documents have been analyzed through a hermeneutic term analysis, where key terms from specialist literature have been searched for, analyzed and interpreted in the management documents. The findings for this project are discussed with regards to my theoretical perspective, against the research questions and the governing question that has been chosen for this thesis

Hvordan vektes hensyn til klima og naturmangfold i konseptvalgutredninger? En case-studie av konseptvalgutredningen for E39 Digernes - Vik

Fergefri E39 er landets største samferdselsprosjekt med mål om å knytte bo-, arbeids- og næringsmarkeder på Vestlandet bedre sammen. Mellom Ålesund og Molde planlegges E39 Møreaksen som firefelts motorveg for å halvere reisetiden mellom byene. Strekningen Digernes - Vik er valgt ut for å nærmere studere hvordan hensyn til klima og naturmangfold er vektet i tidligfase av utredningsprosessen. Denne oppgaven vil bidra til å sette søkelys på organisering, metode og kunnskapsgrunnlag som ligger til grunn for konseptvalgutredninger (KVU) hvor de store føringene for videre planlegging blir lagt. Forskningsspørsmålene som danner utgangspunkt for denne masteroppgaven er: 1. Hva legges til grunn for anbefaling i konseptvalgutredninger? 2. På hvilken måte har hensyn til klima og naturmangfold påvirket avveiingene? 3. Hvordan kan hensyn til klima og naturmangfold bedre ivaretas i tidligfaseplanlegging? Oppgaven er en case-studie av E39 Digernes - Vik, hvor kvalitative metoder for litteraturstudie, dokumentstudium og dybdeintervju er benyttet. Litteraturstudiet omhandler forskning tilknyttet konseptvalgutredninger, korrelasjon mellom arealbruk og transport, samt kunnskapsgrunnlag om påvirkning for klima og naturmangfold. Dokumentstudiet omfatter en inngående analyse av case-spesifikke dokument for konseptvalgutredningen fra 2011 til 2021 for å avdekke hvordan klima- og naturhensyn ble ivaretatt opp mot andre samfunnsinteresser. Intervjuer av aktuelle fagpersoner og involverte gav større innsikt og forståelse for metodikken bak utredningene, samt vekting av hensyn i de case-spesifikke utredningene. Denne studien konkluderer med at hensyn til klima og naturmangfold står svakt i KVU-ordningen, da politiske prioriteringer og stiavhengighet internt i etaten medfører planlegging for økt trafikk og vegkapasitet. Det anbefales at vegvesenet som utreder bør identifisere motstridende transportpolitiske målsetninger, og bedre vurdere hvordan etaten kan bidra til å oppfylle nasjonale miljømål. Etaten kan selv utfordre rammebetingelsene satt av bestillingen på et tidlig stadium, eksempelvis ved å utvikle problem- og behovsanalysen for å vurdere bredere samfunnsmessige utfordringer og åpne for et større mulighetsrom. Studien anser det som nødvendig å utvikle metodikk som ikke favoriserer reisetidsinnkorting, men vurderer konsekvensene av arealbeslag i større grad. Utvikling av eksisterende metoder kan bli et viktig verktøy for å hindre inngrep i sårbar natur og karbonrike områder, i tillegg til å nærmere vurdere alternativer for fremtidig transportbehov.Ferry-free E39 is the country's largest transport project with the aim of linking housing, labor and business markets in Western Norway better together. Between Ålesund and Molde, the E39 Møreaksen is planned as a four-lane motorway to halve the travel time between the cities. The Digernes - Vik section has been selected to study how consideration for climate and biodiversity has been emphasized in the early phase of the assessment process. This master thesis will shed light on the organization, method and knowledge base that forms the basis for the choice of conceptual solutions, the so called Consept Appraisal Study (CAS), where the major guidelines for further planning are set. The research questions that form the basis for this master's thesis are: 1. What is the basis for recommendation in Consept Appraisal Studies? 2. In what way have considerations of climate and biodiversity affected the trade-offs? 3. How can those considerations better be addressed in early-phase planning? This thesis is a case study of E39 Digernes - Vik, where qualitative methods for literature study, document study and in-depth interview are used. The literature study addresses research related to CAS, correlation between land use and transport, as well as impact on climate and biodiversity. The document study includes an in-depth analysis of documents carried out in the CAS phase from 2011 to 2021, in order to uncover how climate and nature considerations were taken into account in relation to other interests. Interviews provided insight of the methodology and case-specific reports. This study concludes that consideration for climate and biodiversity is not prioritized in the CAS scheme, as political priorities and path dependence within the administration entail planning for increased traffic and road capacity. It is recommended that the Norwegian Public Roads Administration should identify conflicting transport policy objectives, and better assess how the administration can contribute to national environmental goals. They can challenge the framework conditions at an early stage, for example by developing the problem and need analysis to assess broader societal challenges and widen the opportunity scope. The study considers it necessary to develop methodologies that does not favor travel time shortening, but assess the consequences of land use to a greater extent. Development of existing methods can be an important tool to prevent land use in vulnerable nature and carbon-rich areas, in addition to further assessing alternatives for future transport needs

Strategic Location of Heterogeneous Resources for the Fire and Rescue Service

The fire and rescue service (FRS) in Norway is responsible for responding to a number of different emergency calls. Keeping an adequate level of preparedness is essential in order to respond quickly and efficiently to emergency fire and rescue calls. This requires extensive planning at the strategic, tactical, and operational levels. Operational research and optimization models are important support tools for decision makers in emergency response planning (ERP). However the previous research on FRS is limited, compared to emergency medical service (EMS), which has been at the interest of operational researchers since the 1960's. When considering the FRS, the preservation of life and property is the main objective. The problem studied in this report is the Maximum Preservation Location Problem for Heterogeneous Accidents and Response Units (MPLP-HAR). It aims at finding the optimal location for the FRS resources in an area that gives the highest level of preparedness, in order to respond to a demand for heterogeneous accidents. To solve the problem, an integer programming model has been developed. The objective function uses a preservation function that captures the distinct ability to preserve life and property in the event of an emergency. Hence, the preservation function reflects the level of preparedness. The model distinguishes between first and total response time. In this case, these response times refer to the time it takes for the FRS to initiate and fully provide emergency relief at the accident site, respectively. Response units respond to different accident types with different resource requirements. Demand for a given accident type is determined based on historical call data. The results show that the model can be used as a support tool for various types of location decisions at the strategic and tactical levels. The computational study includes both a technical and an economical part. The technical study determines the appropriate formulation and solution approach for the problem. The economical studies is performed on the region of Oslo, in corporation with Oslo Brann- og Redningstjeneste (BRE). After validation, the model is able to provide quantifiable measures of preparedness in the region and evaluate the current operational state. Furthermore, the MPLP-HAR is used to investigate a number of alternative resource locations and operational structures that could improve the level of preparedness. The MPLP-HAR is a strategic and tactical location decision support tool and its applicability increases with data accuracy

Brukermedvirkning under skjerming i akuttpsykiatri : en kvalitativ studie av muligheter for medvirkning under tvangsbehandling

Master i psykisk helsearbeidI de siste årene har det vært økt fokus på brukermedvirkning innenfor psykisk helsevern. Tidligere forskning sier lite om muligheter for brukermedvirkning under skjerming. Mange pasienter gir tilbakemeldinger om krenkelser, maktbruk og liten deltagelse under skjerming i akutt psykiatrisk post (Karlsson, 2004; Norvoll, 2007). Helse- og omsorgsdepartementet har gitt ut en forskrift om bruk av skjerming (2006) hvor det står; ”ved bruk av skjerming skal det legges til rette for at pasienten gis så stor innflytelse på tiltaket som mulig”. Der kommer det tydelig frem at pasienten skal kunne yte innflytelse under gjennomføringen av sin skjerming. Hensikten med denne studien er å øke kunnskapen rundt pasientens muligheter for brukermedvirkning under skjerming. Åtte intervju av sykepleiere utgjør datamaterialet, og Grounded theory er brukt som analytisk tilnærming. Den kvalitative tilnærmingen til feltet viser at det fremkommer både hindringer, tilpasninger og muligheter for brukermedvirkning under skjerming. Begrepet anerkjennelse viser seg å være viktig for inkludering av brukermedvirkning.In recent years there has been an increased focus on user involvement in mental health care. Previous research has little to say about opportunities for user interaction during the seclusion. Many patients give feedback on violations, force and low participation during seclusion in the acute psychiatric wards. Health and Care Services has issued a regulation on the use of seclusion, which states: "the use of seclusion should be taken to ensure that the patient is given such an influence on the measure as possible". There it is evident that the patient should be able to provide influence during the implementation of its seclusion. The purpose of this study is to increase the knowledge about the patient's possibilities for user interaction during the seclusion. Eight interviews with nurses make up the data, and Grounded theory is used as an analytical approach. The qualitative approach to the field shows that both obstacles, adaptations and opportunities for user participation, appear during the seclusion. The concept of acknowledgement turns out to be important for the inclusion of user involvement

Sykepleieres erfaring med overflytting av pasienter fra intensiv til sengepost

Bakgrunn: Pasientoverganger er et sårbart punkt i et pasientforløp hvor sykepleiere fra intensivavdeling og sengepost må samarbeide for å sikre kontinuitet i behandling. Mangel på kommunikasjon og svikt i informasjonsflyt ved overganger blir sett på som risikofaktorer for pasientsikkerheten. Hensikt: Denne studiens hensikt er å utforske sykepleiere på intensiv og sengepost sine erfaringer med overflytting av pasienter fra intensivavdeling til sengepost Design: Studien har et kvalitativt deskriptivt design. Til datainnsamling er det brukt individuelle intervjuer med semi-strukturert intervjuguide. Metode: Fire sykepleiere fra sengepost og fire intensivsykepleiere fra intensivavdeling ble rekruttert fra to lokalsykehus i Norge. Intervjuer ble gjort mai-juni 2023. Resultatene ble analysert ved bruk av induktiv kvalitativ innholdsanalyse. Resultat: Analysen resulterte i tre temaer: Opplevelsen av samarbeid ved gjensidig uvisshet om hverandres arbeidshverdag, Å skape gode overganger – preget av tidspress og behov for beredskap og Gi- og ta ansvaret videre – behov for tilpasset informasjon. Intensivsykepleierne på intensiv og sykepleierne på sengepost erfarte at overflyttingene kunne være godt planlagt med involvering av sengeposten, men kunne også være preget av mangel på tid og kapasitet. Vanskeligheter med å forstå hverandres arbeidshverdag kunne gi negative opplevelser og mangler på kommunikasjon ved overføring av pasienter. Konklusjon: Overflyttingsprosessen fra intensiv til sengepost er krevende for sykepleiere og økt fokus på samhandling mellom postene kan forbedre prosessen. Å få større innsikt i hverandres arbeidshverdag gjennom hospitering kan bidra til større forståelse og kompetanseheving på tvers av avdelingene. En presset hverdag på tid og kapasitet stiller høye krav til sykepleierne for å sikre pasientens kontinuitet i behandling. Resultatene fra studien kan bidra til økt fokus på samhandling mellom avdelingene og sette lys på forbedringsområder for praksis. Stikkord: pasientovergang, pasientsikkerhet, sykepleie, kommunikasjon, intensivsykepleieBackground: Patient discharge from ICU to the general ward is a vulnerable step in a patient course where nurses must cooperate to secure continuity in care. Lack of communication and fail to inform in the discharge process are seen as risks for patient safety. Aim: This study aims to explore nurses’ experiences handing over patients from ICU to general ward. Design: This study has a qualitative descriptive design. Data is conducted using individual interviews with a semi-structured interview guide. Method: Four nurses from general ward and four ICU nurses from ICU was recruited from two general hospitals in Norway. Interviews was conducted from May – June 2023. Results analysed using inductive qualitative content analysis. Results: The analysis resulted in three themes: The experience of cooperation through mutual uncertainty about each other’s everyday working life, Creating good transitions – characterized by time pressure and the need for preparedness, and Pass on- and take responsibility – need to adapt information. Both ICU and general ward nurses experienced patient discharge to the general ward as well planned with the involvement of the ward but could also be characterized by a lack of time and capacity. Difficulties in understanding each other's everyday working life could lead to negative experiences and lack of communication when handing over patients. Conclusion: The discharge process from intensive ICU to the general ward is demanding for nurses and increased focus on interaction between posts can improve the process. Gaining greater insight into each other's everyday working life through hospitalization can contribute to greater understanding and increased competence across the departments. A pressured everyday life for time and capacity places high demands on the nurses to ensure the patient's continuity of care. The results of the study can contribute to an increased focus on interaction between the departments and shed light on areas for improvement in practice. Keywords: handoff, patient safety, nursing, communication, intensive care nursin

Changes in green structure and ecosystem services in Sogndalsfjøra from 1988 to 2018

Landskapsplanlegging med landskapsarkitektur Fakultet for ingeniør- og naturvitenskapTettsteder med mellom 2 000 og 20 000 innbyggere utgjør størst areal av bebygde strøk på landsbasis. Grønnstrukturen for disse områdene er likevel lite studert sammenlignet med større byer. I denne oppgaven har vi sett på hvilke verdier som knytter seg til grønnstrukturen for tettstedet Sogndalsfjøra, og hvordan endringer i grønnstrukturen de siste 30 årene har påvirket disse verdiene. Grønnstruktur og arealtyper kartlagt i Sogndalsfjøra i 1988 ble sammenlignet med egne kartlegginger i 2018. Et utvalg urbane økosystemtjenester ble benyttet for å vurdere betydningen av studieområdets trær og grønne flater. I studieområdet har en økning i areal med bygninger og grå flater ført til nedbygging av grønnstrukturer i form av mindre og mer oppstykkede grønne flater. Det har også blitt langt færre frukttrær, mens treslag av løvfellende og vintergrønne trær har økt i antall. Totalt er det blitt færre trær og mindre areal med grønne flater. Slike endringer påvirker ikke bare stedsidentiteten og rekreasjonsverdien i bygda, men har også negativ påvirkning på pollinatorer og områdets evne til å håndtere overvann og forbedre luftkvaliteten. At grønnstruktur blir nedbygget til fordel for bygninger og grå flater samsvarer godt med de generelle utviklingstrendene i norske tettsteder, og tyder på at grønnstrukturer er tapende interesser i planprosesser. Fortetting er et utviklingsmål både nasjonalt og for Sogndal kommune, og har sammen med en befolkningsøkning medvirket til utbygging av sentrumsområdene i Sogndalsfjøra. Verdisetting av urbane økosystemtjenester fra grønnstruktur kan være viktig for å sikre bevaring og utvikling av grønnstrukturer i fremtidige fortettingsplaner.PL49

Hvordan påvirker holdninger utøvelsen av sykepleie i møte med pasienter med levercirrhose?

SAMMENDRAG Tittel: Dato: 16.05.19 "Hvordan påvirker holdninger utøvelsen av sykepleie i møte med pasienter med levercirrhose?" Deltaker: Linn Heidi Gamme Klevengen og Julie Sønsteby Flaagen Veileder: Anne Vifladt Stikkord/ nøkkelord Sykepleiers holdninger, alkoholmisbruk, levercirrhose, stigmatisering (3-5 stk) Antall sider/ord: 36/10535 Antall vedlegg: 0 Bakgrunn: Sykepleieren møter pasienter i alle sammenhenger som har bakgrunn som kan skape holdningsutfordringer. Levercirrhose oppstår i de fleste tilfeller på grunn av alkoholmisbruk og sykdommen kan derfor ses på som selvforskyldt. Dette kan være vanskelige situasjoner å stå i og sykepleieren skal i enhver situasjon behandle pasientene likt til tross for egne holdninger eller fordommer knyttet til pasientens bakgrunn. Hensikt: Hensikten med denne oppgaven er å bevisstgjøre om sykepleierens holdninger har en påvirkning på utøvelse av sykepleie, når pasienten har diagnosen levercirrhose. Metode: Et litteraturstudie hvor seks artikler er brukt for å besvare problemstillingen. Det er brukt både kvantitative og kvalitative vitenskapelige forskingsartikler for å gjøre rede for temaet. Både sykepleier og pasient sin oppfatning av fenomenet er brukt for å belyse helheten. Aveyard sin metode er brukt som kilde. Resultat: Analysen ble rettet mot om sykepleierens holdninger kan påvirke utøvelsen av sykepleie til pasienter med levercirrhose, og vi kom frem til følgende temaer fra de valgte artiklene: Sykepleierens stigmatiserende holdning til pasientgruppen, manglende kunnskap hos sykepleieren om pasientgruppen og manglende interesse og engasjement for pasientgruppen. Konklusjon: Funn viser at lite kunnskap og erfaring med pasientgruppen skaper holdningsutfordringer. Sykepleien blir mindre profesjonell og pasientene blir utsatt for unødvendig stigmatisering og diskriminering i helsetjenesten.ABSTRACT Title: Date: 16.05.19 "How does nurse attitudes affect healthcare delivery to patients with cirrhosis?" Participants: Linn Heidi Gamme Klevengen og Julie Sønsteby Flaagen Supervisor: Anne Vifladt Keywords Nurse attitudes, alcohol abuse, liver cirrhosis, stigma (3-5) Number of pages/words: 36/10535 Number of appendix: 0 Background: The nurse meet patients in every context that has background that can cause attitude problems. Liver cirrhosis often occurs because of alcohol abuse or dependency, and can therefore, be categorized as a self-inflicted disease. These situations can be difficult for healthcare delivery where nurses are mandatory to treat patients likewise regardless of their attitudes and prejudices to the patients` background. Aim: The aim of the study is to be aware if the nurse attitudes have an impact on the healthcare delivery, when the patient has liver cirrhosis. Method: A literature review including six articles were used to answer the question “How does nurse attitudes affect healthcare delivery to patients with cirrhosis?”. Qualitative and quantitative scientific research articles where used to elaborate on the phenomenon. Nurses perceptions of the aspect were used and the patients` perceptions to illuminate the entirety. Aveyards` method for literature review were used as a source. Result: The analysis was targeted towards what can affect nurses’ attitudes for delivery of nursing care to patients with liver cirrhosis. The analysis led to three following themes; nurses stigmatizing attitude toward the patient group, lack of knowledge and experience from nurses about liver cirrhosis and lack of interest and commitment for the patient group. Conclusion: The results show that the challenges with attitudes is based on lack of knowledge and experience with the patient group. Nursing care gets less professional, and patients are exposed to unnecessary stigmatizing and discrimination in healthcare delivery

Promoting Personal Growth and Balancing Risk of Violence in Community-Based Mental Health Care: A Professional Perspective

This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).The aim of this study was to investigate how municipal mental health care workers develop professional strategies, taking the risk of service user violence into account. Factors that professionals regard as hindering or furthering personal growth among the service users are particularly focused. Data were collected through focus group interviews. The analysis resulted in two main categories: working where the clients live their lives and focus on growth and development. Offering opportunities for restraint and growth for people with serious mental health disorders and risk of violence represents the basic factors for improving desirable processes. The health-promoting focus was managed through a resource-oriented and growth-oriented focus, where available services and workers’ qualities and attitudes appear to be crucialPromoting Personal Growth and Balancing Risk of Violence in Community-Based Mental Health Care: A Professional PerspectivepublishedVersio

Samhandling med pårørende og profesjonelle tjenester: erfaringer til pasienter med varige psykiske helseutfordringer

Purpose and background: This study explores patients with severe and persistent mental health challenges in a municipality and their experiences of collaboration. The patient group has complex needs and is dependent on cross-disciplinary services. Method: Every patient with severe and persistent mental health challenges in the municipality were contacted. We conducted 106 semi-structured interviews, out of 208 invited, which were then qualitatively analyzed through systematic text condensation. Results and implications: The patients expressed a fundamental need for their long-term illness and the need for help to be understood. The users expressed satisfaction with the understanding from and collaboration with relatives. They desired to be respected in the relationship and for the professional services to take responsibility for the collaboration, which particularly applied to comprehensive measures that included somatic problems. Further development work needs to be carried out with the patients to optimize the collaboration. Keywords: collaboration, mental health care, severe and persistent mental illnessSamhandling med pårørende og profesjonelle tjenester: erfaringer til pasienter med varige psykiske helseutfordringerpublishedVersio