Professional relations in health and welfare

Caring Futures: Developing Care Ethics for Technology-Mediated Care Practices

We have identified a discrepancy between society’s drive for new technology that is care-ethically ignorant – and an absence of technology-awareness within care ethical theory. The research project QUALITECH addresses this knowledge-deficit in order to secure quality care in a future with increasingly technology-mediated caring practices.

Increased efficiency and innovation are often presented as solutions to these new demands. The development and use of new technology are central aspects of these solutions. However, the evidence on ethical implications of technological innovation in current technology-mediated care practices is scarce. QUALITECH therefore revisits care ethics in practice- and experience-near contexts, at a time of changing health, care and welfare policies, services and practices. The project consists of four work-packages:

1. Digital assessment templates in the child welfare services (WP Lead Åse Vagli, Institute for social work, Faculty of Social Sciences, UiS)
2. Professionals’ ideals and sense of self in technology-mediated care practices (WP Lead Birgitta Haga Gripsrud, Department of care and ethics, Faculty of Health Sciences, UiS)
3. The impact of robots and other caregiving techno-bodies on agency and quality of care (WP Lead Ingvil Hellstrand, Centre for Gender Studies, Faculty of Social Sciences, UiS)
4. Management, design and implementation of technology in care practices (WP Lead Brita Gjerstad, Institute for social work, Faculty of Social Sciences, UiS)

Funding: 12 million from the Norwegian Research Council (HELSEVEL)
Project manager: Ellen Ramvi, Department of care and ethics, Faculty of Health Sciences, UiS
Project period: 2020 - 2024

Find more information about the project at Norwegian Research Council's webpage

The infant's voice - user participation and infants

A qualitative study through interviews
In this project we aim to gather data about this topic doing about 15 semi structured qualitative interviews with representatives with three groups that we suppose have an impact on the opinion about this concepts in the Norwegian society today – the applicability of the concept on user participation as an ideal in meeting and working with infants: 1) employees in services that implies meeting infants: health nurses, midwives and teachers in kindergartens, 2) employees in colleges and universities teaching representatives for these three groups about topics on infants, 3) employees at colleges and universities that teaches representatives for these three groups on the concept of use participation.

Investigators
Principal Investigator: Postdoc Sissel Merete Finholt-Pedersen

Co-researchers: Ass. Professor Eystein Victor Våpenstad, Inland Norway University of Applied Sciences (INN), Department of Psychology

Postdoc. Kristin Margrethe Briseid, University of Agder, The Department of Health and Nursing Science

Project period: 2021-

The significance of tangible memories after death of an infant

Some parents experience grief due to death of their young infants. When this happen health proffesional are helping parents to make memories, such as photos, memory books, hand- and footprint. Parent support groups are also providing memory boxes, containing information and some objects. The function of memory making ca be understood as to create evidence of the infant’s life, but also to affirm parenthood. Anyway, little is known on how the parents that are receiving memories after the infant’s death reflect upon the memories and what significance these memories have. The aim is to explore what meaning tangible memories have.

The study has a qualitative, explorative design. The study was approved by the Norwegian Centre for Research Data (NSD). 20 parents agreed to share their experiences and three focus group interviews were conducted. They had experienced loss of infants from gestational age 20 weeks to 18 months. Their loss happened from approximately one month to 22 years ago. Thematic analysis according to Braun and Clarke (2006) will be used to identify, analyse and describe themes within the data.

Principal Investigator: Inger Emilie Værland, PhD, Stavanger University Hospital

Co-researcher: Anne Beth Gilja Johansen, cand. theol., Stavanger University Hospital, and Marta Høyland Lavik, professor, Stavanger University Hospital and University of Stavanger

Project period: May 2022 - May 2023

The Life Sheet: The use of personal life stories in care work

The aim of the project is to gain new knowledge about how life stories are collected and how they are put to use in relational care practices. We are also concerned with what kinds of care ethical reflections professionals have when working with life stories.

Involved in the project are researchers and students at the University of Stavanger and the University of Agder, in collaboration with professionals in the health –and care sector in municipalities of Stavanger and Sandnes.

Principal Investigator: Ingvil Hellstrand

Practitioners of Coercion

The use of coercion within mental health care in Norway is under increased scrutiny. Despite common jurisdiction, attention has been brought to a variety of practices and different degrees of transparency among service providers in regard to use of coercive measures such as physical restraints, seclusion and involuntary medication.

This leaves pressing questions, key to this study: What informs the moral deliberation made prior to using coercion and how does the experience of using coercion inform the self-understanding of the professional and thus future decision-making processes pertaining to the use of coercive measures? These are questions pursued in the project, of direct relevance to the patient-care, and thus also for policy makers, educational institutions and employing organizations.

Through a hermeneutic-phenomenological approach, in-depth interviews in combination with expressive writing, the study will explore how health professionals working in mental health experience, describe and reflect upon patient encounters involving use of coercion. Part of the exploration will be how the health professional's moral judgements relate to the context(s) in which (s)he is situated.

Both those exercising coercion through physical restraint and involuntary medication (nurses, professionals without health profession) and those formally making the decisions (psychiatrists and specialists in psychology) are enrolled in the study. A consideration of these simultaneously has not been undertaken before, but is very much called for.

Principal Investigator: Associate Professor Kjetil Moen
Project period: 2018 -2023

Full project title: Practitioners of coercion. How use of coercion informs mental health care professionals and their practice

Fundamentals of Care (FoC)

Fundamentals of Care is a framework that involves actions on the part of the nurse that respect and focus on a person’s essential needs to ensure their physical and psychosocial wellbeing. These needs are met by developing a positive and trusting relationship with the person being cared for as well as their family/carers (Feo et al 2017). In this project we introduce this framework for nurses in the clinic. In addition, we test the framework when guiding nursing students in their clinical practice.

The aim of the study is to introduce and evaluate the framework Fundamentals of Care in the clinic and in the guidance of nursing student.

The project is a collaboration between University of Stavanger, Stavanger University Hospital, Aalborg University and University Hospital and The International Learning Collaborative.

Principal investigator: Ass Professor Kirsten Lode

Project period: 2019 -

Memory making as a ritual after death in the NICU

Some infants die shortly after birth, leaving their parents in grief. When parents leave the unit without their infant, some NICUs provide them with a scrapbook with photos of the infant, and with a box with items to help them memorizing the child. The scrapbooks are made by the nursing staff at the local NICU, whereas the boxes are made by a national parent support group.

These efforts of making of memories can be regarded as gathering an evidence of the infant’s short life and of parenthood. Further, such memory making can be regarded as ritualization; symbolic acts that create meaning and confirm affiliation. The study will explore how scrapbooks and boxes can be understood in terms of ritualization.

Focus group interviews will be performed with members of a parent support group who are responsible of making boxes to be handed out to parents, and with experienced nurses in the NICU who make scrapbooks to bereaved parents. Thematic analysis will be used to interpret the data.

Principal Investigator: Inger Emilie Værland, PhD, Stavanger University Hospital

Co-researchers: Anne Beth Gilja Johansen, cand. theol., Stavanger University Hospital and Marta Høyland Lavik, professor, Stavanger University Hospital and University of Stavanger

Jobbvinner

The Jobbvinner project develops recruitment measures for the municipal health care service in collaboration with municipalities and nursing educations.

Feedback from municipalities in Rogaland indicates that recruitment of nurses is most challenging. This project is one measure that seeks to ensure stable recruitment of staff in the health and care services.

Organization and management for nursing students

Recruitment of health care professionals and nurses in Rogaland is therefore the goal of a pilot where Hjelmeland, Sandnes and Strand municipality, the University of Stavanger and nursing unions participate. Surveys show that there is a connection between clinical placement during the studies and choice of workplace after finishing the degree.

We believe that nursing students who gain insight into community nursing and nursing homes as an organization will gain more knowledge about the complexity and challenges of this part of the service. The pilot will develop and test different measures in order to strengthen nursing students' competence in organization and management in all municipalities.

Funding: 700.000 NOK from Kommunenes organisasjon (KS) 
Project manager in Rogaland: Malene Søiland
Project period: September 2019 - desember 2020

Multicultural workforce in nursing homes

Project title: «Multicultural workforce in Nursing Homes: Contemporary challenges, opportunities and potentials for the future in the Norwegian municipal care sector” (MULTICARE)

MULTICARE is a research project funded by the Research Council of Norway through the HELSEVEL program. The project is run by the Center for Care Research at the Western Norway University of Applied Sciences, and is a cross-sectorial and multi-disciplinary project with participant researchers from Center for Care Research, Uni Research Rokkan, University of Stavanger, Stavanger University Hospital and The Netherlands Institute for Health Service Research.

The MULTICARE project does research on the development of, and work in, the municipal health and care services in Norway with a specific focus on work as an arena for integration and inclusion for immigrants. The project will study the ways nursing homes organize care work, care services and their multicultural staff. Thus, it views nursing homes as valuable ethnographical case sites on which analyses of broader dynamics of inclusion, marginalization and social inequality in Norwegian society will be based.

Professional relations contributes with Work Package 4 (WP4), which explores communication of, and practices tied to, patient death in multicultural and multi-religious work communities. The following researchers are involved in WP4:

Principal Investigator (WP4): Professor Ellen Ramvi
Co-researcher: Professor Marta Høyland Lavik
PhD-Fellow: Anne Kristine Ådland

Project period: 2016 - 2020

Developing Nursing Students' Ability for Reflection

The aim of the study is to gain more insight into and knowledge about how nursing students experience developing their ability to reflect through the practical studies in nursing education and how clinical supervisors contribute to this development. The study also seeks to gain a better understanding of how developing students' ability to reflect is experienced from the point of view of clinical supervisors. The findings may be useful in a continuous assessment and development of the practical part of the nursing education.

The following research question will guide the project: How do nursing students develop their ability for reflection in their clinical studies and how do clinical supervisors contribute in this development?

The research problem will be explored through three qualitative sub-studies, and the project will result in an article-based thesis, including three publications in peer-reviewed journals.

PhD-Fellow: Bente Skogen
Supervisor: Associate Professor Kari Vevatne
Co-supervisor: Professor Emerita Ida Torunn Bjørk
Project period: 2018 - ongoing

Full project title: Nursing students and clinical supervisors experiences with nursing students’ development of reflection in their clinical studies in nursing

The importance of self-realization to remain in nursing

Nursing shortage is an international and national challenge. In Norway one in five nurses leave their profession during the first ten years of practice and it is estimated that there will be a shortage of around 30.000 nurses and 600 public health nurses in 2035.

Nurses leave their profession for several reasons, e.g. workload, constraints, working hours, low salaries and limited professional career opportunities. To remain in nursing, it seems nurses need opportunities to realize themselves in focusing both on the patient and on their own personal values.

Self-realization for school nurses

It has been documented that public health nurses working as school nurses experience emotional concerns and lack of knowledge and resources to meet children and adolescents’ complex needs. As the only health professional continuously present in the school health service, school nurses experience challenges related to social and professional affiliation and complex nursing situations. Therefore, school nurses may find it demanding to deal with limited opportunities to realize oneself by focusing on both children and adolescents and themselves.

In recent years, the Norwegian government has allocated millions of Norwegian kroner to school health service. As a result, an increased number of public health nurses are working in school health service. Thus, it is timely to gain a deeper understanding of what is important for public health nurses to self-realize, particularly because more self-oriented moral notions have been found to be of value in contemporary Western societies. Hence, this project aims to explore the significance of self-realization for school nurses’ intention to remain in school health service.

15 school nurses has participated

This project’s purpose is to describe and interpret the importance of self-realization for nurses’ intention to remain in nursing. The project will focus on self-realization related to school nurses’ self-understanding. The research questions will be explored by asking school nurses to describe their everyday nursing experience.

During spring and summer 2018, data has been collected from fifteen public health nurses with a current position as school nurse within the Norwegian school health service. The data consist of one written text and two in-depth interviews with each participant. This material will be analysed by a phenomenological-hermeneutical method inspired by Lindseth and Norberg (2004).

PhD-Fellow: Linda Horne Mæland
Supervisor: Associate Professor Margareth Kristoffersen
Co-supervisor: Professor Bjørg Frøysland Oftedal
Project period: 2018 - ongoing

Death in the multiculturally staffed nursing homes

Ådland uses a psycho-social approach to investigate how health professionals in multicultural staff communities deal with meeting death in nursing homes, and what institutional procedures, structures and rituals support or undermine communication about personal and existential experiences when staff meet death in the nursing home.

Nursing homes have become an important setting for end of life care in Norway. Approximately 50% of all registered deaths in Norway occur today in nursing homes. Due to globalization, and migration from Europe, Asia, and Africa, Norwegian nursing homes have increasingly become a multicultural workplace. Yet, research on how health professionals in multicultural staff communities react to and cope with death remains scarce. Therefore, this project is an important contribution to the development of knowledge and understanding of how death is approached in multicultural staff communities in nursing homes in Norway, which will have consequences for the welfare of employees and for how dying patients and their families experience the last stages of life.

The study has a qualitative, exploratory-descriptive design, based on ethnographic fieldwork and narrative interviews with multicultural nursing home staff at two nursing homes for six months. A psycho-social approach in this project is taken to mean a focus on the relationship between intra- and interpersonal, institutional and societal dimensions in human relations and working practices, and what implications the relationship between these dimensions has for how health professionals in multicultural staff communities deal with meeting death in nursing homes.

The PhD project will result in an article-based thesis, including three publications in peer-reviewed journals.

PhD-Fellow: Anne Kristine Ådland
Supervisor: Professor Ellen Ramvi (University of Stavanger)
Co-supervisors: Professor Marta Høyland Lavik (Stavanger University Hospital/VID) and Post-doctoral Fellow Birgitta Haga Gripsrud (University of Stavanger)
Project period: 2017 - ongoing

This PhD-project is part of Work Package 4 in Multicultural workforce in nursing homes: Contemporary challenges, opportunities and potentials for the future in the Norwegian municipal care sector, MULTICARE, funded by the Research Council of Norway.

Between Health Policy and Care Practice in the Cancer Patient Pathway

Due to an expanding ageing population and more effective medical treatment, the number of persons living with cancer is increasing, with a correspondingly increased demand for cancer care. Cancer patients and survivors often have complex and prolonged care needs. The prevalence of psychological and physical late effects among this population is increasing.

Standardized clinical pathways have emerged at a time when public healthcare services are under increasing pressure to cut costs and improve efficiency. Simultaneously there is a shift in recent policy documents, which heralds an unprecedented focus on user-oriented, patient-centered care and improved quality in public health care. How or whether these policy shifts are compatible in care practice remains to be seen. According to the national health strategy in Norway the question “what matters to you?” is to guide the future care delivery. However, there is a knowledge deficit in this area, as research is sparse concerning patients’ experiences of cancer care within the current health care context.

This PhD-project utilizes a qualitative psychosocial approach to investigate cancer patients’ experience, as situated in the intersection between health care policy and care practice. The project relies on a biographical narrative interpretive method (BNIM) to generate thick descriptions and in-depth interpretations of cancer patients’ experiences in a patient pathway, to provide deeper understanding of psychosocial aspects of cancer care. Experience-near knowledge may suggest ways to develop and improve comprehensive cancer care, which will be of benefit to future cancer patients, next of kin and healthcare professionals, as well as policy makers.

PhD-Fellow: Hanna Baardsen
Main supervisor Birgitta Haga Gripsrud, PhD, associate professor, UiS
Co-supervisor Kjetil Moen, PhD, associate professor II, UiS
Co-supervisor: Alastair Roy, Professor, University of Central Lancashire

Registered nurses' leadership in the field of home care

The PhD project will address registered nurses’ leadership practices in the field of home care. That is, the theme of the project is the informal leadership practices performed by registered nurses who have no formal position as leaders or education as leaders. In daily nursing care, based on his or her professional autonomy, each registered nurse leads practices in direct and indirect nursing, according to professional and ethical standards, focusing on the individual patient's need for medical treatment and collaboration with followers to meet the aim of person-centered care. In the last 50 years, the literature has described the characteristics of nursing care. This has been an individual and direct nursing “at the patient’s bedside” approach, an approach that encompasses patients’ experiences of health and illness. However, nurses have to deal with informal leadership in complex organizations’ context involving an indirect nursing approach to optimize person-centred care in home care. Thus, the aim of this PhD project is to expand the knowledge of leadership practices in nursing care.

The knowledge contribution will provide a better understanding of registered nurses’ leadership practices in the field of home care. In the long term, developing and performing leadership practices is crucial for registered nurses who are practicing high - quality person-centred care.

This PhD project has an exploratory qualitative design based on observation, individual interviews and focus group interviews with registered nursers in home care. The project rests on the theoretical assumptions that human beings make sense of experiences through constructions of meaning and that actions are embedded in social practices where meaning is constructed in the interaction among human beings, institutions and discourses.

The PhD project will result in an article-based thesis, including three publications in peer-reviewed journals.
Main supervisor: Assoc. Professor Margareth Kristoffersen (University of Stavanger)
Co-supervisor: Professor Trude Furunes (University of Stavanger )

Phd Fellow: Malene Søiland
Project period: 2020 - 2024