<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>

Bakgrunn: Forskning viser at tverrfaglig samarbeid er vanskelig. Folkehelsearbeid er sektorovergripene og krever ofte at ulike fag og sektorer samarbeider. Hensikt:Formålet med denne studien er å få større innsikt i hva roller og yrkesbakgrunn betyr for kommunikasjonen i samarbeideti folkehelse. Metode:Studien har benyttet triangulering som strategi med dokumentgranskning, tre teamobservasjoner og 12 individuelle semistrukturerte intervju. Det er benyttet en fenomenografisk tilnærming til analyse av intervjuene. Resultat: Dokumentgranskningen ga forståelse for sammensetningen i de observerte teamene.Observasjonen ga rom for å analysere den muntlige kommunikasjonen og metakommunikasjonen, mens intervjuene ga innblikk i kommunikasjonen som helhet og dens kompeksitet. Intervjuanalysen ga de fire hovedkategoriene; Representasjon av yrker og sektorer,Deltakere som samarbeider i team, Person og menneske i samarbeidet og Betydning av helhet. I analysen kom det fram at yrkesbakgrunn har betydning for kommunikasjon og samarbeid. En er preget av faget som yrkesutøver. Ulik kompetanse og bredde i representasjon bidrar til en rikere diskusjon og et breiere grunnlag for løsninger. Mange av faktorene var ellers uavhengig av yrke og kunne heller relateres til egenskaper hos den enkelte. Evne til å se utover eget fag og ha forståelse for betydningen av andre yrkesgrupper er vesentlig. Konklusjon: Studien viser tverrfaglig samarbeid og kommunikasjon som fungerer og synliggjorde betydningen av trygge fagpersoner med blikk for helhet og evne til refleksjon. Funnenepeker på ulike faktorer av betydning for roller og kommunikasjon slik som tillit, respekt, likeverd, læring og åpenhet. Rollen og hvordan den bekles harbetydning for kommunikasjonen. Yrkesbagrunnen får betydning gjennom den enkelte deltaker og dennes rolle,men da som en del av hele personenmed sine egenskaper, sin personlighet og innstilling. Folkehelsearbeid er et område ingen eier men alle har del i og ansvar for. / Background:Research shows that interdisciplinary collaboration is difficult. Public health work spansmany sectors and demands collaboration among different professionsand sectors. Purpose:This study aimed to gain greater insight into the impact of roles and professional backgrounds on communication in the collaborative process of public health. Method:This study used a triangulation strategy involving document analysis, three observations and 12 semi-structured interviews. A phenomenographic approach was used to analyze the interviews. Result: Document analysis enhanced understanding of the composition of the teams observedin this study. The observations allowed for analysis of verbal communication as wellas meta-communication, and the interviews offeredinsight into communication both as an entiretyandinits complexities. Interviewanalysis produced four main categories:representationof professionals and sectors, participants who collaborate in teams, the individual and the human in collaboration,and the meaning of the whole. Analysis showed that professional background plays a significantrole incommunication and collaboration (i.e.aperson is characterized by his/her profession). Differences in competence and breadth ofrepresentation contribute to richer discussion and a wider ground forsolutions. Many of the factors that emerged were otherwise independent ofprofession and related instead to individual characteristics.The ability to see beyond one`sown profession and understand the importance of other professional groups is essential. Conclusion: The study shows functionality of interprofessional collaboration and communication,it’s revealingthe meaning of confidentprofessionals who areable to see the big pictureand reflect upon its meaning. The findings point to various factors that are important for roles and communication such astrust, respect, dignity, learning and openness. Roles and their interpretation are important incommunication. Professional background derivesmeaningnot only through the individual participant andhis/herrole, but also through his/her properties, personality and perspectives. Public health is an area no one owns but everyone takes part in and has responsibility fo / <p>ISBN 978-91-86739-39-3</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.

Aim: The aim of this comprehensive thesis is to explore different perceptions of public health nursing practice. The intention being to contribute to developing the service, theoretically and practically, in throe with current and future public health needs. Methods: The thesis comprises five studies. Public health nurses, young people, parents and decision makers are interviewed and share their perceptions of public health nursing practice (studies I, II, III and IV). Consultations at local child health clinics, clinics for young people and at school health services are observed (study III). A cross sectional study amongst a sample of doctors, public health nurses, midwives and child protection workers is carried out (study V). The first four studies have an explorative, descriptive design. Study V, with its focus on interprofessional collaboration, is based on the results of studies I, II, and IV. Findings: Study I, a case study, provides a backdrop for the remaining four studies. It focuses on changes the nurses have faced during the period 1984-2005. The results point to issues of visibility and that respect is more important for the nurses than authority or status. Study II is a philosophical study based on interviews with public health nurses. It gives an introduction to the philosophy of Emmanuel Levinas and develops a novel theoretical and practical understanding of aspects of responsibility in public health nursing. Study III shows the importance of relationships with service users in public health nursing practice; and that not only pleasantness but also honesty and openness are important. This study has contributed to further developing models of public health nursing interventions. Decision makers in study IV point to the challenges public health nurses face regarding collaboration, visibility and boundaries. Study V is a cross sectional questionnaire study that focuses on interprofessional collaboration. The results show that size of municipality can influence frequency of meeting points and views on issues relating to collaboration; and that mental health services are those most missed in collaborative relationships. The findings warrant further research and should be of interest when organising municipal health- and social services in Norway. Conclusions: The thesis concludes that service users and decision makers are satisfied with public health nursing services, but that public health nurses face challenges related to collaboration, to boundaries for knowledge and involvement, and in making their health promotive function visible / Denne doktorgradsavhandling: Perceptions of public health nursing practice - on borders and boundaries, visibility and voice, fokuserer på ulike oppfatninger av helsesøsters praksis. Helsesøstre, ungdom, foreldre, samt lokale politikere og administratorer er intervjuet om deres syn på helsesøstertjenesten. Konsultasjoner på helsestasjon for barn, ungdom og i skolehelsetjenesten er observert. Et utvalg av samarbeidspartnere har svart på et spørreskjema om samarbeidsforhold. Avhandlingen består av fem studier. De første fire studier har eksplorativ, deskriptiv design. Studie V er en tverrsnittsstudie som bygger på resultatene fra studiene I,II, og IV. Avhandlingen har til hensikt å løfte frem områder som respondentene mener fortjener oppmerksomhet og som kan ha praktiske og teoretiske implikasjoner for utvikling av tjenesten. Studie I, en case studie danner et bakteppe for de andre studiene. Den fokuserer på endringer i helsesøstertjenesten i perioden 1984-2005. Resultatene fra denne studien peker på helsesøstrenes opplevelse av usynlighet og at respekt er mer viktig for helsesøstrene i studien enn autoritet og status. Studie II er en filosofisk studie basert på intervjuer med helsesøstre. Den gir en introduksjon til Levinas’ filosofi og utvikler en dypere forståelse for teoretiske og praktiske aspekter av etisk ansvar i helsesøsters praksis. Studie III peker på betydningen av relasjoner i helsesøsters praksis. Det var viktig at konsultasjonene var hyggelige for helsesøstrene og brukerne, men ærlighet og åpenhet var også vesentlig for gode relasjoner. Beslutningstakere i studie IV peker på utfordringer helsesøstre har når det gjelder samarbeid, usynlighet, samt grenser for deres kunnskap og involvering. Studie V er en spørreskjemaundersøkelse som fokuserer på samarbeid. Resultatene viser at kommunestørrelse har betydning for hyppighet av møtepunkter og syn på samarbeid og at psykiske helsetjenester er savnet mest i samarbeidsrelasjoner. Disse funn burde være av interesse i fremtidig organisering av helse- og sosialtjenester. Avhandlingen konkluderer med at foreldre, ungdom og beslutningstakere er fornøyde med helsesøstertjenesten, men at helsesøstre står overfor viktige utfordringer i samarbeidsrelasjoner, i forhold til grenser for involvering og i å synliggjøre deres helsefremmende funksjon