Ambiguities concerning the nursing home as a home and place to live, a social environment in which the residents experience most of their social life and the institution where professional health service is provided were uncovered. High-quality care was when ambiguities were managed well and a home could be created within the institution. Implication for practice. Achieving quality care in nursing homes requires reconciling the ambiguities of the nursing home as a home. This implies helping residents to create a private home distinct from the professional home, allowing residents' personal habits to guide institutional routines and supporting meaningful activities. Using these resident developed quality indicators is an important step in improving nursing home services.

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Introduction:This article summarizes and synthesizes the findings of four separate but inter-linked empirical projects which explored challenges of collaboration in the Norwegian health system from the perspectives of providers and patients. The results of the four projects are summarised in eight articles.Methods:The eight articles constituted our empirical material. Meta-ethnography was used as a method to integrate, translate, and synthesize the themes and concepts contained in the articles in order to understand how challenges related to collaboration impact on clinical work.Results:Providers’ collaboration across all contexts was hampered by organizational and individual factors, including, differences in professional power, knowledge bases, and professional culture. The lack of appropriate collaboration between providers impeded clinical work. Mental health service users experienced fragmented services leading to insecurity and frustration. The lack of collaboration resulted in inadequate rehabilitation services and lengthened the institutional stay for older patients.Conclusion:Focusing on the different perspectives and the inequality in power between patients and healthcare providers and between different providers might contribute to a better environment for achieving appropriate collaboration. Organizational systems need to be redesigned to better nurture collaborative relationships and information sharing and support integrated working between providers, health care professionals and patients.

Introduction: The aim of this study is to explore the obstacles to collaborations between nurses in hospital and municipal care in the discharge of hospital patients who need continuing care.

BackgroundVictims of bullying in school may experience health problems later in life. We have assessed the prevalence of children's health symptoms according to whether peer victimization was reported by the children, by their teachers, or by their parents.MethodsIn a cross-sectional study of 419 children in grades 1-10 the frequency of peer victimization was reported by children, teachers and parents. Emotional and somatic symptoms (sadness, anxiety, stomach ache, and headache) were reported by the children.Frequencies of victimization reported by different informants were compared by the marginal homogeneity test for paired ordinal data, concordance between informants by cross-tables and Spearman's rho, and associations of victimization with health symptoms were estimated by logistic regression.ResultsThe concordance of peer victimization reported by children, teachers, and parents varied from complete agreement to complete discordance also for the highest frequency (weekly/daily) of victimization. Children's self-reported frequency of victimization was strongly and positively associated with their reports of emotional and somatic symptoms. Frequency of victimization reported by teachers or parents showed similar but weaker associations with the children's health symptoms.ConclusionThe agreement between children and significant adults in reporting peer victimization was low to moderate, and the associations of reported victimization with the children's self-reported health symptoms varied substantially between informants. It may be useful to assess prospectively the effects of employing different sources of information related to peer victimization.

PurposeThe purpose of this study was to explore the structural mechanisms that facilitate or counteract collaboration between general practitioners (GPs) and other providers of municipal healthcare. Good collaboration between these actors is crucial for high-quality care, especially for persons in need of coordinated services.Material and methodsThe study is based on semistructured interviews with 12 healthcare providers in four Norwegian municipalities: four GPs, six nurses and two physiotherapists.ResultsGPs are key collaborating partners in the healthcare system. Their ability to collaborate is affected by a number of structural conditions. Mostly, this leads to GPs being too little involved in potential collaborative efforts: (i) individual GPs prioritize with whom they want to collaborate among many possible collaborative partners, (ii) inter-municipal constraints hamper GPs in contacting collaboration partners and (iii) GPs fall outside the hospital-municipality collaboration.ConclusionsWe argue a common leadership for primary care services is needed. Furthermore, inter-professional work must be a central focus in the planning of primary care services. However, a dedicated staff, sufficient resources, adequate time and proper meeting places are needed to accomplish good collaboration.

AimThe aim of this study was to explore any differences between nurses working in nursing home and home‐based care in their experiences regarding relatives' ability to accept the imminence of death and relatives' ability to reach agreement when deciding on behalf of patients unable to consent.DesignAn electronic questionnaire‐based cross‐sectional study.MethodAn electronically distributed survey to 884 nurses in long‐term care in Norway in May 2014. A total of 399 nurses responded (45%), of which 197 worked in nursing homes and 202 in home‐based care.ResultsNurses in home‐based care, more often than their colleagues in nursing homes, experienced that relatives had difficulties in accepting that patients were dying. Nurses who often felt insecure about whether life extension was in consistency with patients' wishes and nurses who talked most about life‐prolonging medical treatment in communication with relatives more often experienced that relatives being reluctant to accept a poor prognosis and disagreements between relatives in their role as proxy decision makers for the patient.

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