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The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care.

A questionnaire relating to attitudes towards setting economic priorities within the health care system was sent to all 151 general practitioners in Northern Norway. Of these, 109 (72 per cent) responded. Ninety-six per cent of the respondents agreed or partly agreed that the setting of economic priorities within the health care system was necessary. Ninety-three per cent had experienced a conflict between their responsibility towards the individual patient and the requirement for them to manage the health budget.The responses suggest that doctors act more in the interests of their patient than the interests ofsociety. However, 68 per cent reported having refrainedfrom giving the best treatment to patients because it was too expensive. As many as 60 per cent of the respondents wanted more public guidelines. Only 10 per cent wanted doctors to have more influence in difficult questions arisingfrom setting priorities.

BakgrunnIndividuell tilretteleggelse for eldre pasienter etter sykehusopphold -en fenomenologisk-hermeneutisk studie basert på erfaringer fra sykepleieledere i kommunen Wivi-Ann Tingvoll. Førstelektor, Sven-Tore Dreyer Fredriksen. DrPH, Førsteamanuensis. INDIVIDUAL ARRANGEMENTS FOR ELDERLY PATIENTS AFTER HOSPITALIZATION -a phenomenological-hermeneutic study based on experiences from nurse leaders in the municipality ABSTRACTThis article is about how to develop an understanding of what is in the discharge process to provide individually adapted care and care in the community. Findings were analyzed based on Lindseth and Norbergs phenomenological-hermeneutical analysis. Result:The theme was interpreted out of five sub-themes: lack of professional continuity between the specialist and community health services, quality violations of registration instruments and reporting procedures, lack of flexible arrangements in relation to situation changes in the patient, lack of follow-up regarding the flow of information in and between, each link of service chain, together with a lack of a comprehensive understanding of service understanding of service chain. Conclusion: In health care service in the municipalities implement significant changes to be able to meet the aging population. If the patient is to receive comprehensive services, it is essential that the information provided from the specialist correct right and is given in good time before the patient is discharged, so that the community care can services provide the expertise and resources to follow up the patient. This applies to both treatment and functional level of the individual patient.

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This study is about intensive care patients and the bodily presence of significant others. The aim of the study is to inquire and understand the patients experience of the body in relation to their significant others during critical illness. Open, unstructured, in-depth interviews with six former intensive care patients provide the data for the study. The phenomenological–hermeneutical analysis points to a theme among ICU patients' experience of conflict between proximity and distance during the bodily presence of their relations. Patients experience different and conflicting forms of responses to the presence of their significant others. Patients experience significant positive confirmation but also negation through this presence. In the ICU situation, the reactions of significant others appear difficult to deal with, yet the physical presence is significant for establishing a sense of affinity. Patients seek to take some responsibility for themselves as well as for their relatives, and are met with a whole spectrum of reactions. Intensive care patients experience the need to be actively, physically present, which often creates sharp opposition between their personal needs and the needs of their significant others for active participation.

Background The care of adult patients with a tracheostomy in intensive care unit is complex, challenging and requires skilled intensive care unit nurses. ICU nurses’ live experience is scarcely known. This study aimed to describe the lived experience of intensive care unit nurses of caring for adult patients with a tracheostomy in intensive care unit. Methods This study employs a qualitative design. In-depth interviews were conducted with a purposive sampling of 6 intensive care unit nurses from a medical-surgical ICU of a university hospital in Norway who were interviewed. Data was analyzed and interpreted using a phenomenological-hermeneutic approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ). Results The interpretation yielded the following themes and subthemes: 1) theme: ‘challenges of caring for patients with a tracheostomy’ consisted of the sub-themes: ‘difficult to communicate/interpret and understand the patient’s different forms of expression’, ‘complicated professional assessments’, ‘caring with patience’, and ‘collaborating with patient regarding challenges. 2) theme: ‘the satisfaction from providing care to patients with a tracheostomy’ consisted of the sub-themes: ‘working with intensive care patients is instructive’ and ‘importance to motivate’. Conclusions ICU nurses experienced ambivalent feelings while caring for adult patients with a tracheostomy in ICU. They perceived caring as demanding owing to communication and collaboration at the same time, they experienced satisfaction while they strived to provide proper care and motivation. The identified challenges would lead to further improvement in nurses’ experiences and, in turn, the quality-of-care for patients with a tracheostomy. Awareness of these challenges is crucial to understand the need for an effective communication strategy to improve the quality and safety of adult patients with tracheostomy in ICU.