Brita Gjerstad

Denne rapporten er en oppsummering av arbeidspakken “Implementering av teknologi” i innovasjonsprosjektet “Utvikling av nye boligtilbud bedre tilpasset ROP-beboere med lav boevne med vekt på brukermedvirkning”1. Hovedaktiviteten i prosjektet har vært Karmøy kommunes bygging av tre omsorgsboliger. Å hjelpe vanskeligstilte på boligmarkedet på denne måten er en lovpålagt oppgave for kommunene. ROP-lidelser og livsstil kan gjøre det vanskelig å håndtere en bolig, og oppgaven med å sikre en god bosituasjon er derfor krevende. Prosjektet har blitt gjennomført som aksjonsforskning. Det innebærer at forskere har vært aktive deltakere i diskusjoner underveis i prosjektet, og vi har også besøkt boligene etter innflytting. Arbeidspakken det her rapporteres fra har vært særlig engasjert i diskusjoner om løsninger for varme, ventilasjon og sikkerhet i boligene. Målet har vært å kunne si noe om hvilke løsninger som egner seg i boliger for personer med alvorlig ROP-lidelse. Vår tilnærming er samfunnsvitenskapelig og handler i liten grad om tekniske spesifikasjoner. Datamaterialet omfatter styringsgruppemøter, dialogseminar, workshops, feltbesøk, en boligpilotmesse, tilbakemeldinger fra presentasjoner, individuelle intervjuer og fokusgruppeintervju. Datamaterialet viser at ulike grupper (personer med ROP-lidelser, pårørende, ansatte i kommunen) har ulike ønsker for boligene. Eksempelvis ønsker pårørende mest mulig sikkerhet, mens beboere ofte forstyrres av blinking og lyd og vil ha høy innetemperatur. Kommunen må veie hensyn til sikkerhet, trivsel og helse opp mot lovverk, økonomi, ansattes sikkerhet og andre praktiske hensyn. Resultatet er at boligenes tekniske rom har egen inngang. Ventilasjon og en stabil grunntemperatur styres fra teknisk rom. Ventilasjonsanlegget gir opptil sju ganger høyere luftutskifting enn i en vanlig bolig. Luftkanalene legges over himlingen, slik at kun ventilene er synlige inne i boligen. Temperaturen kommer fra vannbåren varme lagt ekstra dypt i gulvet. En bryter i boligen gir beboer anledning til å justere temperaturen noe. Det er ikke montert sikkerhetsteknologier, men i én av boligene er grunnstrukturen på plass slik at beboer kan gjøre det selv om hen ønsker det. Ansattes sikkerhet antas å bli ivaretatt med bemanning og arkitektur. Den tydeligste (fortest merkbare) effekten av de nye teknologiene kommer av ventilasjonsanlegget. Selv om beboere ikke bemerket det, ble det raskt klart at den økte luftsirkulasjonen gir et bedre fysisk arbeidsmiljø for ansatte som oppholder seg i boligene i forbindelse med rengjøring. I tillegg har prosjektet ført til et bedre samarbeid mellom eiendomsavdelingen og ROP-tjenesten. Samarbeidet er i større grad enn før basert på felles holdninger til ROP-beboere, noe som er et resultat av ansatte på drift/teknisk overtar den helhetlige og mer forståelsesfulle holdningen ansatte i ROP-tjenesten hele tide har hatt.

The welfare state is under pressure. Demographic changes, high expectations for services, and limited resources demand new approaches to service provision. In Norway, national authorities advocate for the use of technology and the involvement of volunteers in health and care services. This paper explores the relationship between solidarity, technology and volunteerism by asking whether the use of technology in health service delivery aligns with the values of solidarity. The empirical basis of the paper is qualitative sub-studies from the research project Caring Futures, as presented in three articles. The sub-studies reveal that technologists strongly support increased use of technology. By framing technology as a means to promote autonomy, they implicitly downplay human dependency. As a result, technology appears to conflict with a concept of solidarity rooted in mutual interaction. In contrast, relatives of nursing home residents recognise and accept dependency. Rather than attempting to eliminate it, they embrace dependency as a foundation for social connection, mutual responsibility and solidarity.

Background: Providing healthcare for the elderly population is challenging due to a shortage of staff. The challenge is addressed by increased use of technology. The article explores the impact of welfare technology on healthcare personnel’s care ethical considerations in Norway’s primary healthcare sector. Through a qualitative study of how healthcare professionals, managers, and technology suppliers understand and perceive welfare technology in healthcare, we examine whether instrumental values displace care-ethical values in primary healthcare practices. Methods: The study is based on a qualitative analysis of interviews with healthcare workers, healthcare managers and technology suppliers in primary healthcare in Norway. Semi-structured interviews were conducted with managers and quality developers at the municipal administrative level and healthcare managers and staff in healthcare units. Interviews with suppliers/manufacturers of welfare technology (GPS, pill dispensers and robotics) were also conducted. We combined an inductive approach with theoretical exploration as we alternated between the empirical data, a thematic approach, and theories of technology and care ethics. Results: In the analysis of the empirical material, we identified two overarching themes that were related to our research question: 1) demands and solutions and 2) two sides of autonomy. The informants generally highlighted the benefits of welfare technology, but the informants were also ambiguous about the use of welfare technology. Autonomy was seen as an important value but was attached with ambivalence. Conclusion: Care ethical considerations are significantly present within healthcare professionals’ understandings of technology even though managers and technology suppliers were advocating for welfare technology in a more instrumental sense. Despite extensive acclaim for user autonomy, healthcare personnel make decisions about care and technology use independently of the resource situation. They hold onto a professional room of freedom in between the patient’s needs, available resources, and suitable technology. They are sceptical about applying technological solutions if they suspect it will lead to potentially adverse consequences, such as loneliness or increased insecurity due to technological illiteracy. By engaging a relational autonomy approach in their care practices, healthcare professionals control technology rather than submit to technology and we see that rather than being displaced by technical-economic reasoning, care ethical reasoning also accommodates technology.

Dagens helse- og omsorgssektor kjennetegnes av økt teknologibruk. Artikkelen diskuterer funn fra en intervjustudie om erfaringer og forventninger pårørende har til teknologiens rolle i samspillet mellom pårørende, beboere på sykehjem og helsepersonell. Datamaterialet består av åtte semistrukturerte intervju med pårørende i ulike omsorgsrelasjoner til sykehjemsbeboere. Selv om myndighetene anerkjenner pårørende som en brukergruppe for velferdsteknologi, finner vi at pårørende ikke opplever å bli involvert i spørsmål om teknologibruk på sykehjem. De pårørende fungerer likevel som pådrivere og har konkrete forslag til teknologiske løsninger i sykehjemmet. Samtidig understreker de at teknologibruk ikke må gå på bekostning av trygge og gode omsorgstilbud. De pårørende trekker frem manglende kommunikasjon og samarbeid, lav bemanning og varierende kompetanse blant helsepersonell som barrierer for å nyttiggjøre seg av velferdsteknologi. Våre funn viser at pårørende er en ubenyttet ressurs i utvikling og implementering av teknologi, men også at teknologi kan påvirke forståelser av hva (god) omsorg kan og skal være.

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.

This study explores Norwegian professionals' experiences of working within partner violence (PV) prevention area, including, cross-sectoral and interdisciplinary cooperation as well as possible successful strategies and measures in this area. This report is one of the deliverables of the “Integrated System of Domestic Violence Prevention” (ISDVP) project and of the agreement with The State Treasury, the Institute of Justice in Warsaw, Poland. This study contributes to research on professionals’ experiences of interprofessional collaboration in the domestic violence prevention area – a similar study was conducted in Poland. To facilitate an interdisciplinary and interagency group discussion, five focus groups (with 19 participants) were conducted. The analysis reveals that there is inter- and intra-sectoral collaboration in the domestic violence prevention area. There are marked challenges but also notable success stories. The participants talked about several barriers to cross-sectoral collaborations, such as i) professional requirements of confidentiality, mandate, and/or duty to report, especially in the domestic violence prevention stages; ii) the complexity and plethora of practical and organizational measures and initiatives as well as who does what and when, particularly when helping a client navigate through the system; and iii) the difficulty in defining as well as uncovering domestic violence because it can be understood differently by various parties, especially from a cross-cultural perspective and gender stereotypes. In terms of effective management of multisectoral collaboration, the participants mentioned i) several tools and models, e.g., SARA and Flexid, and ii) organization of emergency shelters; and iii) networking. Besides, the participants reported a need for a nuanced and multifocal approach to domestic violence prevention, including addressing the specificities of different vulnerable groups such as the elderly and the LGBQT+ community. They also talked about the importance of initiatives aimed at removing the stigma and taboo around domestic violence, also through targeting higher education establishments.

This report is a delivery within the “Integrated System of Domestic Violence Prevention” (ISDVP) bilateral project between Poland and Norway. The bilateral ISDVP project is implemented within the framework of the Norwegian Financial Mechanism (Norwegian FM) 2014–2021 and founded by Norwegian EEA grants. EEA grants represents the contribution of Iceland, Liechtenstein, and Norway towards a green, competitive, and inclusive Europe. The PL- Justice programme is within program area no22 “Prevention of Domestic and Gender-based Violence” in Iceland, Lichtenstein and Norway grants priority sectors and programme areas for 2014-2021. All planned activities shall follow the Council of Europe Convention on Preventing and Combating Violence Against Women and Domestic Violence. The main objective of the ISDVP project is to improve the system for the prevention of domestic violence (DV) and gender-based (GBV) violence. This report intends to contribute to the fulfilment of the ISDVP project’s overall aim to adopt and implement state-wide effective, comprehensive, and coordinated politics encompassing all relevant measures to prevent and combat all forms of violence in Poland. Moreover, following the PL‑Justice–Norwegian FM Programme’s agreement, the aim of this report is to present existing solutions and alternative measures for preventing DV in Norway and to review existing methods used in Norway for providing relational support. To achieve these objectives, desk research has been the preferable method. Desk research (also known as secondary research) reviews governmental documents and reports (e.g., child welfare services), supranational-level documents and reports (e.g., the UN and EU levels), Norwegian research reports, social services acts and academic literature. The review shows that the Norwegian approach to prevention is very broad, as it reflects the diversity and complexity of the problem as well as the understanding of DV. The Norwegian government emphasises the interactional aspects of violence in that violence involves an influential and continuous interaction between individuals and the various situations they encounter. Important risk factors are an interaction of societal and individual factors, such as unequal power relations between the sexes; childhood experiences of violence; cultural and subcultural factors; consumption of alcohol and drugs; family disagreements; and conflicts. DV occurs in different ways, varies in severity, occurs in many types of close relationships and can affect individuals at all ages. DV is gender biased and produced within and part of a gender order. Persons of both sexes are victimised, but generally, women are more severely hit than men. Children are also an important group here, as they become disturbingly affected by DV. Moreover, the Norwegian experiences, positive as well as negative, also point to a set of recommendations that could possibly be related to the challenges of the ISDVP project, as it aims to improve the system for the prevention of DV and GBV and to take the necessary legislative and other measures to adopt and implement state-wide effective, comprehensive efforts to prevent and combat all forms of violence. Our recommendations include experiences and factors which may be related to the task of successfully dealing with couples, or previous couples, in partnerships that are at risk of falling into violence. Hence, we recommend the following. The actual services should have different relational and individual tools at their disposal to cope with diversified needs. The recruitment of couples to the service should be voluntarily based, with opportunities for access by different channels. A new kind of service needs promotional efforts of a different kind. This must be planned for. The development of integrated services requires a cross-sectoral competence strategy aimed at increasing phenomenon knowledge, competence in action and interaction competence among individual service providers and in individual services. Finally, although the focus in the project is on couples, it is very important to integrate gendered perspectives in all the main components of the project, it’s content and implementation. Given the severity of DV, including GBV, the prevention of violence before it occurs is urgent and inevitable to combat GBV/ DV. Because the boundaries between prevention and treatment can be difficult to draw, prevention at all levels is important.

Purpose Trust plays an important role in the organisation of healthcare services. In Norway, the establishment of mandatory municipal acute wards with 24 h inpatient services introduces a new unit into the healthcare system. This article discusses how this new health care service succeeds in building trust with patients and among healthcare workers. Design/methodology/approach The article is an in-depth case study of a single, exemplary inter-municipal acute ward. The study draws on interviews with COPD patients, the leader and doctors at the ward. The study also includes observations of daily work at the municipal acute ward. Moreover, administrators and healthcare workers at related healthcare institutions have been interviewed. Data were analysed using a qualitative method. Findings The study reveals that trust is built in complex relations and that it has both individual and systemic factors. The practices employed in the daily treatment and care of patients and in encounters between health care personnel and patients are important trust-building processes; however, these processes depend on structures and routines that promote efficient and adequate inter-organisational communication and patient-oriented procedures. Practical implications The study provides insight into how trust dynamics work on multiple organisational levels and how they depend on both individual and systemic factors. Additionally, the study may provide a picture of the importance of trust in organising healthcare services in the future. Originality/value Lessons regarding trust building inspired by data from a case-study care institution can be applied in different care settings and countries.