Hilde Thygesen

Based on a thematic content analysis of 63 key policy documents from the five Nordic countries, we discuss national strategies about introducing welfare technology to care for older persons. We argue that the Nordic care regime is a central research context in two senses: 1) the tradition of strong states and extensive social rights, and 2) the transformation of welfare states through marketisation and digitalisation, which also underpin welfare technology policies. We contribute to care policy research by contrasting the Nordic strategies and definitions and by identifying friction emerging within and across them. Our analysis shows that, while the overall image of WT policy is rather similar between the Nordic countries, the Danish, Finnish and Norwegian policy documents show signs of the earliest implementation. While the rest of the countries have implemented pilot-based, regional approaches, Denmark has seen a more centrally driven development. Our analysis also identifies friction in the welfare technology policies, portrayed as overly optimistic expectations; contested national rollouts; and financial resources designated for pilots and acquisition but not for maintenance costs. We argue that the notion of friction may support inter-stakeholder communication by providing cues to and making sense of the complexity of welfare technology innovation.

Interprofessional collaboration in rehabilitation is essential but challenging. Although factors supporting interprofessional collaboration are well known, how professionals make collaboration work within complex practices is underexamined. In response, we explored interprofessional collaboration and communication in a complex, dynamic rehabilitation setting, along with how healthcare professionals experience such collaboration and their actions to make it work across organizational boundaries. To those ends, we conducted semi-structured individual interviews with 14 healthcare practitioners from a hospital and the primary healthcare rehabilitation services in Western Norway. The interview transcripts were analyzed through thematic analysis, and we applied the theoretical perspective of relational expertise in interpreting the findings. We developed two main themes with sub-themes: that professionals enable and orchestrate collaborative work by (1) using different communication approaches flexibly and adjusting the collaboration to each patient's needs and to the collaborative situation, and (2) acknowledging the significance of interpersonal relations by cultivating mutual trust and understanding. Those new insights contribute to interprofessional practice by urging practice and policymakers to acknowledge practitioners' need for flexibility and to develop relational expertise as well professional expertise, especially in dynamic rehabilitation settings. Practitioners, educators and policymakers should support the cultivation of collaborative skills and structures.

This study aimed to explore healthcare professionals' experiences with informal coordination across healthcare levels in complex neurological rehabilitation services in Norway. Semi-structured qualitative interviews were held with fourteen healthcare professionals working in rehabilitation services and representing different professions and healthcare-level workplaces. The transcribed data material was analysed using reflexive thematic analysis and discussed applying perspectives of person-centred rehabilitation. Two themes were developed that related to participants' experiences with informal coordination as supplementing perceived gaps or shortcomings in formal coordination [1]: Engagement and taking initiative in commitments to the patient [2], Challenges and dilemmas with informal coordination. In managing intricate neurological rehabilitation services across various professions and organisations, informal coordinating activities are essential to complement formal structures. While informal coordination is vital for achieving relational and person-centred rehabilitation, it can lead to challenges related to role ambiguity and unclear responsibilities.Our findings are relevant for rehabilitation and disability studies, as interprofessional collaboration and coordination are fundamental to service delivery. Further research is needed to explore how to integrate formal and informal coordination in complex neurological rehabilitation.

Care for persons with severe dementia in highly specialised healthcare in Norway is guided by person-centred care. However, little research has explored healthcare professionals’ perspectives on meaning in life in this patient group. This qualitative study investigated how healthcare professionals recognise experiences of meaning in life among patients with severe dementia. The research question was: How do healthcare professionals, working in a dementia unit in highly specialised healthcare, recognise experiences of meaning in life in patients with severe dementia? An exploratory design was used, drawing on data from focus group interviews with professionals trained and experienced in dementia care. An inductive approach was used to analyse the data, guided by Schnell’s theory of meaning in life as an analytical lens. The findings show that meaning was recognised and responded to in several ways: through bodily activities that created meaning and reinforced identity, underscoring the importance of embodied expressions and interactions; by supporting what mattered to each individual patient, highlighting the value of personalised and attuned care; and during moments of crisis, which were interpreted as signs of ongoing struggles for identity and meaning. By incorporating professionals’ perspectives and experience-based knowledge, the psychology of meaning helped deepen the understanding of person-centred care and how it can be practised with this patient group. More research is needed to develop scholarly knowledge that enables professionals to distinguish more precisely between different aspects of meaning in life and intervene effectively in diverse care situations.

Background: People with problems in functioning following severe injury or illness often need multiple and combined interventions in their rehabilitation processes. In these processes, communication and collaboration between the involved healthcare professionals are essential. Despite efforts in research and policy, communication across hospital and primary healthcare services and within the primary healthcare settings remains challenging. In one region of Norway, a new intermunicipal rehabilitation team has been established to supplement the traditional services and context-bound research is needed to gain insight into the complexity of the new communication structures that are developing. The aim of this study was to explore facilitators and barriers to communication to inform further improvement of the services. Methods: A qualitative case study design was used to explore the exchange of patient information in the rehabilitation processes of four patients. Data collection included participant observations in communication situations and an exploration of the electronic patient records of these four patients. Reflexive thematic analysis was used to analyse the empirical data. Results: The complex rehabilitation processes explored involved a large number of actors across healthcare organisational levels. Lacking a common culture for rehabilitation, poor access to written information and unclear responsibility for sharing information across organisational boundaries seemed to represent barriers to interprofessional communication. Joint meetings, the use of common rehabilitation tools and language and establishing informal communication channels served to facilitate communication. Conclusion: The intermunicipal team collaborating across different organisational levels added complexity to communication structures, but also facilitated interprofessional communication by promoting formal and informal ways of exchanging information. However, the intricate organisational divisions of healthcare provision in the Norwegian context represent boundaries which can be difficult to overcome. Therefore, cross-organisational coordination services should be developed.