Thinking from Experience in Psychosocial Practice: Reclaiming and Teaching ‘Use of Self’

A course based on psychosocial theory and students' experiences in practice has been taught in the UK, Norway and Quebec. It departs from the classical social work concept ‘use of self’ and aims to help novices in health and social work to understand how the social world is internalised and re-produced and the value of thinking from experience. International developments such as, competency-based education, New Public Management and evidence-based practice reduce opportunities for experiential learning. This trend has been exacerbated by a focus on anti-oppressive practice without a corresponding understanding of how oppressive relations are internalized and enacted by defended and conflicted subjects. Attempts to rectify a relational deficit through traditions of reflective practice and critical reflection are important developments, but could be further strengthened by psychosocial and psychodynamic perspectives. The course combines critical, contextual and relational thinking for students in caring profession

Et for friskende arbeidsliv? - Helsetjenestens rolle og funksjon i inkludering av mennesker med psykiske helsevansker i ordinært arbeidsliv, sett fra et lederperspektiv

I Norge har det vært økende vektlegging av arbeidsintegrerende tiltak for mennesker med psykiske helsevansker i ordinært arbeidsmarked. I denne artikkelen utforsket vi lederes erfaringer med helsetjenestens rolle i arbeidsinkluderingen. Det ble foretatt 15 semi-strukturerte intervju med ledere fra ulike deler av arbeidslivet. Analyse av materialet viste at lederne hadde liten erfaring med helsetjenesten, og hadde vanskelig for å se for seg helsetjenestens rolle i inkluderingsprosessen. Noen av lederne uttrykket likevel behov for økt kompetanse på psykiske helseplager. Lederne hadde negative forestillinger om helsetjenesten som kan utgjøre en barriere i samarbeidet

Care in the era of digital health: experiences from Norwegian general practitioners

Abstract Objective This study explores the experiences of General Practitioners (GPs) in Norway, examining the role of care in their practice and the impact of digital health technologies on their caregiving approach. Design A qualitative study employing semi-structured interviews. The data was analysed by systematic text condensation. Setting Conducted in various general practice settings within an urban region in southwestern Norway. Subjects Eleven GPs were interviewed, chosen to reflect a diverse mix of ages, genders, and professional experiences. Results The findings reveal that care occupied a central and multifaceted role in GPs daily practice, and that the care aspect of their practice was experienced as a source of personal fulfilment. Technologies such as Secure Digital Messaging (SDM) and Electronic Health Records could enhance the efficiency of care delivery and facilitate better management of patient interactions, however these technologies also present challenges in maintaining the depth of personal engagement that is central to the care ethics that characterise their caring role. The GPs emphasized the necessity of integrating digital tools in a way that supports the relational and ethical foundations of their caregiving role. Conclusion This study underscores the enduring importance of care in general practice, even as digital technologies become increasingly prevalent. GPs maintain their caregiving roles by navigating the complexities of digital tools, highlighting the need for a careful balance between leveraging digital advancements and preserving the core values of care. The findings suggest a need for ongoing evaluation of digital tools to align them with the ethical foundations of care in general practice.publishedVersio

Silence about encounters with dying among healthcare professionals in a society that ‘de-tabooises’ death

Background: Empirical studies on healthcare personnel indicate that professionals’ experiences with dying and death become silenced and unutterable within the healthcare service. Aim: To explore and interpret silence about encounters with death and dying among healthcare professionals in Norway. Method: The method used was theoretical exploration, using a psychosocial approach. Findings: This analysis reveals complex interrelations and two-way dynamics between subject-worlds, sociocultural and societal worlds when it comes to dealing with death and dying at work. A performance culture saturates these worlds, and may be implicated in silencing death within the healthcare institutions of the Norwegian welfare state. Conclusions: This article suggests that silence about death and dying among healthcare professionals is indicative of crucial emerging and unresolved tensions in the neoliberal episteme, accompanied and reinforced by the ineluctable basic conditions of life and intrapsychic defence against threats towards the self. Implications for practice: •Silence about death and dying presents a serious challenge for dying patients and next of kin. Healthcare professionals should be enabled to acknowledge their thoughts and emotions about death in order to be able to support and contain patients and next of kin •Learning activities such as peer support and supervision can help the processing of difficult psychological content and allow for emotional aspects of professionals’ work to be acknowledged and thought about in a way that encourages reflective and sound practice •Clinical managers should address whether performance pressures induce shameful feelings in staff, who may believe that by providing appropriate levels of care they are compromising productivity. Shame in turn, may undermine professionals’ emotional wellbeing and ability to continue to provide attuned and adequate care for dying patients •Creative approaches to facilitate reflection on this difficult topic could be encouraged by introducing death as a cultural trope (for example, by the symbolic use of art, literature, music) into clinical contextspublishedVersio

Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review

Background: The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. Objective: This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. Methods: Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. Results: Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. Conclusions: The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies.publishedVersio

Ethics of care in technology-mediated healthcare practices: A scoping review

Background Introducing new technologies into healthcare practices may challenge professionals' traditional care cultures. The aim of this review was to map how the ‘ethics of care’ theoretical framework informs empirical studies of technology-mediated healthcare. Method A scoping review was performed using eight electronic databases: CINAHL with full text, Academic Search Premier, MEDLINE, the Philosopher's Index, SocINDEX with Full Text, SCOPUS, APA PsycInfo and Web of Science. This was followed by citation tracking, and articles were assessed against the inclusion criteria. Results Of the 443 initial articles, 18 met the criteria and were included. We found that nine of the articles used the concept of ‘ethics of care’ (herein used interchangeably with the terms ‘feminist ethics’ or ‘relational ethics’) insubstantially. The remaining nine articles deployed care ethics (or its equivalent) substantially as an integrated theoretical framework and analytical tool. We found that several articles suggested an expansion of ethics of care to encompass technologies as part of contemporary care. Furthermore, ethics of care contributed to the empirical research by recognising both new relationships between patients and healthcare professionals as well as new ethical challenges. Conclusion Ethics of care is sparsely used as a theoretical framework in empirical studies of technology-mediated healthcare practices. The use of ethics of care in technology-mediated care brings new dilemmas, relational tensions and vulnerabilities to the foreground. For ethics of care to be used more explicit in empirical studies, it is important that it is recognised by research community as an adequate, universal ethical theory.publishedVersio

CARING FUTURES: a study protocol for transdisciplinary qualitative research on technology-mediated care practices and theory development for ethics of care

Introduction The world’s population is ageing. As older persons live longer and increase in number, society faces a greater disease burden and, in public welfare, a corresponding resource deficit. New technology is one solution to this deficit but there is scarce knowledge about ethical aspects of such innovations in care practices. In CARING FUTURES, we address this scarcity by interrogating how new technology in care can become ethically sound and, correspondingly, how ethics of care can become more technology aware. Our concern is to protect quality care for the future. Methods and analysis CARING FUTURES advances transdisciplinarity through knowledge exchange around technology-mediated care and ethics of care, involving key stakeholders. We rely on established and innovative methods to generate experience-near and practice-near knowledge. Through this empirical research, we seek to expand understanding of technology-mediated care and to enrich ethics of care theory. Ethics and dissemination Empirical studies have been approved or await approval by national ethics committees. CARING FUTURES is designed to create societal impact through Knowledge Transfer Events targeting stakeholders in health, care and welfare, and Educational Packages for students of care—providing knowledge-exchange forums for future academics and practitioners of care. The project’s societal impact is also ensured in that participating researchers are also practitioners and/or educators of care personnel for the future. Project findings will be disseminated through scientific publications and conference presentations. Through communication in both traditional and digital media platforms, we engage in dialogues between researchers, user groups, policy makers and the wider public.publishedVersio

Spenninger i flerkulturelle arbeidsfellesskap ved sykehjem. En etnografisk studie

Bakgrunn: Pleiepersonellets samhandling i sykehjem er viktig for kvaliteten på omsorgen for mennesker i livets sluttfase og for de ansattes egen velferd. I studien undersøker vi hvordan pleiepersonell i norske sykehjem opplever og forholder seg til det flerkulturelle arbeidsfellesskapet. Metode: Etnografisk feltarbeid og narrative intervjuer med nøkkelinformanter i sykehjem. Dataanalysen tok utgangspunkt i to situasjoner beskrevet i feltnotater som var representative for spenninger i arbeidsfellesskapet. Disse ble videre undersøkt gjennom en psykososial tilnærming med gruppebasert dybdehermeneutisk fortolkning. Resultat: Gjennom analyseprosessen identifiserte vi to nøkkelfunn: 1) Å se pleiere med innvandrerbakgrunn som et problem i en arbeidshverdag preget av travelhet og tidspress, og 2) Strategier for å unngå å bli stigmatisert som et (innvandrer)problem. Funnene viser hvordan diskriminering og rasisme utspiller seg på sykehjem, både gjennom indirekte og direkte ytringer. Konklusjon: I denne studien anvendte vi begrepene «indre rasist» og «mikroaggresjon» for å fortolke nøkkelfunnene og bedre forstå både minoritets- og majoritetsnorske pleieres uttalelser om ansatte med minoritetsbakgrunn så vel som våre egne holdninger som forskere i omgang med data fra feltarbeidet. De reelle uttrykkene for både implisitt og eksplisitt diskriminering og rasisme som belyses i denne studien, angår oss alle som medmennesker og medborgere i et mangfoldig samfunn.publishedVersio