Ragnhild Hellesø

• Tingvold, Laila; Hellesø, Ragnhild; Obstfelder, Aud Uhlen & Stokke, Randi (2026). When standards fall short: The use of discretion and just allocation of long-term care services in Norway. BMC Health Services Research. Full text in Research Archive Show summary

  Background: Care administrators in long-term care (LTC) are ‘gatekeepers’ to the services and handle applications, investigate care needs, and decide if, what and how much services applicants are entitled to receive. Various models of service allocation have been in operation in the Nordic countries since the inception of LTC services in the 1970s. The main drivers of the development of allocation models have been concerns about service inequality among users, quality of care, patient safety, and the overall efficiency within healthcare settings. While care administrators have several laws and guidelines to aid their decision-making, the use of professional discretion is known to be widespread but less investigated. In the context of Norway, this article seeks to explore: What guides care administrators in reaching decisions? How and in which circumstances is the use of discretion needed in making decisions? Method: Qualitative in-depth interviews with 5 managers in care administration and 13 care administrators in 5 Norwegian municipalities. The material was analysed using thematic analysis. Results: Two main themes were identified. These are Negotiating standards with discretion and collegial discussion, and Complexities in deciding needs and services. Conclusion: Care administrators hold significant responsibility in ensuring fair service allocation. Discretion is a necessary and valuable tool that can strengthen the integrity and trustworthiness of care services. However, increased reforms and standardisation place heavy pressure on administrators, limiting their discretion through stricter allocation criteria. This may reduce their ability to act in the best interests of service applicants in line with the fiduciary principle.

• Janson, Astri Letnes; Hellesø, Ragnhild; Norlyk, Annelise; Sulosaari, Virpi & Opheim, Randi (2026). Becoming an advanced practice nurse educator. Scandinavian Journal of Educational Research. ISSN 0031-3831. p. 1–11. doi: 10.1080/00313831.2026.2727859. Full text in Research Archive
• Stokke, Randi; Øvern, Karen Marie; Obstfelder, Aud Uhlen; Hellesø, Ragnhild & Tingvold, Laila (2026). Allocation models and prioritising practices in long-term care services in the nordic countries: An integrative systematic review. Social Sciences & Humanities Open (SSHO). 14, p. 103218–103218. doi: 10.1016/j.ssaho.2026.103218. Full text in Research Archive
• Holte, Jon Helgheim; Moger, Tron Anders; Edvardsen, Anne; Tjerbo, Trond; Vøllestad, Nina Køpke & Hellesø, Ragnhild [Show all 7 contributors for this article] (2026). Long-term patterns of health services utilization after hospitalization for COPD. A nationwide registry-based study from Norway. Respiratory Medicine. ISSN 0954-6111. 260. doi: 10.1016/j.rmed.2026.108958. Full text in Research Archive Show summary

  Chronic obstructive pulmonary disease (COPD) is commonly regarded as an ambulatory care-sensitive condition (ACSC), for which targeted outpatient and primary care can improve patients' outcomes and reduce their risk of hospitalization. Yet little is known about how COPD patients' use of such services evolves in real-life settings. Using national health registry data from Norway (2008–2020), linked to demographic and socioeconomic registers, we explore how COPD patients' combined use of primary and specialist services evolves in the first four years after an acute respiratory hospital episode, and assess whether these patterns align with clinical guidelines and vary by sociodemographic characteristics. A two-stage clustering approach was employed to identify individuals with similar care trajectories. The 13 057 patients were first grouped by the number of respiratory hospital episodes after the index episode (0, 1–2, or 3+), then K-medoid clustering was performed within each group to identify similar patterns of respiratory-related outpatient and primary health service utilization. Four distinct care trajectories emerged within each group, with similar combination patterns: (1) predominantly GP services (most common), (2) GP and outpatient services, (3) GP, out-of-hours primary care and infrequent outpatient services, and (4) frequent physiotherapist, GP and outpatient services (rarest). Notably, groups 2 and 4 had higher income and education than groups 1 and 3, and many patients do not follow care trajectories according to current guidelines for COPD treatment. Understanding the mechanisms that explain these variations in health services use, and their implications for care quality and equity, is essential for improving COPD management in universal healthcare systems.

• Hassan, Hero Ibrahim; Ansteinsson, Vibeke Elise; Uhlen-Strand, Marte-Mari; Hellesø, Ragnhild; Skudutyte-Rysstad, Rasa & Hovden, Ewa Alicja Szyszko (2026). Dental health service utilization among older adults receiving home care services in south-eastern Norway | Acta Odontologica Scandinavica. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.2340/aos.v85.46262. Full text in Research Archive Show summary

  Objective: To map dental health service utilization (DSU) and associated factors among older adults receiving home care services (HCS) in south-eastern Norway, using Andersen’s model. Materials and methods: In this cross-sectional study of older adults receiving HCS aged ≥ 65 years, data on oral health practices, general health, and predisposing, enabling, and need-based factors were collected via interviewer-administered questionnaire. Results: Of 116 participants (mean age 83, 53.6% female), 67.2% reported annual DSU, while 24.1% used dental health services only for acute problems. Although 95.6% were entitled to free dental care in the public dental service (PDS), 66 were aware of this, and 56.5% made use of their rights. Awareness of entitlements was associated with more frequent PDS use. A higher self-reported number of teeth and using private dental services were also linked to higher DSU. Conclusions: The present study showed underutilization of dental health services among older adults receiving HCS and unawareness of entitlement of their rights in PDS. However, higher self-reported number of teeth and use of private dental services were linked to more frequent DSU. To address underuse, the PDS should improve awareness of entitlements, enhance information delivery, and further investigate reasons for non-utilization.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2026). Use of primary care physiotherapy and its associations with clinical and socioeconomic outcomes in musculoskeletal disorders: a cohort study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660328. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2026). Matching on health status to estimate the effects of outpatient care and social factors in patients with COPD: a Norwegian registry‑based study. BMC Health Services Research. 26(1). doi: 10.1186/s12913-026-14285-9. Full text in Research Archive Show summary

  Isolating the effects of outpatient care on hospitalisation in observational data is challenging. We estimate the effects of factors believed to influence hospital admissions in patients with COPD. The factors were related to outpatient care and social factors, motivated by recommendations in COPD guidelines and the literature. We applied linked national and municipal registry data on 25,369 COPD patients in Oslo and Trondheim 2008–2019. Yearly frequency and type of healthcare contacts (respiratory and non-respiratory, across providers), together with comorbidities, were used as proxies for patients’ health status. We constructed samples matched on the full set of proxy variables to estimate the effect of each factor on future COPD hospital admissions. Overall, 9.8% of follow up years had at least one COPD hospital admission. Findings indicated beneficial effects of several of the factors. Care interaction between general practitioner (GP) and other health providers, follow-up by GP within 30 days after COPD hospital discharge and counselling/psychotherapy by GP showed significant reductions of 2.9, 4.9 and 1.4% points in the rate of next-year COPD hospital admissions, respectively. The effects are noteworthy when extrapolated to the entire Norwegian COPD population. A reduction of 1% point could result in up to 1,500 fewer patients experiencing one or more COPD hospital admissions during a year. In the absence of detailed clinical information, creating samples that are multidimensionally matched on health service use and comorbidities as pragmatic proxies for health status could be a viable approach for estimating the effects of other factors.

• Haavaag, Silje Bjørnsen; Obstfelder, Aud Uhlen; Hellesø, Ragnhild; Moger, Tron Anders; Amundsen, Olav & Tjerbo, Trond [Show all 9 contributors for this article] (2026). Patient Work in Long-Term Conditions. Qualitative Health Research. ISSN 1049-7323. doi: 10.1177/10497323261430632. Full text in Research Archive Show summary

  Long-term conditions are one of the major causes to morbidity and death worldwide. Management of such conditions in healthcare settings has been framed as a challenge for healthcare systems, and people living with long-term conditions often experience fragmented care. Integrated care approaches have been advocated as the solution, but few studies include the work done by patients and its significance for care processes. The present study aimed to explore the work of people with long-term conditions in the unfolding of their care trajectories. The study is based on semi-structured interviews of people living with chronic obstructive pulmonary disease and musculoskeletal disorders. The participants were all home-dwelling and living in Norway. Reflexive thematic analysis was used to guide the analysis. Theory about work as theorized by Strauss et al. was central to the analysis. The persons highlight that they feel that it is up to them to ask questions and initiate care, that they monitor their bodies to be equipped to act adequately when changes occur, and that they engage in deliberative interaction with healthcare personnel. The findings add depth to current knowledge and highlight that people living with long-term conditions participate in the unfolding of their care trajectories by doing comprehensive work. Framing what people with long-term conditions do when participating in their care trajectories as work brings forth aspects of healthcare use that may be less visible for healthcare personnel and enables addressing individual care trajectories as intertwined with patient work.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2025). Predictors, Healthcare Utilization and Costs Related to Short-Term Stays in Patients with COPD: A Registry-Based Analysis in Norway. Clinical Epidemiology. Volume 17, p. 707–719. doi: 10.2147/clep.s521958. Full text in Research Archive Show summary

  Background: Chronic obstructive pulmonary disease (COPD) incurs significant healthcare costs, often accompanied by multimorbidity. Advanced patients may need short-term stays for rehabilitation, treatment, or respite to maintain home living. Aim: To identify predictors for a first short-term stay and study the healthcare utilization and costs compared with similar patients without a short-term stay. Patients and Methods: Data on COPD patients in the cities Oslo and Trondheim 2010–2019 and including information on specialist, primary and long-term care, diagnoses, sociodemographics and -economics were collected from national and municipal registries, resulting in a sample of 24,613 patients. Using discrete time survival models, we identified predictors for a short-term stay. We described the costs before and after admission, and the duration of living at home, compared to non-recipients matched on age, comorbidities and healthcare use. Results: Depression, anxiety, mental disorders, alcoholism, prior hospitalization and reception of home care were associated with higher odds of short-term stays. One to two GP visits for respiratory diseases, being in the top quartile for GP visits for non-respiratory diseases, visits to specialists, and physiotherapist visits for non-respiratory issues were significantly associated with lower odds of short-term institutional stay. Patients admitted to short-term stays incurred markedly higher costs both in the year before admission and during subsequent years compared to matched non-recipients, primarily due to increased use of inpatient and home care services. Conclusion: Prior receipt of home care, unlike standard outpatient services, was linked to a higher likelihood of short-term stays. This suggests that some outpatient services may delay the need for such stays, or that patients already in municipal services are more readily admitted. Additionally, patients with psychosocial issues may have greater care needs, indicating that resource allocation aligns with these needs. The findings suggest that by the time short-term stays are required, health deterioration has already become considerable.

• Hassan, Hero Ibrahim; Uhlen-Strand, Marte-Mari; Ansteinsson, Vibeke Elise; Hellesø, Ragnhild; Hovden, Ewa Alicja Szyszko & Skudutyte-Rysstad, Rasa (2025). Self-reported oral health and oral health-related quality of life among older adults receiving home care services in South-eastern Norway. Acta Odontologica Scandinavica. ISSN 0001-6357. 84, p. 165–173. doi: 10.2340/aos.v84.43425. Full text in Research Archive
• Hellesø, Ragnhild; Henni, Silje Havrevold; Korzeniewska, Lubomiła; Ansteinsson, Vibeke Elise; Hovden, Ewa Alicja Szyszko & Uhlen-Strand, Marte-Mari [Show all 7 contributors for this article] (2025). Perspectives of user groups in the co-creation of a targeted dental care service intervention for older adults receiving home healthcare: an explorative study. BMC Health Services Research. 25. doi: 10.1186/s12913-025-13156-z. Full text in Research Archive Show summary

  Background An increasing number of older adults receive home healthcare in their homes, some of whom lose their capacity and ability to take care of their own health, including oral health. Poor oral health may have serious consequences that can lead to poor nutrition, diseases, isolation, and even death. There is an urgent need to involve users in developing targeted interventions to ensure that eligible older adults exercise their right to receive appropriate dental care. The purpose of the study was to explore what user groups emphasised in co-creating a targeted dental care intervention for older adults receiving home healthcare. Methods In this study, an exploratory design with an inductive and interpretive approach was employed. In two six-hour workshops, eleven participants representing three older adults, one next of kin, two nurses, and five dental care providers exchanged and discussed their perspectives on dental care as part of a co-creation process. Data were collected from group and plenary discussions during the workshops and were analysed using reflexive thematic analysis. Results The different user groups conveyed confusing and contradictory understandings and interpretations of the dental healthcare landscape. This uncertainty resulted in missed information regarding dental care, leading to situations where they do not always seek dental healthcare services until an acute issue arises. A blurred perception of older adults’ needs for support, combined with shortcomings in collaboration, communication, and the exchange of digital information systems, has led to a lack of knowledge about one another and inadequate dental healthcare for this vulnerable group. The various user groups suggested different solutions; however, several key issues emerged as urgent to address. There is a need to build and integrate systems into home healthcare’s digital administrative and health record systems to support the clarification and identification of eligible patients, as well as to develop a digital coordination and communication system to connect the two levels of service. Conclusions Unpacking the perspectives of the different user groups uncovered that an intervention must take into account the views of all groups. Understanding and incorporating the perceptions of all the different user groups were crucial for developing an intervention that enables a preventive and collaborative dental care approach.

• Hellesø, Ragnhild; Boysen, Elin Sundby & Håpnes, Tove Rigmor (2024). Digitalising Coordination Information in Long-Term Care: Experiences from an Innovation Project. Studies in Health Technology and Informatics. ISSN 0926-9630. 315, p. 342–346. doi: 10.3233/SHTI240166. Full text in Research Archive Show summary

  More patients are being discharged early from hospital and increasing numbers of patients have complex health care needs and receive care in the primary health care sector. To ensure efficient coordination and continuity of care, access to relevant information is crucial. We report from two Norwegian municipalities that, during an innovation project, transferred their information system from a paper-based to a digital coordination system. Workshops and interviews were conducted to address the considerations, reflections and dilemmas of the actors involved during the innovation process. The analysis provided three main themes which were: 1) transition from paper-based to digital overviews; 2) transition from individual patient information to a digital overview of groups of patients; and 3) transition from use of telephone to digital exchange of information. The actors had to overcome several challenges. Nevertheless, the outcome was that they were provided with contextualised information enabling efficiency and patient safety in their coordination work.

• Hellesø, Ragnhild; Rostad, Hanne Marie; Fagertun, Anette; Førland, Oddvar; Skinner, Marianne Sundlisæter & Sundsbø, Astrid Ouahyb [Show all 8 contributors for this article] (2024). Prioriteringslandskapet i de kommunale helse- og omsorgstjenestene i et velferdsstatsperspektiv. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 10(2), p. 46–64. doi: 10.18261/tfo.10.2.5. Full text in Research Archive Show summary

  Bakgrunn: Velferdsstaten er under press, og det forventes at kommunene må prioritere hardere framover. I denne artikkelen analyserer og diskuterer vi prioriteringslandskapet knyttet til helse- og omsorgstjenestene, med et særlig søkelys på utfordringer for langtidstjenester og eldreomsorg i kommunene. Metode: Sammenfatning og analyse av artikler fra en større tverrfaglig multisenterstudie (PriCare), basert på registerdata, spørreskjemadata og feltarbeid med observasjoner og intervjuer. Hovedresultater: Kommunene er på vei mot en økt tjenestespesialisering samtidig som tjenestetilbud også avhenger av kommunale kjennetegn som kommunestørrelse. Dette gir ulike typer modeller for tjenestedistribusjon i kommunene. Det foregår behovsfortolkninger med høye terskler for å tildele omfattende, langvarige helse- og omsorgstjenester. Det er på den annen side klare ambisjoner om å ha lave terskler for å gi forebyggende og rehabiliterende tjenester. Analysene avdekker at konsekvensene av prioriteringene som gjøres på overordnet beslutningsnivå, skyves nedover til tjenesteutøverne som møter tjenestemottakerne personlig. Konklusjon: Prioriteringer i de kommunale helse- og omsorgstjenestene synes å utfordre tradisjonelle verdier i velferdsstaten gjennom redefinering(er) av hva som er nødvendige helse- og omsorgstjenester. Velferdsstatens tradisjonelle kjennetegn med vektlegging av tjenesteyting for å sikre grunnleggende og langvarige helse- og omsorgsbehov er utfordret. Potensialitet for rehabilitering synes å framstå som et sterkt prioriteringskriterium i dagens helse- og omsorgstjenester.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Døhl, Øystein & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). The in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(1). doi: 10.1080/02813432.2024.2404056. Full text in Research Archive Show summary

  Objective: Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death. Design and subjects: Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009–2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals. Results: There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death. Conclusion: Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2024). Patient characteristics and healthcare use for high-cost patients with musculoskeletal disorders in Norway: a cohort study. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-12051-3. Full text in Research Archive Show summary

  Background: A high proportion of healthcare costs can be attributed to musculoskeletal disorders (MSDs). A small proportion of patients account for most of the costs, and there is increasing focus on addressing service overuse and high costs. We aimed to estimate healthcare use contributing to high costs over a five-year period at the individual level and to examine if healthcare use for high-cost patients is in accordance with guidelines and recommendations. These findings contribute to the understanding of healthcare use for high-cost patients and help in planning future MSD-care. Methods: This study combined Norwegian registries on healthcare use, diagnoses, demographic, and socioeconomic factors. Patients (≥ 18 years) were included by their first MSD-contact in 2013–2015. We analysed healthcare use during the subsequent five years. Descriptive statistics were used to compare high-cost (≥ 95th percentile) and non-high-cost patients. Total healthcare contacts and costs for high-cost patients were examined stratified by number of hospitalisations and surgical treatments. Healthcare use of General Practitioners (GPs), physiotherapy, chiropractor and Physical Medicine and Rehabilitation physicians prior to the first hospitalisation or surgical treatment for a non-traumatic MSD was registered. Results: High-cost patients were responsible for 61% of all costs. Ninety-four percent of their costs were related to hospital treatment. Ninety-nine percent of high-cost patients had at least one hospitalisation or surgical procedure. Out of the high-cost patients, 44% had one registered hospitalisation or surgical procedure, 52% had two to four and 4% had five or more. Approximately 30–50% of patients had seen any healthcare personnel delivering conservative treatment other than GPs the year prior to their first hospitalisation/surgical treatment for a non-traumatic MSD. Conclusion: Most healthcare costs were concentrated among a small proportion of patients. In contrast to guidelines and recommendations, less than half had been to a healthcare service focused on conservative management prior to their first hospitalisation or surgical treatment for a non-traumatic MSD. This could indicate that there is room for improvement in management of patients before hospitalisation and surgical treatment, and that ensuring sufficient capacity for conservative care and rehabilitation can be beneficial for reducing overall costs.

• Moger, Tron Anders; Holte, Jon Helgheim; Amundsen, Olav; Haavaag, Silje Bjørnsen; Edvardsen, Anne & Bragstad, Line Kildal [Show all 9 contributors for this article] (2024). Associations between outpatient care and later hospital admissions for patients with chronic obstructive pulmonary disease - a registry study from Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-10975-4. Full text in Research Archive Show summary

  Background Although chronic obstructive pulmonary disease (COPD) admissions put a substantial burden on hospitals, most of the patients’ contacts with health services are in outpatient care. Traditionally, outpatient care has been difficult to capture in population-based samples. In this study we describe outpatient service use in COPD patients and assess associations between outpatient care (contact frequency and specific factors) and next-year COPD hospital admissions or 90-day readmissions. Methods Patients over 40 years of age residing in Oslo or Trondheim at the time of contact in the period 2009–2018 were identified from the Norwegian Patient Registry (in- and outpatient hospital contacts, rehabilitation) and the KUHR registry (contacts with GPs, contract specialists and physiotherapists). These were linked to the Regular General Practitioner registry (characteristics of the GP practice), long-term care data (home and institutional care, need for assistance), socioeconomic and–demographic data from Statistics Norway and the Cause of Death registry. Negative binomial models were applied to study associations between combinations of outpatient care, specific care factors and next-year COPD hospital admissions and 90-day readmissions. The sample consisted of 24,074 individuals. Results A large variation in the frequency and combination of outpatient service use for respiratory diagnoses (GP, emergency room, physiotherapy, contract specialist and outpatient hospital contacts) was apparent. GP and outpatient hospital contact frequency were strongly associated to an increased number of next-year hospital admissions (1.2–3.2 times higher by increasing GP frequency when no outpatient hospital contacts, 2.4-5 times higher in combination with outpatient hospital contacts). Adjusted for healthcare use, comorbidities and sociodemographics, outpatient care factors associated with lower numbers of next-year hospitalisations were fees indicating interaction between providers (7% reduction), spirometry with GP or specialist (7%), continuity of care with GP (15%), and GP follow-up (8%) or rehabilitation (18%) within 30 days vs. later following any current year hospitalisations. For 90-day readmissions results were less evident, and most variables were non-significant. Conclusion As increased use of outpatient care was strongly associated with future hospitalisations, this further stresses the need for good communication between providers when coordinating care for COPD patients. The results indicated possible benefits of care continuity within and interaction between providers.

• Hassan, Hero Ibrahim; Ansteinsson, Vibeke Elise; Dalbak, Ellen Thea Gjelseth; Skudutyte-Rysstad, Rasa; Hellesø, Ragnhild & Mdala, Ibrahimu [Show all 7 contributors for this article] (2024). Oral healthcare beliefs among home care services personnel; a cross-sectional study in south-eastern Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11534-7. Full text in Research Archive Show summary

  Background There is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs? Methods A cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data. Results Two hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn’t positive. Conclusion In the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare.

• Sockolow, Paulina S.; Børøsund, Elin & Hellesø, Ragnhild (2024). Artificial Intelligence in Nursing: Perspectives from Norwegian Nurses. Studies in Health Technology and Informatics. ISSN 0926-9630. 315, p. 217–222. doi: 10.3233/SHTI240139. Full text in Research Archive Show summary

  Nurses continue to face challenges in leading health information technology innovations such as Artificial Intelligence (AI). There is an acknowledged need to explore the attitude of nurses towards AI and nurses’ acceptance of AI in clinical settings. We sought to address this gap in knowledge about the perceptions of AI by nursing-related professionals in their work and as a content area in the education of nursing students. Norwegian nurses and healthcare personnel interested in the topic met in a seminar in Oslo in 2023 to explore their perspectives on AI. Following a lecture on AI, audience members offered their insights in a recorded discussion. Data analysis consisted of inductive coding of concepts in the transcribed recording. Three major themes emerged: Expectations, Identified needs and related recommendations; and Policy to guard safety; as well as recommendations new to the literature.

• Sulosaari, Virpi; Blaževičienė, Aurelija; Bragadottir, Helga; Backstrom, Josefin; Johanna, Heikkila & Hellesø, Ragnhild [Show all 10 contributors for this article] (2023). A comparative review of advanced practice nurse programmes in the Nordic and Baltic countries. Nurse Education Today. ISSN 0260-6917. 127. doi: 10.1016/j.nedt.2023.105847. Full text in Research Archive Show summary

  Background Advanced practice nurses (APNs) programs are career-development opportunities significant for nursing workforce retention as well as for the quality of patient care. Inconsistency regarding policy, education, titles, scope of practice, skills and competencies have been identified as major challenges in developing advanced practice nursing in Europe. APN roles and education are under development in the Nordic and Baltic countries. However, there is a lack of information on the current state in this region. Objective The purpose of this paper is to compare APN programs in the Nordic and Baltic countries to identify their commonalities and differences. Design and methods This descriptive comparative study reviewed seven master's level APN programs in six Nordic and Baltic countries. Data was extracted from the programme by the expert teachers or leaders of the programmes (N = 9). Competencies recommended in the European Tuning Project (ETP) and the International Council of Nurses (ICN) guidelines on advanced practice nursing, were used to evaluate the programs. The same informants provided additional information on the current state of APN education in the country. Results The admission requirements were similar in the six countries but in two, clinical work experience is an entry requirement. There are two commonly identified APN roles: clinical nurse specialist (CNS) and nurse practitioner (NP). Most of the programs included all the EPT and ICN competencies. The main differences regarded prescribing competencies. All programmes included clinical training, but the methods on how it is implemented varies. Conclusion The findings indicate that APN programs in the Nordic and Baltic countries correspond with the recommendations of the European Tuning Project and ICN guidelines. This is an important message for administrators, policymakers, and politicians, as well as the nursing community, on providing opportunities for APNs to practice to their full potential within each country as well as cross-country.

• Amundsen, Olav; Moger, Tron Anders; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen; Bragstad, Line Kildal & Hellesø, Ragnhild [Show all 8 contributors for this article] (2023). Combination of health care service use and the relation to demographic and socioeconomic factors for patients with musculoskeletal disorders: a descriptive cohort study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09852-3. Full text in Research Archive Show summary

  Background Patients with musculoskeletal disorders (MSDs) access health care in different ways. Despite the high prevalence and significant costs, we know little about the different ways patients use health care. We aim to fill this gap by identifying which combinations of health care services patients use for new MSDs, and its relation to clinical characteristics, demographic and socioeconomic factors, long-term use and costs, and discuss what the implications of this variation are. Methods The study combines Norwegian registers on health care use, diagnoses, comorbidities, demographic and socioeconomic factors. Patients (≥ 18 years) are included by their first health consultation for MSD in 2013–2015. Latent class analysis (LCA) with count data of first year consultations for General Practitioners (GPs), hospital consultants, physiotherapists and chiropractors are used to identify combinations of health care use. Long-term high-cost patients are defined as total cost year 1–5 above 95th percentile (≥ 3 744€). Results We identified seven latent classes: 1: GP, low use; 2: GP, high use; 3: GP and hospital; 4: GP and physiotherapy, low use; 5: GP, hospital and physiotherapy, high use; 6: Chiropractor, low use; 7: GP and chiropractor, high use. Median first year health care contacts varied between classes from 1–30 and costs from 20€-838€. Eighty-seven percent belonged to class 1, 4 or 6, characterised by few consultations and treatment in primary care. Classes with high first year use were characterised by higher age, lower education and more comorbidities and were overrepresented among the long-term high-cost users. Conclusion There was a large variation in first year health care service use, and we identified seven latent classes based on frequency of consultations. A small proportion of patients accounted for a high proportion of total resource use. This can indicate the potential for more efficient resource use. However, the effect of demographic and socioeconomic variables for determining combinations of service use can be interpreted as the health care system transforming unobserved patient needs into variations in use. These findings contribute to the understanding of clinical pathways and can help in the planning of future care, reduction in disparities and improvement in health outcomes for patients with MSDs.

• Rostad, Hanne Marie; Skinner, Marianne Sundlisæter; Wentzel-Larsen, Tore; Hellesø, Ragnhild & Sogstad, Maren Kristine Raknes (2023). Modes and models of care delivery in municipal long-term care services: a cross-sectional study from Norway. BMC Health Services Research. 23. doi: 10.1186/s12913-023-09750-8. Full text in Research Archive Show summary

  Background Numerous forces drive the evolution and need for transformation of long-term care services. Decision-makers across the globe are searching for models to redesign long-term care to become more responsive to changing health and care needs. Yet, knowledge of different care models unfolding in the long-term care service landscape is limited. The objective of this article is twofold: 1) to identify and characterise models of care in Norwegian municipal long-term care services based on four different modes of service delivery: Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity, and 2) to analyse whether the identified care models vary with regard to municipal characteristics, more specifically ‘population size’ and ‘income’. Methods We adopted a cross-sectional approach and used data from a web-based survey conducted in 2019 to identify and characterize models of care in Norwegian long-term care services, based on four modes of service delivery. The questionnaire was developed through a comprehensive review of national healthcare policy documents and previous research and amended in collaboration with a user panel. A set of questions from the questionnaire were used to create four modes of service delivery. Hierarchical cluster analysis was used to cluster the municipalities based on the mean scores of the modes to identify care models. Results In total, 277 municipalities (response rate 66%) completed the survey. The four modes made it possible to identify four care models that differ on the level of Specialised municipal services, Assistive technology, Planning and coordination, and Health Promotion and Activity. Additionally, the models differed regarding municipal population size (p < 0.001) and income (p = 0.006). Conclusions We put forward a theoretical description of the variety of ways long-term care services are provided, offering a way of simplifying complex information which can assist care providers and policymakers in analysing and monitoring their own service provision and making informed decisions. This is important to the development of services for current and future care needs.

• Moger, Tron Anders; Amundsen, Olav; Tjerbo, Trond; Hellesø, Ragnhild; Holte, Jon Helgheim & Vøllestad, Nina Køpke (2023). Innovations in use of registry data (INOREG) - Design of a registry-based study analyzing care pathways and outcomes for chronic patients. Nordic Journal of Health Economics. ISSN 1892-9729. 6(1), p. 129–146. doi: 10.5617/njhe.10097. Full text in Research Archive Show summary

  In recent years there have been several political initiatives in Norway, requiring more research into how multimorbidity and health care pathways in the municipality affect outcomes such as work participation, hospital admissions, disability and quality of life for patients with chronic diseases. Most of the care is provided outside hospitals and has been difficult to capture in large, registry-based studies. Focusing on two important groups, patients with chronic obstructive pulmonary disease (COPD) and musculoskeletal disorders (MSD), the INOREG project aims to reduce these knowledge gaps. In the paper we present 1) the data that are used in the project, 2) the construction of samples, variables and possible methods for analysis and 3) an example on how the data and methods will be applied. The project database is constructed from a novel linkage of national health and welfare registries. The data cover social, primary and specialized care for all COPD and MSD patients in Norway, long-term care data from Oslo and Trondheim municipalities and functioning and quality of life for ca. 2,700 patients treated at physiotherapy clinics in the FYSIOPRIM project. This enables construction of care pathways and outcomes at the individual level from 2008 through 2019. The project will fill knowledge gaps regarding the patterns of care at different levels in the health care system, and the association to outcomes for chronic patient groups. If the project is successful, it will provide improved insight on how to further develop provision and coordination of services to the decision makers, and ideally reduce inequalities in health.

• Mondahl, Julie; Hellesø, Ragnhild; Thomsen, Thora Grothe; Preben, Homøe; Emilie, Rosted Elizabeth & Kirsten, Frederiksen (2023). Obstacles for patients with a low socio-economic status treated within the head and neck cancer pathway: A multiple case study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. p. 1–14. doi: 10.1111/jocn.16691. Full text in Research Archive
• Rostad, Hanne Marie; Burrell, Lisa Victoria; Skinner, Marianne Sundlisæter; Hellesø, Ragnhild & Sogstad, Maren Kristine Raknes (2023). Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway. Health Services Insights (HSI Journal). 16. doi: 10.1177/11786329231185537. Full text in Research Archive Show summary

  The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers’ day-to-day practice.

• Henni, Silje Havrevold; Ansteinsson, Vibeke Elise; Mamykina, Lena; Hovden, Ewa Alicja Szyszko; Hove, Lene Hystad & Hellesø, Ragnhild (2023). Factors influencing home health care providers' performance of oral health care for older people: A qualitative study. International Journal of Older People Nursing. ISSN 1748-3735. p. 1–10. doi: 10.1111/opn.12561. Full text in Research Archive Show summary

  Aim To examine factors that affect the performance of oral health care (OHC) for older people receiving nursing care at home. Background Oral health is often neglected by health care providers caring for older people. Research shows that health care providers' provision of OHC may be influenced by various factors (barriers and facilitators). When this research was conducted, health care providers from home healthcare services (HHCS) and nursing homes were grouped together despite setting differences; therefore, this study focuses on the performance of OHC by home health care providers (HHCPs) as a single group. Design Explorative design with a qualitative approach. Methods The managers of four HHCS units recruited 17 HHCPs to participate in focus group interviews. One interview was conducted per unit, and there were four to five participants in each interview. The analysis of interviews was based on theoretical thematic analysis and the PRECEDE constructs in the PRECEDE–PROCEED model. Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines were used in reporting this study. Findings The analysis resulted in two themes with predisposing factors (HHCPs' professional responsibilities, older people's attitude), five themes with enabling factors (knowledge and skills, older people/carer trust, available time, available equipment and collaboration with public dental service (PDS)), and two themes with reinforcing factors (routines and OHC focus on the workplace) that affect the provision of OHC. The factors were categorised as individual, organisational and collaboration factors. Conclusions In addition to individual factors found in previous studies, factors related to the organisation of services and communication between HHCPs and PDS seem to affect HHCPs' provision of OHC for adults receiving HHCS. Implications for Practice This study provides in-depth knowledge that can contribute to increasing HHCPs' provision of OHC and thereby prevent oral and dental disease among older people receiving HHCS.

• Janson, Astri Letnes; Opheim, Randi & Hellesø, Ragnhild (2023). Advanced practice nurse education in its infancy: an exploratory study of Norwegian higher education institutions’ program descriptions. Scandinavian Journal of Educational Research. ISSN 0031-3831. doi: 10.1080/00313831.2023.2185810. Full text in Research Archive
• Mondahl, Julie; Hellesø, Ragnhild; Thomsen, Thora Grothe; Homøe, Preben & Frederiksen, Kirsten (2023). A support nurse may strengthen the participation of patients with low socio-economic status in treatment pathways of head and neck cancer: A theory-based evaluation. Journal of Advanced Nursing. ISSN 0309-2402. p. 1-13–1-13. doi: 10.1111/jan.15816. Full text in Research Archive Show summary

  Abstract Aim: To test and evaluate a support nurse intervention within the head and neck cancer (HNC) pathway. Background: Even though interventions aiming to support patients with a low socioeconomic status have been a focus for development and implementation in several countries, research still shows that these patients often have unmet needs and encounter challenges in communicating with health professionals during their treatment pathways. Furthermore, support interventions are few in Denmark and none of the existing interventions target patients with HNC receiving radiation therapy of whom the majority have a low socio-economic status and therefore potentially carry a high risk of being challenged during their treatment pathways. Design: A theory-based evaluation was used as framework. A support nurse intervention was designed to offer patients with a low socio-economic status help and support in the initial part of the HNC pathway. Eleven patients were included in the trial period. Methods: The evaluation of the intervention was based on interviews, a questionnaire survey and field notes. Results: The expected outputs were achieved, thus: (1) the patients felt supported and assisted, (2) the support nurse was capable of supporting, helping and accompanying the patients, (3) the patients were informed as relevant and understood the information provided. Unexpected outputs were that the support nurse was capable of co-ordinating the pathway in line with the patient's needs and that she facilitated the interaction between patients and health professionals. Conclusions: Support for patients with a low socio-economic status improves their ability to engage in their cancer treatment pathway. This, in turn, increases their preparedness for participation and, hence, strengthens their choice of treatment. Reporting method: This study is reported using consolidated guideline for reporting interventions Template for intervention description and replication (TIDieR checklist). We used theory-based evaluation as described by Peter Dahler-Larsen.

• Kvæl, Linda Aimee Hartford; Hellesø, Ragnhild; Bergland, Astrid & Debesay, Jonas (2022). Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals. BMC Health Services Research. 22(22), p. 1–17. doi: 10.1186/s12913-022-07823-8. Full text in Research Archive Show summary

  Background Transitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals’ experiences of challenges to achieving high-quality transitional care. Methods We used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles. Results The analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus “What Matters to You”, and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care. Conclusions There is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients’ individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.

• Henni, Silje Havrevold; Skudutyte-Rysstad, Rasa; Ansteinsson, Vibeke Elise; Hellesø, Ragnhild & Hovden, Ewa Alicja Szyszko (2022). Oral health and oral health-related quality of life among older adults receiving home health care services: A scoping review. Gerodontology. ISSN 0734-0664. doi: 10.1111/ger.12649. Full text in Research Archive Show summary

  Objective To map the literature on subjective and objective oral health indicators and oral health-related quality of life (OHRQoL) in older adults receiving home health care services (HHCS). Background The proportion of older adults in need of HHCS will increase in the coming years. Previous studies indicate that frail and dependent older adults are at increased risk for oral diseases, due to challenges with daily oral hygiene and regular access to dental services. Materials and methods Four databases were searched in November 2020 for relevant literature. Search terms included a comprehensive list of terms for adults 65 years or older receiving HHCS, clinical and subjective oral health indicators, and OHRQoL. The literature was reviewed based on inclusion and exclusion criteria. Results Of the 3114 sources identified, 18 were included. Data on oral diseases and symptoms among older adults receiving HHCS were limited and heterogeneous. Overall, older adults often lacked some of their natural teeth and often had removable dentures that needed repair. In addition, plaque, caries, xerostomia, and chewing and swallowing problems were common among the population group. Data on OHRQoL were scarce and indicated a positive association with a higher number of present teeth, while decayed teeth, root remnants, and dry mouth had substantial negative impacts on the daily activities of older adults receiving HHCS. Conclusion This scoping review show that older adults above 65 years receiving HHCS generally have poor oral health status and that there is a knowledge gap regarding their OHRQoL.

• Kumlin, Marianne; Berg, Geir Vegard; Kvigne, Kari Johanne & Hellesø, Ragnhild (2022). Dilemmas and deliberations in managing the care trajectory of elderly patients with complex health needs: a single-case study. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08422-3. Full text in Research Archive Show summary

  Today, the ageing population is larger than ever before, and people who are living longer with chronic illnesses and multimorbidity need support from multiple healthcare service levels. Similarly, healthcare systems are becoming increasingly specialised and fragmented. The World Health Organization has highlighted novel policies for developing integrated and person-centred services. However, patients, next of kin and health professionals face several challenges in managing healthcare during the care trajectory. Limited literature has addressed the challenges experienced by these groups. Therefore, this study aimed to identify the dilemmas and deliberations faced by patients, next of kin and health professionals during the care trajectory of elderly patients with complex healthcare needs.

• Aamodt, Ina Thon; Lie, Irene; Lycholip, Edita; Strömberg, Anna; Jaarsma, Tiny & Celutkiené, Jelena [Show all 7 contributors for this article] (2022). Informal Caregivers’ Experiences with Performing Telemonitoring in Heart Failure Care at Home—A Qualitative Study. Healthcare. 10(7). doi: 10.3390/healthcare10071237. Full text in Research Archive Show summary

  Informal caregivers have an important role in caring for family members at home. Supporting persons with a chronic illness such as heart failure (HF) in managing their self-care is reported to be a challenge and telemonitoring has been suggested to be of support. Aim: to explore informal caregivers’ experiences with performing non-invasive telemonitoring to support persons with HF at home for 30 days following hospital discharge in Norway and Lithuania. Methods: A qualitative explorative study of informal caregivers performing non-invasive telemonitoring using lung-impedance measurements and short message service (SMS). Data was collected using semi-structured interviews with informal caregivers of persons with HF in NYHA class III-IV in Norway and Lithuania. Results: Nine interviews were conducted with informal caregivers of persons with HF who performed non-invasive telemonitoring at home. A sequential process of three categories emerged from the data: access to support, towards routinizing, and mastering non-invasive telemonitoring. Conclusion: Informal caregivers performed non-invasive telemonitoring for the first time in this study. Their experiences were of a sequential process that included access to support from health care professionals, establishing a routine together, and access to nurses or physicians in HF care as part of mastering. This study highlights involving informal caregivers and persons with HF together in the implementation and future research of telemonitoring in HF care.

• Germossa, Gugsa Nemera; Sjetne, Ingeborg Strømseng; Småstuen, Milada Cvancarova & Hellesø, Ragnhild (2022). Patient Satisfaction With a Nurse-Led Pain Management Program: A Quasi-Experimental Study in Ethiopia. Sage Open Nursing. 8, p. 1–11. doi: 10.1177/23779608221141237. Full text in Research Archive Show summary

  Introduction Patient satisfaction is one of the important indicators of quality care. Objective To examine patient ratings of pain management satisfaction before and after introducing a nurse-led management program. Methods A quasi-experimental design with three cross-sectional surveys between October 1, 2016 and June 15, 2017. A total of 845 patients admitted to the four inpatient departments (medicine, surgery, maternity, and gynecology) of Jimma University Medical Centre were invited to participate in the study. A questionnaire adapted from the American Pain Society Patient Outcome Questionnaire, Pain Treatment Satisfaction Scale, and related literature was used for the survey. Data were analyzed using the chi-square test (categorical variables), t-tests for continuous variables, and robust regression to determine the effect of nurse-led management program on patient satisfaction. For all tests, p-values &lt;.05 were considered statistically significant. Results Of the 845 patients invited, 782 (92.5%) participated in the surveys—Survey 1: N = 256; Survey 2: N = 259; Survey 3: N = 267. The proportion of patients who perceived that staff responded within 30 min increased from 67.8% in Survey 1 to 71.1% in Survey 2 and 74.2% in Survey 3. On a scale of 1 to 5 (1 = strongly dissatisfied and 5 = strongly satisfied), the overall mean patient satisfaction with pain management was 3.61 (SD 0.80) in Survey 1, 3.81 (SD 0.86) in Survey 2, and 4.10 (SD 0.64) in Survey 3. Moreover, the patients scored significantly higher on all satisfaction items in Survey 2 (B ranged between 0.12 and 0.41) and Survey 3 (B ranged between 0.24 and 0.74) compared to Survey 1. Conclusion The patients’ ratings of their satisfaction and staff nurse responsiveness following the nurse-led pain management program have increased compared to the levels before the intervention. However, further studies, including those with a control group, are warranted to confirm the results.

• Mondahl, Julie; Thomsen, Thora Grothe; Hellesø, Ragnhild & Frederiksen, Kirsten (2022). A critical discourse analysis of the influence of organisational structures on inequality in head and neck cancer treatment in Denmark. Scandinavian Journal of Caring Sciences. ISSN 0283-9318. doi: 10.1111/scs.13122. Full text in Research Archive
• Østensen, Elisabeth; Hardiker, Nicholas R. & Hellesø, Ragnhild (2021). Facilitating the Implementation of Standardized Care Plans in Municipal Healthcare. Computers, Informatics, Nursing. ISSN 1538-2931. doi: 10.1097/CIN.0000000000000798. Full text in Research Archive Show summary

  Standardized care plans have the potential to enhance the quality of nursing records in terms of content and completeness, thereby better supporting workflow, easing the documentation process, facilitating continuity of care, and permitting systematic data gathering to build evidence from practice. Despite these potential benefits, there may be challenges associated with the successful adoption and use of standardized care plans in municipal healthcare information practices. Using a participatory approach, two workshops were conducted with nurses and nursing leaders (n = 11) in two Norwegian municipalities, with the objective of identifying success criteria for the adoption and integration of standardized care plans into practice. Three themes were found to describe the identified success criteria: (1) “facilitating system level support for nurses' workflow”; (2) “engaged individuals creating a culture for using standardized care plans”; and (3) “developing system level safety nets.” The findings suggest success criteria that could be useful to address to facilitate the integration of standardized care plans in municipal healthcare information practice and provide useful knowledge for those working with implementation and further development of standardized care plans.

• Kumlin, Marianne; Berg, Geir Vegard; Kvigne, Kari Johanne & Hellesø, Ragnhild (2021). Unpacking Healthcare Professionals’ Work to Achieve Coherence in the Healthcare Journey of Elderly Patients: An Interview Study. Journal of Multidisciplinary Healthcare. 14. doi: 10.2147/JMDH.S298713. Full text in Research Archive Show summary

  Aim: Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain. Methods: This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed. Results: The analyses revealed three central themes in the healthcare professionals’ work to build coherence in the patients’ care trajectory: Working to manage a patient’s illness trajectory during the course of the patient’s life, working to achieve a comprehensive overall picture, and considering multiple options in a “patchwork” terrain. Conclusion: Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person’s journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient’s life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient’s complex care trajectory. Keywords: older, care trajectory, complex healthcare, health personnel, interdisciplinary

• Sockolow, Paulina S.; Bowels, Kathryn H.; Topaz, Maxim; Koru, Gunes; Hellesø, Ragnhild & O’Connor, Melissa [Show all 7 contributors for this article] (2021). The Time is Now: Informatics Research Opportunities in Home Health Care. Applied Clinical Informatics. ISSN 1869-0327. 12, p. 100–106. doi: 10.1055/s-0040-1722222. Full text in Research Archive
• Hellesø, Ragnhild & Hagen, Terje P. (2021). Samhandlingsreforma- kva fungerte, kva må gjerast vidare? In Botten, Grete Synøve (Eds.), Mangfold og engasjement i ti år. Institutt for helse og samfunn ved Universitetet i Oslo 2010-2020.. Norwegian Medical Society. ISSN 9788292871768. p. 92–98. Full text in Research Archive
• Svensberg, K.; Kalleberg, Birgitte Grøstad; Rosvold, E.O.; Mathiesen, Liv; Wøien, H. & Hove, L.H. [Show all 11 contributors for this article] (2021). Interprofessional education on complex patients in nursing homes: a focus group study. BMC Medical Education. 21(1). doi: 10.1186/s12909-021-02867-6. Full text in Research Archive Show summary

  Background An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describes graduate students’ experiences of working practice based in interprofessional teams with complex patients’ care needs in nursing homes. Method Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data. Results Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified. Conclusions IPE in nursing homes facilitated the students’ scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students’ curricula. This could ensure that IPE is experienced more efficient by the students.

• Gautun, Heidi; Hellesø, Ragnhild & Veenstra, Marijke (2021). The association between hospital nurses’ perspectives on their information practices and quality of care transitions in older patients: A nation-wide cross-sectional study. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 7(2), p. 85–96. doi: 10.18261/issn.2387-5984-2021-02-07. Full text in Research Archive Show summary

  Background: The main aim of the current study is to provide updated knowledge on hospital nurses’ assessments of quality of care transitions in older patients in Norway. A secondary aim is to analyse to what extent these assessments are associated with perceived information practices. Methods: Nation-wide cross-sectional web-based survey conducted in 2017 including hospital nurses involved in the discharge of older (≥ 65 years) patients (N=1,785). Four items were used to measure different aspects of quality of transitional care in older patients. Information practices were operationalised as Medical information; Follow-up Information, Cross-sectoral contact. Analyses of variance (ANOVA) were used to analyse associations. Results: Seven out of ten respondents perceived that the older patient feels safe in the transition. Six out of ten respondents perceived that the patient was well informed about the availability of community services, and six out of ten perceived that the patient was well informed about the timing of discharge. Only a little over half of the nurses agreed or strongly agreed with the statement that the patient knows where to turn in case of complications. More positive assessments of quality of care transitions were associated with better perceived information practice (i.e. Follow-up) Almost 50 % of the nurses wanted more contact with community nurses. A stronger perceived need for more contact was negatively associated with all four aspects of quality of care transitions. Conclusion: Our findings suggest a need for more telephone contact and face to face contact over and above the digital/electronic contacts between hospital- and community care nurses to improve quality of care transitions in older patients.

• Aamodt, Ina Thon; Lycholip, Edita; Celutkiené, Jelena; Lueder, Thomas Gero von; Atar, Dan & Falk, Ragnhild Sørum [Show all 10 contributors for this article] (2020). Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 22. doi: 10.2196/15445. Full text in Research Archive Show summary

  Background Self-care is key to the daily management of chronic heart failure (HF). After discharge from hospital, patients may struggle to recognize and respond to worsening HF symptoms. Failure to monitor and respond to HF symptoms may lead to unnecessary hospitalizations. Objective This study aimed to (1) determine the feasibility of lung impedance measurements and a symptom diary to monitor HF symptoms daily at home for 30 days following hospital discharge and (2) determine daily changes in HF symptoms of pulmonary edema, lung impedance measurements, and if self-care behavior improves over time when patients use these self-care monitoring tools. Methods This study used a prospective longitudinal design including patients from cardiology wards in 2 university hospitals—one in Norway and one in Lithuania. Data on HF symptoms and pulmonary edema were collected from 10 participants (mean age 64.5 years; 90% (9/10) male) with severe HF (New York Heart Association classes III and IV) who were discharged home after being hospitalized for an HF condition. HF symptoms were self-reported using the Memorial Symptom Assessment Scale for Heart Failure. Pulmonary edema was measured by participants using a noninvasive lung impedance monitor, the CardioSet Edema Guard Monitor. Informal caregivers aided the participants with the noninvasive measurements. Results The prevalence and burden of shortness of breath varied from participants experiencing them daily to never, whereas lung impedance measurements varied for individual participants and the group participants, as a whole. Self-care behavior score improved significantly (P=.007) from a median of 56 (IQR range 22-75) at discharge to a median of 81 (IQR range 72-98) 30 days later. Conclusions Noninvasive measurement of lung impedance daily and the use of a symptom diary were feasible at home for 30 days in HF patients. Self-care behavior significantly improved after 30 days of using a symptom diary and measuring lung impedance at home. Further research is needed to determine if daily self-care monitoring of HF signs and symptoms, combined with daily lung impedance measurements, may reduce hospital readmissions.

• Aamodt, Ina Thon; Strømberg, Anna; Hellesø, Ragnhild; Jaarsma, Tiny & Lie, Irene (2020). Tools to support self-care monitoring at home: Perspectives of patients with heart failure. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 17(23). doi: 10.3390/ijerph17238916. Full text in Research Archive Show summary

  Abstract: Self-care monitoring at home can be a challenge for patients with heart failure (HF). Tools that leverage information and communication technology (ICT), comprise medical devices, or have written material may support their efforts at home. The aim of this study was to describe HF patients’ experiences and their prioritization of tools that support, or could support, self-care monitoring at home. A descriptive qualitative design employing semi-structured interviews was used with HF patients living at home and attending an HF outpatient clinic in Norway. We used a deductive analysis approach, using the concept of self-care monitoring with ICT tools, paper-based tools, medical devices, and tools to consult with healthcare professionals (HCPs) as the categorization matrix. Nineteen HF patients with a mean age of 64 years participated. ICT tools are used by individual participants to identify changes in their HF symptoms, but are not available by healthcare services. Paper-based tools, medical devices, and face-to-face consultation with healthcare professionals are traditional tools that are available and used by individual participants. HF patients use traditional and ICT tools to support recognizing, identifying, and responding to HF symptoms at home, suggesting that they could be used if they are available and supplemented by in-person consultation with HCPs.

• Østensen, Elisabeth; Hardiker, Nicholas R.; Bragstad, Line Kildal & Hellesø, Ragnhild (2020). Introducing standardised care plans as a new recording tool in municipal health care. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 29(17-18), p. 3286–3297. doi: 10.1111/jocn.15355. Full text in Research Archive Show summary

  Aims and Objectives: To explore how nurses use standardised care plans as a new recording tool in municipal health care, and to identify their thoughts and opinions. Background: In spite of being an important information source for nurses, care plans have repeatedly been found unsatisfactory. Structuring and coding information through standardised care plans is expected to raise the quality of recorded infor- mation, improve overviews, support evidence-based practice and facilitate data ag- gregation. Previous research on this topic has mostly focused on the hospital setting. There is a lack of knowledge on how standardised care plans are used as a recording tool in the municipal healthcare setting. Design: An exploratory design with a qualitative approach using three qualitative methods of data collection. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Methods: Empirical data were collected in three Norwegian municipalities through participant observation and individual interviews with 17 registered nurses. In addi- tion, we collected nursing records from 20 electronic patient records. Results: Use of standardised care plans was influenced by the nurses' consideration of their benefits. Partial implementation created an opportunity for nonuse. There was no consensus regarding how much information to include, and the standardised care plans could become both short and generic, and long and comprehensive. The themes “balancing between the old and the new care planning system,” “considering the usefulness of standardised care plans as a source of information” and “balancing between overview and detail” reflect these findings. Conclusions: Nurses' use of standardised care plans was influenced by the plans' par- tial implementation, their views on usefulness and their personal views on the detail required in a care plan. Relevance to Clinical Practice: The structuring of nursing records is a fast-growing trend in health care. This study gives valuable information for those attempting to implement such structures in municipal health care.

• Kumlin, Marianne; Berg, Geir Vegard; Kvigne, Kari Johanne & Hellesø, Ragnhild (2020). Elderly patients with complex health problems in the care trajectory: A qualitative case study. BMC Health Services Research. 20. doi: 10.1186/s12913-020-05437-6. Full text in Research Archive Show summary

  Background Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients’ perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved. Methods The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65–91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients’ hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken. Results Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory. Conclusions The patients’ considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient’s pace in the decision-making process may lead to a more appropriate level of health care in line with the patient’s preferences and goals.

• Rostad, Hanne Marie; Skinner, Marianne Sundlisæter; Hellesø, Ragnhild & Sogstad, Maren Kristine Raknes (2020). Towards specialised and differentiated long-term care services: a cross-sectional study. BMC Health Services Research. 20(793). doi: 10.1186/s12913-020-05647-y. Full text in Research Archive Show summary

  Background Numerous forces drive the evolution and need for transformation of long-term care services. During the previous decade, primary health care has assumed increased responsibility for developing and providing care services, but there is still limited knowledge about how European care service systems are evolving to address new tasks and patients. Based on data from Norwegian municipalities, this study aims to (1) describe the availability of specialised services in Norwegian nursing homes and home care services and (2) analyse whether structural factors, like population size and/or centrality, are associated with the availability of specialised services in nursing homes and home care. Methods This is a cross-sectional study of survey data. An online survey was designed specifically for this study. Its questions were developed from a comprehensive review of the literature and in partnership with a user panel. One representative from all of Norway’s 422 municipalities were invited to answer the survey from February to April 2019. In total, 277 municipalities completed the survey (response rate 66%). Chi-square analysis and Fisher’s exact test were used to test the associations between different categorical variables. Results Specialised care services were highly prevalent. For example, there were nursing home units specialising in dementia care (89%) and rehabilitation (81%) and home care teams for dementia care (79%) and reablement (76%). Approximately two-thirds of our sample were categorised as having high availability of specialisation in nursing home and home care services. The larger, more central municipalities had higher availability of specialisation compared to medium-sized and small, less central municipalities. Conclusions Our study indicates that a majority of nursing homes and home care services provide specialised and differentiated services that serve patient groups of different ages and diagnoses. Municipalities’ population size and centrality are associated with availability of specialised services in nursing homes and home care services.

• Sogstad, Maren Kristine Raknes; Hellesø, Ragnhild & Skinner, Marianne Sundlisæter (2020). The Development of a New Care Service Landscape in Norway. Health Services Insights (HSI Journal). 13. doi: 10.1177/1178632920922221. Full text in Research Archive Show summary

  Demographic changes, as well as the transfer of medical and caring tasks from specialist to primary care in Norwegian municipali- ties, have led to changes in care service delivery. So far, we have limited knowledge of how this affects the design of the care services. Based on a semi-structured questionnaire survey, this article presents the development of a new care service landscape in Norway, where municipalities increasingly set up specialized care services for different patient groups and their care needs. This leads to a continuum of care service models from a generalist approach to highly specialized care services. Larger municipalities typically have a higher degree of specialization, indicating that volume is an important prerequisite for specialization. Similarly, a higher degree of specialization corresponds to higher formal competen- cies in the workforce. To understand the development of the services and the impact on care service delivery, further research is required.

• Lycholip, Edita; Palevičiūtė, Eglė; Aamodt, Ina Thon; Hellesø, Ragnhild; Lie, Irene & Strömberg, Anna [Show all 8 contributors for this article] (2019). Non-invasive home lung impedance monitoring in early post-acute heart failure discharge: Three case reports. World Journal of Clinical Cases (WJCC). ISSN 2307-8960. 7(8), p. 951–960. doi: 10.12998/wjcc.v7.i8.951. Full text in Research Archive
• Ore, Stephan; Rosvold, Elin Olaug & Hellesø, Ragnhild (2019). Lessons learned from introducing huddle boards to involve nursing staff in targeted observation and reporting of medication effect in a nursing home. Journal of Multidisciplinary Healthcare. Volume 2019(12), p. 43–50. doi: 10.2147/JMDH.S182872. Full text in Research Archive Show summary

  Background: Medication administration and management in nursing homes can occur during all phases of the medication process. The aim of this study was to investigate if an introduction of a systematic use of huddle board led to an increased amount of documentation in the patient record of observations of effects and side effects following a change in medication. Methods: A three-layer intervention approach combining huddle boards, educating the entire staff in medication observation and documentation, and frequent feedback to the staff about the outcome was applied. A standard was set for the expected reporting. Correlation between expected and actual reporting as an average was calculated and the staff received weekly updates on their observation–reporting results. Results: The huddle board became a hub in providing an overview of the expectations of observations. To visualize the impact of the intervention, use of a run chart gave comprehensive information about the extent to which the expected goal of documentation was reached. Four different organizational steps and one individual action in the last step were taken to improve the observation–reporting. The identifying of the nonreporting nurses and individual staff guidance to these nurses resulted in a significant improvement in observation–reporting. The expected goal of 100% average reporting was achieved 6 months after all wards were included in the improvement project. Conclusion: The combination of huddle boards, educating the entire staff in observation and documentation, and frequent feedback to the staff about the outcome proved to be a useful approach in medication safety work in nursing homes.

• Germossa, Gugsa Nemera; Hellesø, Ragnhild & Sjetne, Ingeborg Strømseng (2019). Hospitalized patients’ pain experience before and after the introduction of a nurse-based pain management programme: a separate sample pre and post study. BMC Nursing. 18. doi: 10.1186/s12912-019-0362-y. Full text in Research Archive Show summary

  Background Many patients suffer from unrelieved pain in hospital settings. Nurses have a pivotal role in pain management. Hence, a nurse-based pain management programme may influence how hospitalized patients experience pain. In this study we investigated hospitalized patients’ experience of pain before and after the introduction of a two-component nurse-based pain management programme. Methods A quasi-experimental design with a separate sample pretest-posttest approach was conducted on a convenience sample of 845 patients (Survey 1: N = 282; Survey 2: N = 283; Survey 3: N = 280) admitted to the four inpatient units (medical, surgical, maternity, and gynecology) of a university medical center. Data were collected at baseline, before the intervention six weeks after pain management education, and finally immediately after four months of rounding using an interviewer-administered questionnaire adopted from a Brief Pain Inventory and the American Pain Society Patient Outcome Questionnaire. Results All the samples had similar sociocultural backgrounds. The proportion of patients who reported average moderate and severe pain intensity in the last 24 h were 68.8% in Survey 1, 72.8% in Survey 2 and then dropped to 48.53% in Survey 3 whereas those who reported moderate and severe pain intensity at the time of interview were 53.9% in Survey 1, 57.1% in Survey 2 and then dropped to 37.1% in Survey 3. The mean pain interference with the physical and emotional function was generally reduced across the surveys after the introduction of the nurse-based pain management programme. These reductions were statistically significant with p < 0.05. Conclusions Though the survey findings must be taken with caution, they demonstrate that the nurse-based pain management programme positively influenced patient-reported pain intensity and functional interference at the university medical center. This shows the potential clinical importance of the programme for hospitalized patients.

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• Hellesø, Ragnhild & Opheim, Randi (2023). Samhandling i helsetenesta - Sjukepleiarens faglege og organisatoriske rolle. Det Norske Samlaget. ISBN 9788234003110. 136 p. Full text in Research Archive
• Hellesø, Ragnhild & Olsen, Rose Mari (2019). Digitalisering i sykepleietjenesten – en arbeidshverdag i endring. Cappelen Damm Akademisk. ISBN 9788202632649. 205 p. Full text in Research Archive Show summary

  Helsetjenesten er inne i en brytningstid hvor betingelser endres og etablerte måter å arbeide på er satt under press. En endring som har betydning for sykepleietjenesten, er den økende digitaliseringen hvor nye informasjonssystemer lever parallelt med papirbaserte og analoge systemer. Vi har i denne boka samlet bidrag fra forskere fra et bredt spekter av fagområder og forskningstradisjoner. Formålet er å tematisere sentrale perspektiver på informasjons- og dokumentasjonsarbeidet i sykepleietjenesten i en tid med økt digitalisering. Det gjør vi ved å sette søkelys på pasientens endrede rolle, sykepleierens journalføring og noen sentrale verktøy som har betydning for kvalitet og samhandling i helsetjenesten.

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• Hellesø, Ragnhild (2026). Pasientens helsetjeneste - pasientsikkerhet og kvalitet del 4. Full text in Research Archive
• Hellesø, Ragnhild (2026). Pasientens helsetjeneste - pasientsikkerhet og kvalitet del 3. Full text in Research Archive
• Hellesø, Ragnhild (2026). Pasientens helsetjeneste - pasientsikkerhet og kvalitet. Full text in Research Archive
• Hellesø, Ragnhild (2026). Pasientens helsetjeneste - pasientsikkerhet og kvalitet. Full text in Research Archive
• Hellesø, Ragnhild (2026). Samhandlingsperspektiv i den komplekse helsetenesta. Full text in Research Archive
• Hellesø, Ragnhild; Hovden, Ewa Alicja Szyszko; Ansteinsson, Vibeke Elise; Melby, Line Kari & Obstfelder, Aud Uhlen (2025). Brukermedvirkning i forskning som kollektivt arbeid i utvikling av komplekse intervensjoner i helsetjenesten. Full text in Research Archive
• Hovden, Ewa Alicja Szyszko; Uhlen-Strand, Marte-Mari; Hellesø, Ragnhild; Skudutyte-Rysstad, Rasa & Ansteinsson, Vibeke Elise (2025). Dental Professionals' Perspectives on Collaboration in Elderly Dental Care. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Amundsen, Olav; Holte, Jon Helgheim & Haavaag, Silje Bjørnsen [Show all 8 contributors for this article] (2025). Bruk av registerdata i analyse av tjenesteforløp for muskelskjelett- og KOLS-pasienter – et sammendrag av INOREG prosjektet. Full text in Research Archive Show summary

  Bakgrunn: Muskel-/skjelettlidelser (MSK) og kronisk obstruktiv lungesykdom (KOLS) representerer to betydelige typer av kroniske sykdommer. I et tverrfaglig forskningsprosjekt ved Institutt for Helse og Samfunn, UiO, som ble introdusert på Helsetjenestekonferansen 2022, har vi analysert tjenesteforløpene for disse pasientgruppene ved hjelp av koblede registerdata. Formål: Beskrive pasientforløpene for de to pasientgruppene, finne faktorer i forløpene assosiert med utfall som sykehusinnleggelser, hjemmetjenester, høy fremtidig tjenestebruk og uførhet. Metode: Kvantitative og kvalitative analyser av pasientforløp. Kvantitative analyser baseres på data fra nasjonale registre, fra registre i pleie- og omsorgstjenestene i Oslo og Trondheim, samt internt fysioterapiregister. Resultater: Flere viktige avvik fra anbefalt oppfølging for pasientgruppene ble oppdaget i analysene. Noen eksempler er at mer enn 50 % av MSK-pasienter fikk kirurgi, uten å ha forsøkt konservativ behandling først, og at mer enn 10 % av KOLS-pasienter ikke mottar oppfølging for luftveisdiagnoser i året før en sykehusinnleggelse med KOLS. Samtidig hadde mange av pasientene med gjentatte KOLS-innleggelser begrenset oppfølging i primærhelsetjenesten i årene etter indeksinnleggelsen. For KOLS-pasienter observerer man videre en sterk økning i fastlegekontakter i året før man mottar hjemmetjenester, som har betydning for å predikere fremtidig tjenestebruk. På den positive siden fant vi at MSK-pasienter med dårlig prognose hadde fire ganger høyere sjanse for å rapportere et godt klinisk utfall dersom de hadde høy bruk av fysioterapi, som videre var assosiert med lavere sjanse for fremtidig uførhet. For pasienter med god/middels prognose var det ingen sammenheng mellom klinisk utfall og høy frekvens av fysioterapi. For KOLS-pasienter fant vi at bruk av samhandlingstakster, kontinuitet i fastlegeoppfølging, og psykososial støtte for særlig sårbare grupper var assosiert med lavere sannsynlighet for fremtidige akutte sykehusinnleggelser for KOLS. Konklusjon: Prosjektet illustrerer mulighetene ved bruk av administrative helseregisterdata. Samtidig finnes det flere begrensninger dersom man ikke har data på tvers av tjenestene, mer detaljerte kliniske data, samt pasientrapporterte utfallsmål

• Moger, Tron Anders; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim; Haavaag, Silje Bjørnsen & Bragstad, Line Kildal [Show all 8 contributors for this article] (2025). INOREG workshop, perspective paper. Full text in Research Archive
• Moger, Tron Anders; Haavaag, Silje Bjørnsen; Vøllestad, Nina Køpke; Tjerbo, Trond; Holte, Jon Helgheim & Hellesø, Ragnhild [Show all 8 contributors for this article] (2025). INOREG workshop 2025. Full text in Research Archive
• Stokke, Randi; Tingvold, Laila; Obstfelder, Aud Uhlen & Hellesø, Ragnhild (2024). Long-term care in Norway. Allocation of long term care services. Full text in Research Archive
• Obstfelder, Aud Uhlen; Allen, Davina; Melby, Line Kari; Hellesø, Ragnhild & Holden, Ewa Szyszko (2024). Learning by doing - collaboration between researchers and stakeholders in developing an integrated oral health model for older people with frailty. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild; Bragstad, Line Kildal & Holte, Jon Helgheim [Show all 8 contributors for this article] (2024). INOREG workshop 2024. Full text in Research Archive
• Ansteinsson, Vibeke Elise & Hellesø, Ragnhild (2024). Ivaretakelse av munnhelse i hjemmesykepleien er en arena for etiske dilemmaer. Full text in Research Archive
• Hellesø, Ragnhild; Henni, Silje Havrevold; Ansteinsson, Vibeke Elise & Hovden, Ewa Alicja Szyszko (2024). Det må være noen andres ansvar – oss og dem – om samhandling mellom hjemmetjenesten og tannhelsetjenesten. Full text in Research Archive
• Kirkevold, Marit; Blix, Bodil Hansen; Graue, Marit; Bragstad, Line Kildal; Hellesø, Ragnhild & Brinchmann, Berit Støre [Show all 8 contributors for this article] (2024). Nye forskningsmidler fordrer tilpasset forskningskompetanse. Full text in Research Archive
• Amundsen, Olav; Moger, Tron Anders; Vøllestad, Nina Køpke; Tjerbo, Trond; Hellesø, Ragnhild & Bragstad, Line Kildal [Show all 8 contributors for this article] (2023). INOREG workshop 2023. Full text in Research Archive
• Henni, Silje Havrevold; Hovden, Ewa Alicja Szyszko; Ansteinsson, Vibeke Elise; Korzeniewska, Lubomiła & Hellesø, Ragnhild (2023). Co-creating a novel practice model for connecting oral health- and home health care services – The importance of the users’ experiences. Full text in Research Archive
• Ansteinsson, Vibeke Elise; Skudutyte-Rysstad, Rasa & Hellesø, Ragnhild (2023). Munnhelse - et forsømt samhandlingslandskap. Full text in Research Archive
• Janson, Astri Letnes; Opheim, Randi & Hellesø, Ragnhild (2023). Applying document analysis in nursing research – possibilities for understanding advanced practice nurse education. Full text in Research Archive
• Hellesø, Ragnhild (2023). Uten mat og drikke... God munnhelse og ernæring er grunnleggende behov, hvordan kan det ivaretas. Full text in Research Archive
• Korzeniewska, Lubomiła; Henni, Silje Havrevold; Hovden, Ewa Alicja Szyszko; Ansteinsson, Vibeke Elise & Hellesø, Ragnhild (2023). Involvering av ulike brukergrupper i utvikling av en helsetjenesteintervensjon. Erfaringer fra forskningsprosjektet Samhandling for bedre tannhelsetjeneste til hjemmeboende pasienter. Full text in Research Archive
• Ansteinsson, Vibeke Elise; Korzeniewska, Lubomiła; Hovden, Ewa Alicja Szyszko; Henni, Silje Havrevold & Hellesø, Ragnhild (2023). Det må være noen andres ansvar - om samhandling mellom hjemmetjenesten og tannhelsetjenesten. Full text in Research Archive
• Hassan, Hero Ibrahim; Ansteinsson, Vibeke Elise; Skudutyte-Rysstad, Rasa; Hellesø, Ragnhild & Hovden, Ewa Alicja Szyszko (2022). Oral healthcare related beliefs among personnel working in home care services in Norway. Full text in Research Archive
• Ansteinsson, Vibeke Elise; Hellesø, Ragnhild; Henni, Silje Havrevold & Hovden, Ewa Alicja Szyszko (2022). The dental service and home-care services , two disintegrated services – us and them. Full text in Research Archive
• Moger, Tron Anders; Vøllestad, Nina Køpke; Hellesø, Ragnhild; Tjerbo, Trond; Holte, Jon Helgheim & Amundsen, Olav (2022). INOREG workshop 2022. Full text in Research Archive
• Rostad, Hanne Marie; Skinner, Marianne Sundlisæter; Wentzel-Larsen, Tore; Hellesø, Ragnhild & Sogstad, Maren Kristine Raknes (2022). Models of Long-term care. Full text in Research Archive
• Hellesø, Ragnhild; Henni, Silje Havrevold; Ansteinsson, Vibeke Elise; Korzeniewska, Lubomiła & Hovden, Ewa Alicja Szyszko (2022). Det må være noen andres ansvar – om samhandling mellom hjemmetjenesten og tannhelsetjenesten. Full text in Research Archive
• Hovden, Ewa Alicja Szyszko; Uhlen, Marte-Mari Nordsetmoen; Ansteinsson, Vibeke Elise; Skudutyte-Rysstad, Rasa & Hellesø, Ragnhild (2022). Tannhelsetjenester til hjemmeboende eldre - samhandling med hjemmetjenester og pårørende. Full text in Research Archive
• Hellesø, Ragnhild; Henni, Silje Havrevold; Ansteinsson, Vibeke Elise; Hovden, Ewa Alicja Szyszko & Skudutyte-Rysstad, Rasa (2022). Connecting ORAL health- and home healthcare service for patients receiving home healthcare in Norway. Full text in Research Archive
• Hellesø, Ragnhild; Skudutyte-Rysstad, Rasa & Ansteinsson, Vibeke Elise (2022). CORAL – Connecting ORAL health- and home care services for patients receiving home care in Norway. Full text in Research Archive
• Janson, Astri Letnes; Opheim, Randi & Hellesø, Ragnhild (2021). Kliniske masterutdanninger for sykepleiere. Kompetanseheving for primærhelsetjenesten? Full text in Research Archive
• Moger, Tron Anders; Tjerbo, Trond; Hellesø, Ragnhild & Vøllestad, Nina Køpke (2021). INOREG opening seminar. Full text in Research Archive
• Hellesø, Ragnhild; Ansteinsson, Vibeke; Hovden, Ewa Alicja Szyszko; Skudutyte-Rysstad, Rasa & Henni, Silje Havrevold (2021). Hva er CORAL? Introduksjon til prosjektet. Full text in Research Archive
• Henni, Silje Havrevold; Ansteinsson, Vibeke Elise; Hellesø, Ragnhild & Hovden, Ewa Alicja Szyszko (2021). CORAL –Connecting ORAL health-and home care service for patients receiving home care in Norway. Full text in Research Archive
• Henni, Silje Havrevold; Hellesø, Ragnhild; Ansteinsson, Vibeke Elise & Hovden, Ewa Alicja Szyszko (2021). Challenges in Establishing Integrated Oral Care for Elderly Receiving Home-Based Health Care. Full text in Research Archive
• Hellesø, Ragnhild (2021). Samhandling om den hjemmeboende pasient - utfordringer og muligheter. Full text in Research Archive
• Hellesø, Ragnhild (2021). CORAL - nye muligheter i samhandlingen rundt den hjemmeboende pasienten. Full text in Research Archive
• Hellesø, Ragnhild (2021). Forskning på tverrfaglig samarbeid og kontinuitet mellom spesialist- og kommunehelsetjenesten. Full text in Research Archive
• Hellesø, Ragnhild; Svendsen, Edel Jannecke; Frederiksen, Kirsten & Norlyk, Annelise (2021). Similarities and differences in developing and educating Advanced Practice Nurses (APN) in two Nordic countries. Full text in Research Archive
• Heggestad, Anne Kari Tolo; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Førde, Reidun & Hellesø, Ragnhild (2020). Ofrer vi de gamle? Full text in Research Archive
• Hellesø, Ragnhild; Hovden, Ewa Alicja Szyszko; Ansteinsson, Vibeke; Henni, Silje Havrevold & Skudutyte-Rysstad, Rasa (2020). Overview, ambitions and roles in CORAL - introduction to the project. Full text in Research Archive
• Lycholip, Edita; Aamodt, Ina Thon; Lie, Irene; Hellesø, Ragnhild; Simbelyte, Toma & Puronaité, Roma [Show all 9 contributors for this article] (2020). Young and computer-literate healthcare professionals have the greatest expectations for heart failure tele monitoring. European Heart Journal-Digital Health. 1, p. 6–7. doi: 10.1093/ehjdh/ztaa001. Full text in Research Archive
• Obstfelder, Aud & Hellesø, Ragnhild (2020). Koronapandemien viser at vi trenger omsorg for å holde samfunnet i gang. Full text in Research Archive
• Kirkevold, Marit; Heggen, Kristin & Hellesø, Ragnhild (2020). Nødvendig med en frontlinjekommisjon. Full text in Research Archive
• Ansteinsson, Vibeke; Szyszko, Ewa Alicja & Hellesø, Ragnhild (2020). Forskningsrådet må prioritere oral helse. Full text in Research Archive
• Hellesø, Ragnhild (2019). Samhandling til det bedre eller verre? Full text in Research Archive
• Hellesø, Ragnhild (2019). Kunnskapsgrunnlaget om pleie- og omsorgsmeldinger. Full text in Research Archive
• Hellesø, Ragnhild; Berg, Geir Vegar; Kvigne, Kari & Kumlin, Marianne (2023). Elderly patients care trajectories from the perspectives of patients, next of kin and health care professionals: A qualitative case study. Universitetet i Oslo. ISSN 9788234803185. Full text in Research Archive Show summary

  An increasing number of elderly people are living longer with chronic illnesses. Many need healthcare from different health care professionals at various levels in the health care services. It is known that patient and next of kin experience the services incoherent and fragmented and health professionals strive to provide coherent and person-centered healthcare. To get an in-depth understanding of the challenges and issues regarding the care trajectory where several actors are involved it is emphasized that the perspectives from patient, next of kin and health professional need to be included. The aim of this thesis was to explore and describe the care trajectory for elderly patients with complex healthcare needs from their hospitalization to their return to primary care as it is experienced from the patient, next of kin and health care professional involved. The patients were followed through their care trajectory from their hospital stay, during discharge and after being discharged to the municipalities. In a multiple-case study participation observations and interviews were used as methods, in addition to extracted data from the patients’ records. The main findings show that the patient and next of kin´s decisions and choices for further follow up during and after the hospital stay were part of a long term and continuous process that included conditions about life otherwise. For healthcare professionals the differences between patient’s long-term needs and organizational requirements led to challenges in providing person-centered healthcare. The thesis reveals that one must facilitate the time and space needed by the patient and next of kin to make decisions with a long-term perspective in mind. This means that the patient’s considerations about decisions and choices must be seen in the light of their life in general.

• Rostad, Hanne Marie; Sogstad, Maren Kristine Raknes; Førland, Oddvar; Hellesø, Ragnhild; Melby, Line & Ingstad, Kari [Show all 15 contributors for this article] (2020). Hvilke muligheter har omsorgstjenestene? Senter for omsorgsforskning. Full text in Research Archive Show summary

  Et hasteoppdrag for Helsedirektoratet der Senter for omsorgsforskning så på mulighetene for å øke kapasiteten i tjenestene dersom COVID-19 skulle kreve det. Oppsummeringene er korte analyser av muligheter og konsekvenser ved å øke kommunenes innsats uten å gå på bekostning av kommunens plikt til å gi forsvarlig helsehjelp. Forskerne mener omsorgstjenestene kan være i stand til å mobilisere, men at utfordringen er at norske kommuner er svært ulike ut fra befolkning, ressurser, antall smittede og tilgang på helsepersonell og kompetanse.

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