Janne Myhre

• Myhre, Janne; Bergh, Sverre; Feiring, Ingvild Hjorth; Høgset, Lisbeth Dyrendal; Kirkevold, Øyvind & Lichtwarck, Bjørn (2026). Crisis development in frail home-dwelling patients: A process analysis of clinical records. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 12(1), s. 18–18. doi: 10.18261/tfo.12.1.6. Fulltekst i vitenarkiv Vis sammendrag

  Background: New knowledge about the process leading to crises among community-dwelling frail patients, such as acute hospital admissions, may contribute to improved understanding, prevention, and new approaches to future crises. The aim of this study was to explore the development of crises among frail patients as documented in the patient records by home care services and general practitioners. Methods: This study comprised a qualitative process analysis of documents from electronic patient records systems retrieved from home care services and general practitioners in ten municipalities in Norway for 20 patients. Findings: The analysis showed that the structure of the examined patient records influences the ability to disclose the processes leading to crises. Events within the crisis process were often described without addressing the underlying reasons for their occurrence. Furthermore, the development of a crisis was found to follow individual and complex pathways for each patient.

• Habtu, Thomas Asmelash; Obstfelder, Aud Uhlen; Myhre, Janne & Andfossen, Nina Beate (2026). Navigating safety in practice: a qualitative study of how health care personnel organize medication management in Norwegian home care services. BMC Health Services Research. 26. doi: 10.1186/s12913-026-14761-2. Fulltekst i vitenarkiv Vis sammendrag

  Medication management for older adults receiving municipal home care services involves daily coordination between home care staff, general practitioners, pharmacies, and hospitals across frequent care transitions and regulatory requirements. Although regulations, guidelines, and safety approaches are intended to support safe medication practices, healthcare professionals (HCPs) in home care work under conditions marked by time pressure, limited resources, and frequently changing medication information. However, there is limited knowledge about how HCPs interpret and apply these regulatory frameworks in everyday home care practice. This study aims to explore how HCPs organize medication management to ensure patient safety in Norwegian home care services. A focused ethnographic design was employed in three purposively sampled Norwegian municipalities. Data were generated through 218 h of participant observation, informal interviews, photographs, and document collection involving 25 participants from various professional backgrounds. The data were analyzed via an iterative ethnographic method inspired by Roper and Shapira. The findings revealed an overarching cultural orientation, “the here and now,” along with two interconnected pattern categories: “performing resilience: making the day run” and “enacting system integration: chasing the right information.” Medication management was organized through continual coordination, task prioritization, and repeated efforts to obtain and verify medication information. Although HCPs adhered to regulations and guidelines, written procedures were inconsistently referenced in daily work. Instead, medication safety relies on locally organized practices, shared understandings, and adaptation to immediate demands. Medication safety in municipal home care is maintained through a continuous, interpretive process shaped by the practical realities of daily work. Regulations and guidelines function alongside locally organized coordination and information work rather than as linear instructions. Understanding medication management as it unfolds in the here and now provides insight into the gap between work-as-imagined and work-as-done. This study contributes to the analytical concept of “here and now” to explain how medication safety is enacted through real-time coordination and information work in municipal home care. These findings indicate that guidelines and digital systems require improvement to better support real-time coordination and information work, and safety interventions also need to address local sensemaking and cross-organizational communication.

• Væringstad, Anette; Kirkevold, Øyvind; Dalbak, Ellen Thea Gjelseth; Myhre, Janne; Feiring, Ingvild Hjorth & Bergh, Sverre [Vis alle 7 forfattere av denne artikkelen] (2025). Development of the PRACTIC Goal Setting Interview (PGSI) for Frail Community-Dwelling Patients. Feasibility, Interrater Reliability and Content validity—a Mixed Methods Study. Patient Preference and Adherence. Volume 19, s. 4050–4050. doi: 10.2147/ppa.s557233. Fulltekst i vitenarkiv
• Myhre, Janne; Bergh, Sverre; Kirkevold, Øyvind & Lichtwarck, Bjørn (2024). An organisation working mainly reactively instead of proactively: a qualitative study of how frail users of home care services and their next of kin experience crises. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11544-5. Fulltekst i vitenarkiv Vis sammendrag

  Background: Frail people receiving home care services face an increased risk of developing crisis, which can result in adverse events, coercive measures, and acute institutionalisation. The prevalence of frailty is expected to increase due to the ageing population in most countries. However, our knowledge of the process leading to crises among frail community-dwelling patients remains limited. The aim of our study was to explore how users of home care services and their next of kin experienced crises and how these crises were approached by home care services. Methods: A qualitative explorative design with 21 interviews was conducted. We explored crises within the last year that had led to an acute institutionalisation (hospital or nursing home) or to an unstable situation with high risk of institutionalisation. Systematic text condensation (STC) was used to analyse the data. Results: Our findings are summarised into one overarching theme; an organisation working mainly reactively instead of proactively, which is supported by four subthemes: (1) insufficient communication—a determinant of crises, (2) the lack of a holistic approach, (3) a sense of being a burden, and (4) the complexity of crises. The reactive approach is demonstrated in the participant’s experience of insufficient communication and the lack of a holistic approach from the service, but also in the user’s sense of being a burden, which seems to be reinforced by the experienced busyness from the staff in the home care services. This reactive approach to crises seems to have contributed to difficulties in detecting the various stressors involved in the complex process leading to crisis. Conclusions: Our findings suggest that home care services tend to be characterised by a reactive approach to rising instability and the development of crises for users. This can be interpreted as an emergent property of the organisation and the adaptation towards exceeding demands due to insufficient capacity in health care services. We recommend the use of multicomponent care programmes comprising interdisciplinary case conferences in home care services to implement a cultural change that can shift the service from a reactive, fragmented, and task-oriented approach to a more proactive approach.

• Væringstad, Anette; Dalbak, Ellen Thea Gjelseth; Holle, Daniela; Myhre, Janne; Kirkevold, Øyvind & Bergh, Sverre [Vis alle 7 forfattere av denne artikkelen] (2024). Preventing and Approaching Crises for frail community-dwelling patients Through Innovative Care (PRACTIC): protocol for an effectiveness cluster randomised controlled trial. Trials. 25. doi: 10.1186/s13063-024-08117-6. Fulltekst i vitenarkiv
• Myhre, Janne & Lichtwarck, Bjørn (2024). How and why does it work? A video-based qualitative analysis of case conferences to reduce BPSD through the lens of Habermas’s theory of communicative action. BMC Psychiatry. 24(1). doi: 10.1186/s12888-024-05959-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: Case conferences are described as a goal-oriented, systematic method that team members can use to exchange professional opinions and develop treatment actions for a particular care problem. However, not all case conferences have proven to be effective. The Norwegian Targeted Interdisciplinary Model for the Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) is an effective multicomponent model based on case conferences that informs approaches to behavioural and psychological symptoms in residents with dementia in nursing homes. Our aim was to explore how TIME case conferences structured based on cognitive behavioural therapy (CBT) contributed to person-centred actions and how the specific inductive structure of the TIME may have contributed to the effectiveness of the model. Methods: We used video observation of six case conferences and analysed these videos by performing a thematic cross-case analysis of the transcripts from the videos and by iteratively watching the videos. According to Habermas's theory of communicative action, we emphasized the case conference content, i.e., what was talked about in the case conferences, and the display of communication between the participants in the case conferences. Results: Our findings showed that the theoretical principles behind the TIME, including both person-centred care and the inductive structure of CBT, reflected many aspects of Habermas's theory of communicative actions. In particular, the TIME case conferences emphasized the lifeworld perspective for both residents and staff and contributed to what Habermas labelled communicative rationality as a means to develop shared understanding among staff and create person-centred action. Conclusions: One causal assumption of how and why the TIME case conferences contributed to the effectiveness of the TIME in reducing BPSD in nursing homes is that the specific inductive structure of the case conferences with the column technique based on the ABC method together with PCC, emphasized the importance of the lifeworld for both the resident and the staff. Even though case conferences have been highlighted as useful, it is not indifferent how these case conferences are structured and conducted.

• Vossius, Corinna Elisabeth; Borda, Miguel Germán; Lichtwarck, Bjørn; Myhre, Janne; Sollid, May Ingvild Volungholen & Borza, Tom [Vis alle 9 forfattere av denne artikkelen] (2023). Body mass index in nursing home residents during the first year after admission. BMC Nutrition. 9(1). doi: 10.1186/s40795-023-00710-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods: Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results: The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion: Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes. Keywords: BMI; Malnutrition; Nursing home; Nursing home residents; Overweight; Unternutrition; Weight changes. © 2023. The Author(s).

• Vossius, Corinna Elisabeth; Bergh, Sverre; Selbæk, Geir; Benth, Jurate Saltyte; Myhre, Janne & Aakhus, Eivind [Vis alle 7 forfattere av denne artikkelen] (2022). Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years. BMC Geriatrics. 22(1), s. 1–10. doi: 10.1186/s12877-022-02994-9. Fulltekst i vitenarkiv Vis sammendrag

  Background: There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods: NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results: A total of 1349 participants were included. When compared to persons with Alzheimer's disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson's disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2-2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion: Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment. Keywords: Dementia; Dementia subtypes; Long term nursing home residents; Mortality; Nursing home; Nursing home mortality. © 2022. The Author(s).

• Vossius, Corinna Elisabeth; Bergh, Sverre; Selbæk, Geir; Lichtwarck, Bjørn & Myhre, Janne (2022). Cause and place of death in Norwegian nursing home residents. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948221140195. Fulltekst i vitenarkiv Vis sammendrag

  Nursing home (NH) residents are in their last phase of life, and two aims of the NH’s medical care in Norway is to prevent unnecessary hospital admissions that would not benefit the resident and to facilitate a peaceful death in familiar surroundings when the time comes. However, little is known about the share of residents dying in NHs and the causes of death. We therefore evaluated the cause and place of death in a cohort of NH residents followed from the time of NH admission until death. Methods: NH residents were followed from admission to the NH and over the entire course of their NH stay. Demographic and clinical data were collected. Cause and place of death were retrieved from the Norwegian Cause of Death Registry. Results: Of 1283 residents, 6.2% died in hospital and 91.2% in a NH. Those who died in hospitals were more often male, died sooner after NH admission, had a less severe degree of dementia and had poorer general health. Dementia was the most common underlying cause of death, followed by cardiovascular disease. Conclusions: Dementia is one of the main causes of death in NH residents. In addition, our findings indicate a low number of inappropriate referrals to hospital during the last stage of life. However, further research should explore whether the terminal phase of NH residents is formed in accordance with their preferences and whether appropriate palliative care is offered.

• Guazzarini, Anna Giulia; Casanova, Georgia; Buchholz, Friederike; Kozori, Mahi; Lavolpe, Sara & Lichtwarck, Bjørn [Vis alle 15 forfattere av denne artikkelen] (2022). The Special Care Unit for People with Behavioral and Psychological Symptoms of Dementia (SCU- B) in the Context of the Project “RECage-Respectful Caring for Agitated Elderly”: A Qualitative Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(24). doi: 10.3390/ijerph192416913. Fulltekst i vitenarkiv Vis sammendrag

  Background: Dementia is a priority for global public health. The management of behavioral and psychological symptoms of dementia (BPSD) is one of the highest ongoing challenges and needs new approaches. The special care unit for people with dementia and BPSD (SCU-B) is viewed in this context as a further medical intervention. Aim: this study aims to explore SCU-B units in order to describe their main characteristics in relation to different implementation contexts, identify the characteristics of their replicability, and examine the social innovation elements promoted by SCU-B units. Method: This qualitative study is based on focus groups (FGs) and interviews involving nine international centers. Five of the centers have a memory clinic unit and SCU-B, compared with six that only have a memory clinic unit. A total number of 18 FGs were held, which altogether involved 164 participants. All data were transcribed verbatim and analyzed by means of a content analysis and a SWOT (strengths, weaknesses, opportunities, and threats) analysis. Results: The qualitative analysis offers a vision of the SCU-B model as an innovative care unit for BPSD, promoting social innovation in the long-term care (LTC) sector. This system mainly targets people with dementia and BPSD and their informal caregivers but encourages collaboration between dementia care stakeholders at the micro and meso levels. Conclusions: Specific characteristics of the country’s LTC systems and the organization of specialized units are determinants for the success of the SCU-B experience. The replicability of the entire SCU-B model was considered low; however, the implementation of single elements composing the SCU-B model may foster innovation. This study provides relevant suggestions on how to implement the SCU-B unit and innovative solutions for dementia care. Keywords: dementia; BPSD; special care unit; psychosocial intervention; qualitative study; social innovation; implementation; replicability; RECage project

• Myhre, Janne & Lichtwarck, Bjørn (2021). Kan kompleksitetsteori bidra til bedre forståelse og tiltak ved aggresjon, overgrep og forsømmelser i sykehjem? Geriatrisk sykepleie. ISSN 1891-1889. 2, s. 18–25. Fulltekst i vitenarkiv Vis sammendrag

  Sammendrag: Utfra vår erfaring og forskning vet vi at hendelser med aggresjon, overgrep og forsømmelse i sykehjem har en sterk sammenheng, opptrer ofte samtidig, og har flere sammenfallende determinanter. De er vanligvis komplekse fenomener som har en tendens til å gjenta seg, og som praksisfeltet opplever som krevende. Tradisjonelt er vi opplært til å tenke lineært om slike hendelser, dvs. at det finnes en eller flere årsaker vi kan gjøre noe med ved å sette inn noen generelle tiltak som f.eks. tradisjonell opplæring, kurs og forelesninger. Vi stiller spørsmål med om denne lineære måten å forstå aggresjon, overgrep og forsømmelser på, er tilstrekkelig for å tilnærme seg og forebygge disse hendelsene. I denne artikkelen vil vi diskutere hvordan vi ved bruk av kompleksitetsteori kan endre vår forståelse av disse fenomenene og sammenhengen mellom beboeren, ansatte, relasjonene de alle inngår i og konteksten sykehjemmet og samfunnet. En slik forståelse kan også være viktig i utviklingen av effektive modeller for forebygging og tilnærming i praksis. For å underbygge hvordan konsepter fra kompleksitetsteori kan bidra til endringer i vår forståelse av og vår tilnærming til disse fenomenene, har vi anvendt empiri fra våre to dr. gradsprosjekter: Utvikling og evaluering av TID, Tverrfaglig Intervensjonsmodell ved utfordrende atferd ved Demens (TID-studien) og Lederskapets rolle for å fremme pasientsikkerhet og forebygge vold, overgrep og forsømmelser i sykehjem (Ledelse- og pasientsikkerhetsstudien). Nøkkelord: kompleksitet, kompleksitetsteori, aggresjon, overgrep, forsømmelse, wicked problems, TID, ledelse, sykehjem. Can complexity theory contribute to a better understanding and more appropriate measures for aggression, abuse, and neglect in nursing homes?

• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). Elder abuse and neglect: an overlooked patient safety issue. A focus group study of nursing home leaders’ perceptions of elder abuse and neglect. BMC Health Services Research. 20(199 ), s. 1–14. doi: 10.1186/s12913-020-5047-4. Fulltekst i vitenarkiv Vis sammendrag

  Background:The definition and understanding of elder abuse and neglect in nursing homes can vary in differentjurisdictions as well as among health care staff, researchers, family members and residents themselves. Differentunderstandings of what constitutes abuse and its severity make it difficult to compare findings in the literature onelder abuse in nursing homes and complicate identification, reporting, and managing the problem. Knowledgeabout nursing home leaders’perceptions of elder abuse and neglect is of particular interest since theirunderstanding of the phenomenon will affect what they signal to staff as important to report and how theyinvestigate adverse events to ensure residents’safety. The aim of the study was to explore nursing home leaders’perceptions of elder abuse and neglect.Methods:A qualitative exploratory study with six focus group interviews with 28 nursing home leaders in the roleof care managers was conducted. Nursing home leaders’perceptions of different types of abuse within differentsituations were explored. The constant comparative method was used to analyse the data.Results:The results of this study indicate that elder abuse and neglect are an overlooked patient safety issue. Threeanalytical categories emerged from the analyses: 1) Abuse from co-residents:‘A normal part of nursing home life’;resident-to-resident aggression appeared to be so commonplace that care leaders perceived it as normal and hadno strategy for handling it; 2) Abuse from relatives:‘A private affair’; relatives with abusive behaviour visiting nursinghomes residents was described as difficult and something that should be kept between the resident and therelatives; 3) Abuse from direct-care staff:‘An unthinkable event’; staff-to-resident abuse was considered to bedifficult to talk about and viewed as not being in accordance with the leaders’trust in their employees.

• Myhre, Janne; Malmedal, Wenche Karin; Saga, Susan; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). Nursing home leaders’ perceptions of factors influencing the reporting of elder abuse and neglect: a qualitative study. Journal of Health Organisation and Management. ISSN 1477-7266. 34(6). doi: 10.1108/JHOM-02-2020-0031. Fulltekst i vitenarkiv Vis sammendrag

  Purpose The purpose of this study is to explore the factors that influence the reporting of adverse events related to elder abuse and neglect in nursing homes from nursing home leaders' perspectives. Good leadership requires in-depth knowledge of the care and service provided and the ability to identify and address problems that can arise in clinical practice. Design/methodology/approach A qualitative explorative design with data triangulation was used. The sample consisted of 43 participants from two levels of nursing home leadership, representing six municipalities and 21 nursing homes in Norway. Focus group interviews were undertaken with 28 ward leaders and individual interviews with 15 nursing home directors. The constant comparative method was used for the analyses. Findings Both ward leaders and nursing home directors described formal and informal ways of obtaining information related to elder abuse and neglect. There were differences between their perceptions of the feasibility of obtaining formal reports about abuse in the nursing home. Three main categories of influencing factors emerged: (1) organisation structural factors, (2) cultural factors and (3) abuse severity factors. A main finding is that in its present form, the Norwegian adverse event reporting system is not designed to detect abuse and neglect. Originality/value This paper provides an in-depth understanding of patient safety and factors related to reporting elder abuse in nursing homes in Norway.

• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2020). React and act: a qualitative study of how nursing home leaders follow up on staff-to-resident abuse. BMC Health Services Research. 20(1). doi: 10.1186/s12913-020-05969-x. Fulltekst i vitenarkiv Vis sammendrag

  Background: Elder abuse in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organisational factors. One way leaders can prevent abuse and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. The aim of this study was to explore how nursing home leaders follow up on reports and information regarding staff-to-resident abuse. Methods: A qualitative explorative design was used. The sample comprised 43 participants from two levels of nursing home leadership representing six municipalities and 21 nursing homes in Norway. Focus group interviews were conducted with 28 care managers, and individual interviews took place with 15 nursing home directors. The constant comparative method was used for the analyses. Results: Nursing home leaders followed up incidents of staff-to-resident abuse on three different levels as follows: 1) on an individual level, leaders performed investigations and meetings, guidance, supervision, and occasionally relocated staff members; 2) on a group level, feedback, openness, and reflection for shared understanding were strategies leaders used; and 3) on an organisational level, the main solutions were to adjust to available resources, training, and education. We found that leaders had difficulties defining harm and a perceived lack of power to follow up on all levels. In addition, they did not have adequate tools for evaluating the effect of the measures that were taken. Conclusions: Nursing home leaders need to be clear about how they should follow up incidents of elder abuse on different levels in the organisation and about their role in preventing elder abuse. Evaluation tools that facilitate systematic organisational learning are needed. Nursing homes must operate as open, blame-free cultures that acknowledge that incidents of elder abuse in patient care arise not only from the actions of individuals but also from the complex everyday life of which they are a part and in which they operate. Keywords: Nursing home, Leaders, Patient safety, Organisational learning, Elder abuse, Staff-to-resident abuse, Adverse events

• Lichtwarck, Bjørn; Myhre, Janne; Selbæk, Geir; Kirkevold, Øyvind; Rokstad, Anne Marie Mork & Benth, Jurate Saltyte [Vis alle 7 forfattere av denne artikkelen] (2019). TIME to reduce agitation in persons with dementia in nursing homes : a process evaluation of a complex intervention. BMC Health Services Research. 19(1), s. 1–16. doi: 10.1186/s12913-019-4168-0. Fulltekst i vitenarkiv Vis sammendrag

  Background: The Targeted Intervention Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a three-month cluster randomised controlled trial demonstrated reduction in agitation in nursing home residents with dementia. To ease replication and future implementation, and to clarify possible causal mechanisms, we performed a process evaluation of the intervention based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). Methods: An exploratory and a quasi-experimental design with mixed methods were used. The RE-AIM dimensions were explored by questionnaires to 807 staff members and 46 leading ward nurses in both the intervention nursing homes (INH) and the control nursing homes (CNH), before the start of the trial (baseline), and six and 12 months later. These questionnaires assessed data regarding the reach, effectiveness (staff level) and adoption dimensions. To assess implementation, we used a checklist for performance of the main components in TIME and analysed the minutes from 84 case conferences in the INH. To explore adoption and maintenance, five focus group interviews with 32 participants from the staff in the INH were conducted three to 6 months after the end of the trial. Results: Reach: On average 61% (SD 22) of the staff in each ward in the INH attended the training sessions. Effectiveness at staff level: There were no between-group differences throughout the study period for attitudes towards dementia, perceived competence or perception of mastery and social interaction. Adoption: 16 of the 17 INH completed the intervention. Implementation: 75% or more of the components of TIME were performed for 91% of the included residents. Maintenance: Most of the nursing homes used TIME three to 6 months after the end of the trial. An easy to grasp model and an engaged leadership facilitated the intervention and maintenance. Conclusions: A high degree of reach, adoption, implementation and maintenance contributed to the effectiveness of TIME at resident level. One other causal assumption of the effectiveness of TIME is the development in the staff of a new, shared and situated knowledge about each individual resident, not reflected by measurements in general knowledge and attitudes.

• Lichtwarck, Bjørn; Myhre, Janne; Goyal, Alka Rani; Rokstad, Anne Marie Mork; Selbæk, Geir & Kirkevold, Øyvind [Vis alle 7 forfattere av denne artikkelen] (2018). Experiences of nursing home staff using the targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms (TIME) : a qualitative study. Aging & Mental Health. ISSN 1360-7863. 23(8), s. 966–975. doi: 10.1080/13607863.2018.1464116. Fulltekst i vitenarkiv Vis sammendrag

  Background/Aims: Neuropsychiatric symptoms (NPS) in dementia pose great challenges for residents and staff in nursing homes. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) has recently in a randomized controlled trial demonstrated reductions in NPS. We explored the participating staff's experiences with the model and how it meets the challenges when dealing with the complexity of NPS. Methods: Three to six months after the end of the intervention, we interviewed 32 of the caregivers, leaders, and physicians participating in the trial, in five focus groups. We used thematic content analysis. Results: The analysis yielded two main themes: (1) a systematic reflection method enhanced learning at work; (2) the structure of the approach helped staff to cope with NPS in residents with dementia. Conclusion: TIME shifts the way of learning for the staff from a traditional to a more innovative and reflection-based learning through a process of learning how to learn at work. The staff's experienced increased coping in their approach to complex problems. Our results emphasise the importance of a structured and biopsychosocial approach to NPS in clinical practice. Future research should explore models for integrating situated learning in daily routines in nursing homes. Keywords: neuropsychiatric symptoms, agitation, dementia, case conference, psychosocial intervention, nursing home

• Myhre, Janne; Lichtwarck, Bjørn & Bergh, Sverre (2018). Delt forståelse og felles forpliktelse. En kvalitativ studie av personalets erfaringer med TID-refleksjon i en alderspsykiatrisk avdeling. Tidsskriftet aldring og helse. ISSN 1890-4130. 22(1), s. 38–45. Fulltekst i vitenarkiv
• Myhre, Janne; Tonga, Johanne Bjørnstad; Ulstein, Ingun; Høye, Sevald & Kvaal, Kari (2018). The coping experiences of spouses of persons with dementia. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(3-4), s. e495–e502. doi: 10.1111/jocn.14047. Fulltekst i vitenarkiv Vis sammendrag

  Aims and objectives The aim of the present study was to explore how spouses who are caregivers to persons with dementia experience everyday life six to twelve months after participation in the intervention condition in the Norwegian Cognitive Behavioural Therapy for Early Dementia (N-CORDIAL) study. Background There is no current medical curative treatment for cognitive impairment and dementia-associated conditions. These conditions will lead to an increased need for daily assistance and care, as well as greater stress for caregivers. The Norwegian CORDIAL Study is a manual-based randomized controlled trial based on the German CORDIAL study (Cognitive rehabilitation and cognitive behavioural treatment for early dementia in Alzheimer's disease), consisting of cognitive rehabilitation, cognitive behavioural therapy and life review methods. Design and Methods A descriptive exploratory study with qualitative semi-structured in-depth interviews with six spouses of persons with dementia who had participated in the Norwegian CORDIAL study. The transcribed text was analysed by systematic text condensation. Result The main theme identified, “An everyday search for meaning”, referred to the stress experienced by the caregivers and their coping strategies in everyday life. Conclusion The caregivers had gained increased awareness of coping strategies in everyday life six to twelve months after the intervention. Caregivers who experienced fewer neuropsychiatric symptoms in their spouses with dementia benefitted most from the intervention.

• Lichtwarck, Bjørn; Selbæk, Geir; Kirkevold, Øyvind; Rokstad, Anne Marie Mork; Benth, Jurate Saltyte & Myhre, Janne [Vis alle 8 forfattere av denne artikkelen] (2016). TIME – Targeted interdisciplinary model for evaluation and treatment of neuropsychiatric symptoms : protocol for an effectiveness-implementation cluster randomized hybrid trial. BMC Psychiatry. 16, s. 1–12. doi: 10.1186/s12888-016-0944-0. Fulltekst i vitenarkiv Vis sammendrag

  Background: Nearly all persons with dementia will experience neuropsychiatric symptoms (NPS) during the course of their disease. Clinicians and researchers emphasize the need for an evidence-informed standardized approach to managing NPS that integrates pharmacological and nonpharmacological treatments for real-world implementation. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) represents such an approach and is a multicomponent intervention based on the theoretical framework of cognitive behavioural therapy. Methods/design: The trial is a 3-month cluster randomized trial conducted in 30 nursing homes including 168 participants with dementia and a high level of agitation. Each nursing home defined as a cluster will be randomized to receive either the TIME intervention (the intervention group) or a brief education-only intervention regarding dementia and NPS (the control group). TIME is a manual-based, multicomponent programme that includes a rigorous assessment, one or more case conferences and the treatment and evaluation of NPS. Patient-level measurements are taken at baseline (prior to randomization) and 8 and 12 weeks later. The primary outcome measure is the change in agitation, as defined by the Neuropsychiatric Inventory-Nursing Home Version, at 8 weeks from baseline. Secondary outcome measures include change in agitation at 12 weeks from baseline, and change from baseline at 8 and 12 weeks in other NPS, quality of life, and the use of psychotropic and analgesic medications. Mixed methods will be used to follow, measure and explore the implementation process and the effect of the intervention at the individual staff level and the organization level. Combining measurements of clinical effectiveness and implementation outcomes define this trial as an effectiveness-implementation hybrid trial. Discussion: Measuring the implementation and effect of complex interventions aimed at reducing NPS in nursing homes is challenging. In this study protocol, we describe a multicomponent program, TIME, and discuss how an effectiveness-implementation cluster randomized hybrid trial can meet these challenges. Trial registration: ClinicalTrials.gov identifier NCT02655003. Registered 6 January 2016. Keywords: dementia, neuropsychiatric symptoms, behavioural and psychological symptoms of dementia (BPSD), psychosocial interventions, nursing home, case conference

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• Rykkje, Linda Lee Risnes & Myhre, Janne (2026). Gerontologi og geriatrisk sykepleie. Cappelen Damm Akademisk. ISBN 9788202896287. 320 s. doi: https:/www.cappelendamm.no/boker/gerontologi-og-geriatrisk-sykepleie-9788202896287/bla-i-boka. Fulltekst i vitenarkiv Vis sammendrag

  Denne boken handler om sykepleie til eldre mennesker og vektlegger både gerontologiske og geriatriske perspektiver for å kunne gi helhetlig omsorg tilpasset pasientenes individuelle behov. Forfatterne er sykepleiere med spesialkompetanse som skriver for å styrke sykepleieres kliniske vurderingsevne. Målgruppen er sykepleiere på videreutdanning og mastergradsnivå, men også bachelorstudenter og andre helsearbeidere kan ha nytte av boken. Temaer i boken: aldring helhetlig sykepleie eldreomsorg i Norge sykepleie til akutt og kronisk syke eldre hjerte- og karsykdom lungesykdom ernæringssvikt diabetes kreft kroppslige plager psykisk helse demens seksuell helse vold mot eldre omsorg ved livets slutt opp Hovedbudskapet er at god sykepleie til eldre krever faglig innsikt, etisk forståelse og helhetlig omsorg som inkludert fysisk, psykisk, åndelig/eksistensiell og sosiale tiltak. Boken er et nyttig verktøy for sykepleiere som ivaretar eldre mennesker i mange ulike arbeidssteder innen helse- og omsorgstjenestene.

• Lichtwarck, Bjørn & Myhre, Janne (2022). Dumme pasienter og troll til pleiere?: Ny forståelse av aggresjon, overgrep og utelatt helsehjelp i institusjon. Fagbokforlaget. ISBN 9788245035605. 190 s. Fulltekst i vitenarkiv Vis sammendrag

  I denne boka belyser forfatterne ny kunnskap om hvordan aggresjon, overgrep og utelatt helsehjelp utspiller seg i praksisfeltet, og beskriver ulike tilnærminger for å forebygge og redusere aggresjon, overgrep og utelatt helsehjelp i institusjon. Aggresjon, overgrep og utelatt helsehjelp er komplekse fenomener som er nært knyttet til hverandre, til dels overlappende, og ofte del av et og samme fenomen med felles risiko-, utløsende og vedlikeholdende faktorer. Betydningen av å forstå disse fenomenene i en helhetlig sammenheng både i forskning og praksis framheves. Boka tar for seg begreper og teorier om fenomenene og om kompleksitet, refleksjon, makt og ledelse i institusjon.

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• Rykkje, Linda Lee Risnes; Myhre, Janne; Førland, Oddvar; Morland, Marianne; Puaschitz, Nathalie Genevieve Søyland & Hjelmeland, Inger Helen Hardeland [Vis alle 8 forfattere av denne artikkelen] (2026). Boklansering - presentasjon av boken Gerontologi og geriatrisk sykepleie. Fulltekst i vitenarkiv
• Myhre, Janne (2026). Debatt: Eldre, BankID og digital svindel i Norge. Fulltekst i vitenarkiv Vis sammendrag

  Digitalt utenforskap gjør eldre sårbare for BankID-deling, økonomisk utnyttelse og svindel. Forsker Janne Myhre ved NKVTS ber utsatte over 60 år dele erfaringer.

• Rykkje, Linda Lee Risnes & Myhre, Janne (2026). Sykepleie ved eliminasjonsplager hos eldre. I Rykkje, Linda Lee Risnes & Myhre, Janne (Red.), Gerontologi og geriatrisk sykepleie. Cappelen Damm Akademisk. ISSN 9788202896287. s. 165–180. doi: https:/www.cappelendamm.no/boker/gerontologi-og-geriatrisk-sykepleie-9788202896287/bla-i-boka. Fulltekst i vitenarkiv Vis sammendrag

  Kapittelet handler om sykepleie ved utfordringer knyttet til eliminasjon hos eldre personer. Hovedvekten legges på urinveiene, med omtale av urininkontinens, infeksjoner, urinretensjon, urinkateter og urostomi, samt hjemmedialyse. Når det gjelder tarmsystemet avgrenses kapittelet til å omtale obstipasjon, diaré, fekalinkontinens og stomipleie.

• Myhre, Janne (2026). Sykepleie til eldre utsatt for vold og overgrep. I Rykkje, Linda Lee Risnes & Myhre, Janne (Red.), Gerontologi og geriatrisk sykepleie. Cappelen Damm Akademisk. ISSN 9788202896287. s. 254–265. doi: https:/www.cappelendamm.no/boker/gerontologi-og-geriatrisk-sykepleie-9788202896287/bla-i-boka. Fulltekst i vitenarkiv Vis sammendrag

  Eldre mennesker kan være utsatt for vold, overgrep, omsorgssvikt og utelatt helsehjelp, både i hjemmet og i institusjonelle omsorgstilbud. Når krenkelsene skjer i relasjoner preget av avhengighet og tillit, kan det være særlig vanskelig for den eldre å fortelle om sine erfaringer. Stillhet og skam, samt manglende kunnskap og bevissthet hos helsepersonell om at eldre kan være utsatt, bidrar til at dette ofte forblir et skjult samfunnsproblem. Sykepleier har en nøkkelrolle i å avdekke, avverge og forebygge vold, overgrep og omsorgssvikt.

• Myhre, Janne (2026). Sykepleie til skrøpelige og mulitisyke eldre. I Rykkje, Linda Lee Risnes & Myhre, Janne (Red.), Gerontologi og geriatrisk sykepleie. Cappelen Damm Akademisk. ISSN 9788202896287. s. 88–100. doi: https:/www.cappelendamm.no/boker/gerontologi-og-geriatrisk-sykepleie-9788202896287/bla-i-boka. Fulltekst i vitenarkiv Vis sammendrag

  I møte med den geriatriske pasient er kunnskaper om skrøpelighet og multimorbiditet sentralt. Når flere sykdommer og aldersrelaterte endringer opptrer samtidig, vil de påvirke og forsterke hverandre og dermed skape et komplekst sykdomsbilde. Dette vil igjen øke risikoen for funksjonstap, sykehusinnleggelse og tidlig død. For sykepleiere innebærer dette at praksis preges av klinisk kompleksitet, etiske dilemmaer og behov for tverrfaglig samhandling. Skrøpelige og multisyke eldre personer har sammensatte behov som ikke alltid lar seg fange opp i standardiserte løsninger. Det krever at sykepleier gjør en helhetlig vurdering, innehar god klinisk dømmekraft, samt har evner og muligheter til å balansere mellom å fremme funksjon, forebygge forverring og lindre plager. Samtidig må sykepleieren ivareta pasientens verdighet og livskvalitet også når helseutfordringen er omfattende og utsiktene usikre. I dette kapittelet vektlegges sykepleierens rolle i å møte, vurdere og forstå behovene til skrøpelige og multisyke eldre. Det blir lagt vekt på klinisk vurderingskompetanse, personsentrerte tiltak og tverrfaglig samarbeid. Målet er å styrke sykepleierens evne til å utøve kunnskapsbasert, empatisk og profesjonell omsorg i møte med eldre pasienter med sammensatte og komplekse behov.

• Myhre, Janne (2026). Gerontologi og aldring. I Rykkje, Linda Lee Risnes & Myhre, Janne (Red.), Gerontologi og geriatrisk sykepleie. Cappelen Damm Akademisk. ISSN 9788202896287. s. 15–34. doi: https:/www.cappelendamm.no/boker/gerontologi-og-geriatrisk-sykepleie-9788202896287/bla-i-boka. Fulltekst i vitenarkiv Vis sammendrag

  Dette kapittelet handler om aldersrelaterte endringer som er en naturlig del av livet og det å bli eldre. Kunnskap om normale endringer som følger med det å bli eldre, er viktig for å forstå eldres situasjon og for å kunne utvikle tilbud som er tilpasset deres behov. Samtidig er ikke eldre en homogen gruppe. Det kan være store biologiske, psykologiske og sosiale variasjoner gjennom livsløpet som må tas hensyn til når helsetilbudet skal utformes til hver enkelt. Samfunnet blir også stadig mer mangfoldig, noe som gjør at forståelsen av aldring også må sees i et flerkulturelt perspektiv.

• Habtu, Thomas Asmelash; Andfossen, Nina Beate; Obstfelder, Aud Uhlen & Myhre, Janne (2026). Medication Management i the Here and Now: An ethnographic study of healthcare personnel's medication management practice in home care. Fulltekst i vitenarkiv
• Myhre, Janne (2025). Innsparing beskrives som realisme – betyr dårligere kvalitet i praksis. Fulltekst i vitenarkiv Vis sammendrag

  Det er de mest sårbare eldre som taper når ambisjonen senkes som sparetiltak i hjemmetjenesten.

• Nord-Baade, Silje; Myhre, Janne; Bolstad, Ingeborg; Bakmann, Anne Stine Mjelve; Mygland, Jenny Solveig & Kielland, Torhild (2025). Teori og praksis: Når idealer møter virkeligheten. doi: https:/www.kommunal-rapport.no/meninger/teori-og-praksis-nar-idealer-moter-virkeligheten/840475. Fulltekst i vitenarkiv
• Habtu, Thomas Asmelash; Obstfelder, Aud Uhlen; Myhre, Janne & Andfossen, Nina Beate (2025). Helsepersonells erfaring med og praktisering av legemiddelhåndtering i hjemmetjenesten. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Eldre bruker ofte flere legemidler. Mange eldre har vedtak om hjemmetjenester for hjelp til legemiddelhåndtering. Sikker legemiddelhåndtering er en sentral utfordring i den kommunale helse- og omsorgstjenesten. Helsepersonell må håndtere fragmentert kommunikasjon og begrensede ressurser noe som utgjør en risiko for pasientsikkerheten. Personsentrert tilnærming er viktig for å ivareta trygg medisinering og brukermedvirkning. Formål: Studien hadde som formål å undersøke hvordan helsepersonell opplever og praktiserer legemiddelhåndtering for eldre i den kommunale hjemmetjenesten i Norge. Metode: En fokusert etnografisk studie ble gjennomført i tre kommuner. Data ble generert gjennom 218 timer med deltakende observasjon sammen med 25 helsepersonell på ulike vakter. I tillegg ble det tatt feltnotater, gjennomført uformelle intervjuer, gjennomgått institusjonelle dokumenter og tatt fotografier. Etnografisk rammeanalyse ble anvendt til å analysere forskningsdata. Konklusjon/resultat: Foreløpig resultater fra studien viser at legemiddelhåndteringen i den kommunale hjemmetjenesten i Norge er preget av helsepersonellets adaptive praksis her og nå. To kategorier ble analysert frem: 1. strukturell dynamikk, som inkluderer mangel på arbeidskraft, avbrudd i prosedyrer, teamarbeid og varierende praksis for rapportering av hendelser 2. system kompleksitet, som gjenspeiler fragmenterte digitale systemer, reseptuoverensstemmelser og koordineringsansvar på tvers av nivåer i helsevesenet. Til sammen viser funnene at helsepersonell er avhengig av improvisasjon, lokale løsninger og uformelle støttenettverk for å opprettholde den daglige legemiddelhåndteringen i kommunale hjemmetjenester. Helsepersonellets adaptive praksis bidrar til legemiddelsikkerhet på kort sikt, men risikerer å svekke langsiktig læring og forebyggende tiltak. Fremtidig forskning er nødvendig for å utforske fordelene og den effektive implementeringen av personsentrerte strategier for sikker medikamenthåndtering i hjemmetjenesten.

• Dalbak, Ellen Thea Gjelseth; Væringstad, Anette; Lichtwarck, Bjørn; Myhre, Janne; Holle, Daniela & Bergh, Sverre [Vis alle 7 forfattere av denne artikkelen] (2025). Preventing and approaching crises for frail community-dwelling patients through innovative care (PRACTIC): study protocol for a process evaluation of a complex intervention in home care service. doi: 10.1186/s13063-025-08876-w. Fulltekst i vitenarkiv
• Væringstad, Anette; Dalbak, Ellen Thea Gjelseth; Holle, Daniela; Myhre, Janne; Kirkevold, Øyvind & Bergh, Sverre [Vis alle 7 forfattere av denne artikkelen] (2024). Correction: PReventing and Approaching Crises for frail community-dwelling patients Through Innovative Care (PRACTIC): protocol for an effectiveness cluster randomised controlled trial (Trials, (2024), 25, 1, (304), 10.1186/s13063-024-08117-6). Trials. 25(1). doi: 10.1186/s13063-024-08257-9. Fulltekst i vitenarkiv
• Lichtwarck, Bjørn & Myhre, Janne (2024). A New Understanding of Challenging Behavior, Missed Care and Abuse in Nursing Homes. Complex Intertwined Problems Demand Complex Approaches. WAPR Bulletin. No53, s. 47–55. Fulltekst i vitenarkiv
• Lichtwarck, Bjørn & Myhre, Janne (2023). Kompetanse alene løser ikke sykehjemskrisen. Fulltekst i vitenarkiv Vis sammendrag

  Mange har gode grunner til å rope om bedre bemanning på sykehjem, enten ropene kommer fra helse- og omsorgspersonell, pårørende eller fagorganisasjoner.

• Myhre, Janne & Lichtwarck, Bjørn (2023). A Video-based qualitative analysis of case conferences to reduce BPSD. Fulltekst i vitenarkiv
• Sandmoe, Astrid; Myhre, Janne; Iversen, Maria; Eriksen, Siren & Lichtwarck, Bjørn (2022). Vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon: Begrepsbruk i en norsk sykehjemskontekst. Tidsskrift for omsorgsforskning. ISSN 2387-5976. 8(3), s. 1–15. doi: 10.18261/tfo.8.3.7. Fulltekst i vitenarkiv Vis sammendrag

  Vold, overgrep, trusler, aggresjon, krenkelser, mishandling, forsømmelser, omsorgssvikt, kvalitetsbrist og utelatt helsehjelp er noen av de begrepene som brukes for å beskrive hendelser vi ikke ønsker, men som kan oppstå i sykehjem. Kunnskapen og forståelsen om disse fenomenene er i kontinuerlig endring. Dette vises gjennom skiftende bruk av begreper og hvordan disse begrepene oppfattes. Uønskede hendelser kan føre til skade, men ikke alltid (WHO, 2005; Cooper et al., 2018). Grensene for uønskede hendelser påvirkes av konteksten, samfunnets normer, lover og retningslinjer. En begrepsavklaring er viktig fordi en felles forståelse av begrepene øker muligheten for at forskning og praksis snakker med samme språk om de samme fenomenene. Ulike forståelser og ulik begrepsbruk kan være et vesentlig hinder i arbeidet med å redusere uønskede hendelser. I denne artikkelen vil vi se nærmere på de mest brukte begrepene i norsk sammenheng, det vil si vold, overgrep, utelatt helsehjelp, forsømmelser og aggresjon i sykehjem. Målet vårt er å komme fram til begreper som er hensiktsmessige og gjenkjennbare både i forskning og praksis, og som avspeiler at disse fenomenene er komplekse og utspiller seg i en kompleks kontekst.

• Lichtwarck, Bjørn & Myhre, Janne (2020). Til ethvert komplekst spørsmål finnes et enkelt svar – og det er feil. Fulltekst i vitenarkiv Vis sammendrag

  Verden er for kompleks til å favnes i vedtak, selv for en spesifisert sydenreise.

• Myhre, Janne (2019). Vold og overgrep mot eldre. Fulltekst i vitenarkiv
• Myhre, Janne; Saga, Susan; Malmedal, Wenche Karin; Ostaszkiewicz, Joan & Nakrem, Sigrid (2019). Nursing home leaders perception of elder abuse and neglect- A qualitative study. Fulltekst i vitenarkiv
• Myhre, Janne; Kvaal, Kari; Tonga, Johanne Bjørnstad; Høye, Sevald & Ulstein, Ingun (2016). Cognitive behaviour therapy in dementia care - the Norwegian KORDIAL study: The relatives' perspectives on everyday life after the intervention. Fulltekst i vitenarkiv
• Kvaal, Kari; Myhre, Janne; Høye, Sevald; Tonga, Johanne Bjørnstad & Ulstein, Ingun (2016). Cognitive behavioural therapy in dementia care: The Norwegian KORDIAL-study. Fulltekst i vitenarkiv
• Myhre, Janne; Nakrem, Sigrid; Saga, Susan; Malmedal, Wenche Karin & Ostaszkiewicz, Joan (2021). The role of leadership in promoting safety for nursing home residents and preventing elder abuse and neglect. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232657308. Fulltekst i vitenarkiv Vis sammendrag

  This thesis describes the phenomenon of elder abuse and neglect in the institutional context from the perspective of nursing home leaders. Elder abuse and neglect in nursing homes is a complex multifactorial problem and entails various associations across personal, social, and organizational factors. One -way leaders can prevent abuse and neglect and promote quality and safety for residents is to follow up on any problems that may arise in clinical practice in a way that facilitates staff learning. How nursing home leaders follow up and what they follow up on might reflect their perceptions of abuse, its causal factors, and the prevention strategies used in the nursing home. At the same time, descriptions, perceptions, and understandings around the concept of elder abuse and neglect in nursing homes vary in different jurisdictions as well as among healthcare staff, researchers, family members, and residents themselves. Different understandings of what constitutes abuse and neglect and its severity complicate identification, reporting, and managing the problem. To address the knowledge gap outlined above, the aim of this thesis is to explore the role of leadership in patient safety concern related to elder abuse and neglect. Knowledge about nursing home leaders’ perceptions of elder abuse, their experiences of barriers and enablers to reporting elder abuse and neglect, and how the leaders follow up on reports and information are essential because their understanding of the phenomenon will influence what they signal to staff as important to report and what they investigate to create a safe and healthy environment for both residents and staff. The specific objectives were to explore: • How nursing home leaders perceive elder abuse and neglect; • What nursing home leaders experience as barriers and enablers to reporting elder abuse and neglect; and • How nursing home leaders follow up on information and reports of elder abuse and neglect. The research method and design were qualitative and explorative, including both focus group interviews with care managers and individual interviews with nursing home directors. A total of 43 participants from six different municipalities and 21 nursing homes were included. A core finding was a lack of awareness about the concept of elder abuse and neglect. Keywords from the categorization of abuse helped the participants to reflect upon the topic and revealed examples of events they interpret as being harmful or distressful to residents. At the same time, our findings revealed an ambiguity in the nursing home leaders’ examples. While, on one hand, they described the situation as harmful, on the other hand, they rationalized and attempted to provide excuses for why it was happening. The ambiguity in the nursing home leaders’ examples can be viewed as an attempt to adapt to internal and external demands by rationalizing abuse and diminishing personal and professional accountability. The nursing home leaders in our study experienced difficulties obtaining information related to abuse and neglect within the nursing homes because of structural factors related to the organization, cultural factors, and abuse severity factors. Because of difficulties obtaining information from the formal reporting system, nursing home leaders have to adjust and find other ways to obtain information such as reading the nursing notes in the electronic patient record system and using an informal reporting system, including information provided verbally by staff and through observation. Nursing home directors expressed a more positive view of the usefulness of the formal reporting system than care managers did. Generally, the follow-up on reports and various information leaders receive is linked to the belief that patient safety can be improved by learning from incidents and “near misses” Our findings revealed that nursing home directors and care managers differ in their beliefs about the root causes of elder abuse. A felt powerless within the leaders in terms of being able to follow up on all levels, and a lack of evaluation tools was seen as a barrier to facilitating patient safety and systematic organizational learning. The leaders’ attempts to adapt both internal and external demands could be seen in their reliance on a linear personal approach rather than a system approach when they followed up on abuse and neglect within the nursing home context.

• Myhre, Janne (2011). Fra vask til bad. Miljøet, taktil stimulering og berøringens betydning for personer med demens i sykehjem. Utviklingssenter for sykehjem og hjemmetjenester. Fulltekst i vitenarkiv

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