<p>I mai 2000 ble NOU 2000:12 Barnevernet i Norge utgitt. Utredningen var et sentralt dokument for barnevernet, i det utredningsgruppens mandat var å gi en helhetlig gjennomgang og vurdering av barnevernets funksjon. Videre skulle de gi råd til hvordan etaten kunne løse sine fremtidige oppgaver.</p><p>Ett av de forhold som drøftes i utredningen, er barnevernets kontakt med frivillige organisasjoner. Deres rolle omtales i to ulike sammenhenger. For det første påpeker utvalget at frivillige organisasjoner har spilt, og fremdeles vil komme til å spille en svært viktig rolle innen barnevernets forebyggende arbeid. Norsk Folkehjelp, Kirkens Bymisjon og Røde Kors er organisasjoner som nevnes eksplisitt (NOU 12:2000 pkt.4.1.5). I følge utvalget er det mer å hente ut av eksisterende samarbeid, og barnevernet oppfordres derfor til å intensivere sin kontakt med de frivillige organisasjonene.</p>

I mai 2000 ble NOU 2000:12 Barnevernet i Norge utgitt. Utredningen var et sentralt dokument for barnevernet, i det utredningsgruppens mandat var å gi en helhetlig gjennomgang og vurdering av barnevernets funksjon. Videre skulle de gi råd til hvordan etaten kunne løse sine fremtidige oppgaver. Ett av de forhold som drøftes i utredningen, er barnevernets kontakt med frivillige organisasjoner. Deres rolle omtales i to ulike sammenhenger. For det første påpeker utvalget at frivillige organisasjoner har spilt, og fremdeles vil komme til å spille en svært viktig rolle innen barnevernets forebyggende arbeid. Norsk Folkehjelp, Kirkens Bymisjon og Røde Kors er organisasjoner som nevnes eksplisitt (NOU 12:2000 pkt.4.1.5). I følge utvalget er det mer å hente ut av eksisterende samarbeid, og barnevernet oppfordres derfor til å intensivere sin kontakt med de frivillige organisasjonene.

<p>This thesis is about the implementation of individual plans in the municipal mental health sector. Persons with need for long-term and coordinated services are entitled to have an individual plan. The objectives of an individual plan are to see that the service provides user participation, individual adaptation, comprehension and coordination. The purpose of this thesis is to see if an individual plan really contributes to reaching these objectives.</p><p>It is possible to see individual plans as a tool based on the ideology of New Public Management (NPM). As such, their basis is rational-instrumental logic. Mental health is, however, a sector recognized for different knowledge bases, indefinite relations between cause and result, and users with vague and complex needs. The reason for choosing this field of investigation is to see what happens when a sector recognized for ambiguity meets products designed upon a rational-instrumental logic.</p><p>The study shows that it is difficult to achieve user participation and individual adaptations. The reason for this is first of all insignificant resources in the municipal sector. The service providers are mostly positive to user participation and user involvement. This is, however, difficult to achieve as long as the users do not understand the reason for an individual plan and they lack concrete goals for their lives. The prospect of making a comprehensive and coordinated service is only to a small extent dependent on individual plans. Instead it seems as if factors like how the municipality is organized, professional boundaries and insight into rehabilitation ideology and cooperation, account for how comprehensive and coordinated the service becomes. The individual plan should be administered by a service provider with overall responsibility to follow up the work (a coordinator). My results show that this coordinator usually has a very important role in assisting the users in getting the service they need. Often the plan is followed by a team meeting where the different service providers together meet the user. For some of the users, these meetings are an arena where they can influence decisions about the service.</p>

This thesis is about the implementation of individual plans in the municipal mental health sector. Persons with need for long-term and coordinated services are entitled to have an individual plan. The objectives of an individual plan are to see that the service provides user participation, individual adaptation, comprehension and coordination. The purpose of this thesis is to see if an individual plan really contributes to reaching these objectives. It is possible to see individual plans as a tool based on the ideology of New Public Management (NPM). As such, their basis is rational-instrumental logic. Mental health is, however, a sector recognized for different knowledge bases, indefinite relations between cause and result, and users with vague and complex needs. The reason for choosing this field of investigation is to see what happens when a sector recognized for ambiguity meets products designed upon a rational-instrumental logic. The study shows that it is difficult to achieve user participation and individual adaptations. The reason for this is first of all insignificant resources in the municipal sector. The service providers are mostly positive to user participation and user involvement. This is, however, difficult to achieve as long as the users do not understand the reason for an individual plan and they lack concrete goals for their lives. The prospect of making a comprehensive and coordinated service is only to a small extent dependent on individual plans. Instead it seems as if factors like how the municipality is organized, professional boundaries and insight into rehabilitation ideology and cooperation, account for how comprehensive and coordinated the service becomes. The individual plan should be administered by a service provider with overall responsibility to follow up the work (a coordinator). My results show that this coordinator usually has a very important role in assisting the users in getting the service they need. Often the plan is followed by a team meeting where the different service providers together meet the user. For some of the users, these meetings are an arena where they can influence decisions about the service.

Praktisering av brukermedvirkning krever at sykepleierne ser på brukerne som likeverdige partnere. Det bryter med det tradisjonelle sykepleier–pasientforholdet og krever andre arbeidsmetoder og holdninger. For å kunne få til en slik endring forutsetter det at sykepleierne har nødvendig kunnskap og forståelse for brukermedvirkning og den bakenforliggende ideologien. Hensikt: Hensikten med studiet var å studere sykepleiernes teoretiske forståelse av begrepet brukermedvirkning og kartlegge hvordan sykepleierne selv opplever at de praktiserte brukermedvirkning i kommunens omsorgstjeneste. Metode: Det har blitt gjennomført en kvalitativ studie med halvstrukturerte intervjuer. Analysemetode var meningsfortettning og meningskategorisering etter beskrivelse av Kvale. Studien har 20 respondentern fra sykehjem og hjemmetjenesten i en stor norsk kommune. Resultater: Sykepleiernes kunnskap om brukermedvirkning var i stor grad situasjonsbestemt. Den ble beskrevet ut fra pasientene de selv arbeider med, situasjonene og konteksten. Det ble knyttet usikkerhet til den teoretiske forståelse av begrepet. Brukermedvirkning blir i hovedsak beskrevet som samråd og må forstås som symbolsk deltagelse der pasientenes deltar og gir uttrykker behov eller gir råd uten at de har reell innflytelse eller myndighet. Langt færre beskrev brukermedvirkning som brukerinnflytelse i form av partnerskap der pasienten gis anledning til å ta avgjørelse og oppleve kontroll.I hvilken grad brukermedvirkning praktiseres avhenger av avveininger i tjenesteutforming, institusjonelle forhold og strukturelle rammer. Sykepleiere opplevde ved håndtering av meningsforskjeller mellom pasient og pårørende en lojalitet overfor pasienten samtidig som de viser forståelse overfor pårørende. Konklusjon: Sykepleiernes forståelse av brukermedvirkning handler i stor grad om symbolsk deltagelse fordi de gis mulighet til å uttrykke ønsker men ikke fatte endelig avgjørelse. Implementering av brukermedvirkning på systemnivå og en kombinasjonen av teoretisk kunnskap og refleksjon over praksis, vil kunne styrke bevisstheten og vektleggingen av brukermedvirkning. / The practice of user participation requires nurses to regard users as equal partners. It breaks with the traditional nurse-patient relationship and demands different working methods and attitudes. Achieving such a change requires nurses to have the necessary knowledge and understanding of user participation and the ideology behind it. Objective: This study aimed to investigate nurses’ understanding and practice of user participation in the municipal care service. Method: We implemented a qualitative study by conducting semi-structured interviews with 20 respondents from nursing homes and home care services in a major Norwegian municipality.Analysis involved consolidating and categorizing the subjects’ intent, as described by Kvale. Results: The nurses’ knowledge of user participation was situational (i.e., they based their descriptions on current patients, situations, and context). Their theoretical understanding of the concept was uncertain. Most described user participation as a consultation that must be understood as symbolic participation, where the patients express their needs or give advice without having any real influence or authority. Far fewer nurses described user participation as user influence in the form of a partnership, where patients are given the opportunity to make decisions and experience control. The extent to which nurses practice user participation depends on trade-offs among services, institutional situations, and structural frameworks. When faced with differing opinions between patients and their relatives, nurses experienced loyalty toward their patients and simultaneously showed empathy for the relatives. Conclusion: Nurses’ understanding of user participation largely deals with symbolic participation because it enables patients to express desires without making any final decisions. Implementing user participation at the system level and combining theoretical knowledge and reflection in practice would strengthen awareness and focus attention on user participation / <p>ISBN 978-91-85721-73-3</p>