Aud Obstfelder

Changing the Record: The Inter-Professional, Subjective and Embodied Effects of Electronic Patient Records

Electronic patient record systems promise to optimise the delivery of health care. However, changing the record can disrupt established health-care work and organisation, producing less than optimum outcomes. Changing the record may not only change what health-care professionals do but may also change their understandings of work and self.

Beyond implementation and resistance: how the delivery of ICT policy is reshaping healthcare

New information and communication technologies (ICTs) offer great promise for the organisation of healthcare. Despite difficulties in implementation, commitment to the use of ICT in healthcare policy remains strong. Using examples from Norway, this article argues that this has set in motion changes beyond concerns about implementation and resistance, tied to an emergent mode of policy delivery dependent on private sector contractors and ICT experts working inside healthcare bureaucracies. We explore the consequences of this, as new centres of knowledge driven by distinctive and often conflicting rationalities come to shape the policy outcomes of strategic importance in healthcare.

Therapeutic encounters with preterm infants: interaction, posture and movement.

Abstract Background and purpose: Physiotherapy is a common intervention for preterm infants with motor disorders. There is a limited knowledge on how individual and contextual actions influence what is created and achieved in clinical encounters between physiotherapists and infants born preterm. In this theoretical paper the aim is to open a discussion for clinicians in pediatrics to take into consideration that patient interaction might have a significant impact for the outcome. Through introducing theoretical principles based on the phenomenology of the body and enactive intersubjectivity the paper provides a framework for better understanding the contribution that the interactional components in physiotherapy with preterm infants may have. Conclusion: The elaboration shows how social interaction and intentional actions influence each other in therapy. Accordingly, a fundamental driving force for effective physiotherapy intervention in preterm infants may involve a dynamical process of embodied interaction with the generation of meaning between physiotherapist and infant. Clinical implications: Our elaboration suggests that a coordinated process of embodied interaction with preterm infants can enhance motor performance during therapeutic encounters.

Un/doing gender with ICT?

What might new information and communication technologies (ICTs) at work do for gender? This question is explored here through an empirical study that traces the introduction of one ICT application—an electronic patient record (EPR)—into nursing and medical work in a University hospital in Norway. Health care work is well documented as a highly gendered field, where normalizing gender practices have dominated. The aim of this article is to explore emergent configurations of gender, ICT, and health care work following the introduction of the EPR. Drawing on Judith Butlers conceptualization of performativity, where gender is produced only as it is cited in everyday practice, we pay attention to both the normative and the disruptive moments of these configurations. In order to understand gender in modern health care we suggest an analysis of the performative co-constitution of gender, technology, and work as it is done on a daily basis at the hospital. We explore the gender effects of this co-constitution, also as gender norms are challenged and new ways of performing professional identities in health care are moved beyond the familiar categories of the past.

Parents' Perceptions of Primary Health Care Physiotherapy With Preterm Infants: Normalization, Clarity, and Trust.

Having a preterm infant is a life-altering event for parents. The use of interventions intended to support the parents is recommended. In this study, we investigated how parents’ perceptions of physiotherapy in primary health care influenced their adaptation to caring for a preterm child. We conducted 17 interviews involving parents of seven infants, at infants’ corrected age (CA) 3, 6, and 12 months. The analysis was a systematic text condensation, connecting to theory of participatory sense-making. The parents described a progression toward a new normalcy in the setting of persistent uncertainty. Physiotherapists can ameliorate this uncertainty and support the parents’ progression toward normalization, by providing knowledge and acknowledging both the child as subject and the parent–child relationship. Via embodied interaction and the exploration of their child’s capacity, the parents learn about their children’s individuality and gain the confidence necessary to support and care for their children in everyday life.

Self-Reported Food Hypersensitivity: Prevalence, Characteristics, and Comorbidities in the Norwegian Women and Cancer Study

Background This study aims to investigate the prevalence of self-reported food hypersensitivity, (SFH), the characteristics of women with SFH, and whether SFH is associated with multiple health complaints among the participants of the Norwegian Women and Cancer study (NOWAC). Methods We conducted a cross-sectional study among 64,316 women aged 41–76 years. The women were randomly selected from the Norwegian Central Person Register. Information on SFH and all covariates except age and place of residence was collected by questionnaires in 2002–2005. Results The prevalence of SFH in our study sample was 6.8% (95% confidence interval: 6.7–7.0). Logistic regression analysis showed a negative association between SFH and age (odds ratio [OR] 0.97). The odds of SFH increased among women living in or near urban centers, women with more than 9 years of education, women who did not have full-time work, women who had experienced poor economic conditions in childhood, those living without a partner, and those who did not consume alcohol or smoke (OR varied from 1.10 to 1.70). Women with a low body mass index had higher odds of SFH (OR 1.37) than those with a moderate body mass index. SFH was positively associated with poor self-perceived health (OR 2.56). The odds of SFH increased with the number of concurrent health complaints, with an OR for 5–6 comorbidities of 4.93. Conclusion We found an association between SFH, poor health, and different socio demographic and lifestyle characteristics. Women with SFH had increased odds of reporting multiple health complaints.

Whose decision is it anyway? A qualitative study of user participation and how clinicians deal with the patient perspective in mental healthcare

Purpose The concept of user participation is well accepted internationally. Nevertheless, studies show that both patients and health professionals find it challenging to maintain patient-centred ideals in the context of severe mental illness. The purpose of this paper is to explore how professionals deal with the ideals in light of patients’ right to participate in planning and decision making regarding milieu therapeutic measures and activities. Design/methodology/approach This is a qualitative study with an interactionist approach based on fieldwork at three district psychiatric centres in Norway during 2011-2012. The observations focused on patient-staff interaction in milieu therapeutic activities. Interviews were based on observed situations. Findings Adherence to treatment, rules and routines restricted patient autonomy. The professionals’ practical orientation towards routines overrode the ideals of patients’ rights. The staff regarded user participation primarily as participation in organised and mandatory activities. Refusal to comply was met with different sanctions, e.g. the prospect of being discharged. Originality/value Although user participation calls for patient-centred approaches, there is some debate about the challenges and premises for cooperation with persons suffering from severe mental conditions. This study adds insight into the everyday organisational context that facilitates or impedes user participation. It helps to explain why the user perspective can be overlooked, thus providing important information to both clinicians and policy makers who aim to fulfil the patient’s right to participate in planning and decision making regarding treatment and care.

Coping with increased managerial tasks: tensions and dilemmas in nursing leadership

The present study explores how increased managerial tasks affect nursing leadership in Norwegian nursing homes. Responding to New Public Management reforms, increased managerial tasks have been implemented by Norwegian central government into public nursing homes. Even though nursing leadership plays a key role in implementing managerial tasks, it is still unclear how nurses describe the influence of increased managerial tasks in nursing leadership. This was a qualitative study, including 100 hours of observations and 18 semi-structured interviews of nurses holding various positions in three public nursing homes. Thematic analysis was used in analysing data. Three changes were identified in the exercise of nursing leadership: (1) leading daily care from a distance; (2) lack of support in problem-solving; and (3) difficulties in adopting new managerial language. The study demonstrates that managers take on a more administrative role that, in turn, weakens their ability to supervise and motivate nurses in daily care. Lack of a reciprocal relationship between managers and nurses in goal achievement has significantly weakened nursing leadership in nursing homes. The study contributes knowledge on how nursing leadership weakens as a response to changes in nurses’ roles with increased managerial tasks.

Perceptions, actions and interactions of supervised aides providing services to children with cerebral palsy in pre-school settings: a qualitative study of knowledge application

Abstract Background: Aides are increasingly providing services to children with cerebral palsy to promote better functioning and participation; these aides work under the direction and supervision of physiotherapists. Objectives: In this qualitative study, we explored how aides in pre-school settings apply professional knowledge to their daily routines. Methods: Based on 65 h of observations, including sequential video recordings and seven interviews, we conducted a theme based content analysis connecting to enactive theory of participatory sense-making. Results: The aides highlighted that time management is challenging due to the temporality of their work, which requires flexibility to provide services as situations occurred. They also requested more supervised interactive involvement to learn and make sense of their own experiences while interacting with the child. Therapeutic handling was highlighted as particularly challenging. Conclusions: The application of physiotherapy knowledge is not merely knowledge transfer between settings but involves a transformation of knowledge on many levels, including personal, social, and contextual levels.

How physiotherapists supervise to enhance practical skills in dedicated aides of toddlers with cerebral palsy: A qualitative observational study

ABSTRACT Background: Physiotherapy from an early age is considered important for children with cerebral palsy (CP). In preschool, dedicated aides are responsible for the daily follow-up and training under the supervision of a physiotherapist (PT). Knowledge is sparse regarding what is created and achieved in clinical practice involving triads (i.e. the PT, aide, and child) with respect to the enhancement of practical skills in dedicated aides. The study purpose was to explore form and content in supervision. Methods: Nonparticipating observations were performed on a purposive sample of seven triads, including seven PTs, seven dedicated aides, and seven preschool toddlers with CP with function level III–IV of the Gross Motor Function Classification System. Each triad was video-recorded once. Data consisted of 371 minutes of video recordings analyzed using content analysis and enactive theory on participatory sense-making. Results: From the analysis, three supervision approaches emerged: (1) the Cognitive Supervision approach; (2) the Joint Action Supervision approach; and (3) the Embodied Supervision approach. Each approach gives rise to different types of sense-making processes, ranging from merely reflective ways of knowing through verbal and visual conveyance to mutual embodied ways of knowing through joint actions and physical interplay. To make use of all approaches, PTs require incorporated handling skills and action competence. Conclusion: Supervision is an emergent process where knowledge is transformed through interactions and shared sense-making processes. Implications: Clinicians should be aware of the context-dependent and interactional factors that drive the supervision process.