Ragnhild Karen Astad Michaelsen

• Synnes, Oddgeir; Orøy, Aud Jorun; Råheim, Målfrid; Bachmann, Liv; Ekra, Else Mari Ruberg & Gjengedal, Eva [Show all 12 contributors for this article] (2020). Finding ways to carry on : stories of vulnerability in chronic illness. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 15(1), p. 1–13. doi: 10.1080/17482631.2020.1819635. Full text in Research Archive Show summary

  Purpose: In this study, we explore the lived experiences of chronic illness in four groups of patients; children with asthma, adolescents with diabetes, young adults with depression, and adult patients with chronic, obstructive pulmonary disease (COPD). Persons living with chronic illness are often designated as vulnerable. This study builds on the assumption that being vulnerable belongs to being human, and that vulnerability also might entail strength and possibilities for growth. Methods: A narrative analysis was undertaken to illuminate how experiences of vulnerability were narrated across the four patient groups, presenting four individual stories, one from each of the patient groups. Results/conclusion: The stories illuminate how living with a chronic illness implies differing capabilities and capacities dependent on the specific condition. At the same time the stories point to how various abilities and challenges in living with chronic illness can be alleviated or seen as resources. Considered together, the stories underscore how ´finding ways to carry on´ in chronic illness requires interpretational work. By calling upon resources among significant others, in the surroundings and in oneself, the narrator can find ways of interpreting living with chronic illness that might open towards a hopeful future. Keywords: chronic illness, vulnerability, narrative analysis, life

• Bachmann, Liv; Michaelsen, Ragnhild Karen Astad & Vatne, Solfrid (2019). Professional vulnerability in mental healthcare contexts : a focus group study of milieu‐therapists’ experiences. Nursing Open. ISSN 2054-1058. 6(3), p. 1076–1087. doi: 10.1002/nop2.292. Full text in Research Archive Show summary

  Aims and objectives: To gain insight into how the workplace influences milieu‐therapists’ vulnerability in the mental healthcare context. Background: Mental health services have experienced substantial changes. Reduced institutional treatment capacity is replacing the development of locally based treatment. Changes in external conditions in mental health services have influenced the working conditions of nurses and milieu‐therapists. Design: Qualitative design. The study complied with the COREQ checklist. Methods: Focus group interviews. Results: “Vulnerability due to unpredictable and threatening working context” was the common key theme that emerged in both contexts. Two key themes were different and opposite. In municipal mental health care, “Alone and unprotected” and in institutional care, “Together and protected.” Conclusion: The participants from both specialized and community mental health care, experienced vulnerability at different levels interpreted as a contradictory relationship between the healthcare system and their own ideals of what professional practice ought to be. Relevance to clinical practice: This study contributes to extended knowledge and understanding about the experienced influence of the working environment on professional vulnerability of nurses and milieu‐therapists` in mental health services. The impact of contextual conditions on health professionals’ working conditions has multi‐professional relevance for milieu‐therapists and managers of mental health services, and it is an important topic in health and social higher education. Keywords: focus group study, mental Health care context, milieu‐therapists, professional vulnerability

• Bachmann, Liv; Michaelsen, Ragnhild K A & Vatne, Solfrid (2016). Feeling “overloaded” and “shortcomings” : milieu therapists’ experiences of vulnerability in caring for severely mentally ill patients. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 9, p. 285–296. doi: 10.2147/JMDH.S106310. Full text in Research Archive Show summary

  Background: Milieu therapists’ relationships with patients with severe mental illnesses are viewed as challenging. Elucidating vulnerability from their perspective in daily face-to-face encounters with patients might contribute to extending our knowledge about milieu therapists’ vulnerability and the dynamics of the interaction between patients in mental health services and expertise in building caring and therapeutic relationships. The aim of this project was to study educated milieu therapists’ experiences of their own vulnerability in their interactions with patients in mental health services. Materials and methods: The data collection method was focus-group interviews. Thirteen part-time master’s in mental health students (eight nurses, three social workers, two social educators) participated. All participants had experience with community or specialized mental health services (2–8 years). Results: The milieu therapists mainly related their experiences of vulnerability to negative feelings elicited by challenging work conditions, disclosed as two main themes: 1) “overloaded”, by the possibility of being physically and mentally hurt and the burdens of long-lasting close relationships; milieu therapists were extremely vulnerable because of their difficulty in protecting themselves; and 2) “shortcomings”, connected to feelings of despair associated with not acting in concordance with their professional standards and insecurity about their skills to handle challenging situations, which was a threat to their professional integrity. There seemed to be coherence between vulnerability and professional inauthenticity. A misunderstanding that professionalism refers to altruism seems to increase milieu therapist vulnerability. Conclusion: Vulnerability in health care is of interest to multiple disciplines, and is of relevance for knowledge development in higher education. Extended knowledge and understanding about milieu therapists’ vulnerability might strengthen their personal and professional integrity in professional practice in mental health services. Health care managers’ focus on the supervision of individual professionals in practice and practical training is important. Further research on the coherence between vulnerability and professionalism is recommended. Keywords: vulnerability, milieu therapists, mental health services, caring and therapeutic relationships, threat to professional integrity

• Gjengedal, Eva; Ekra, Else Mari Ruberg; Hol, Hege Bente; Kjelsvik, Marianne; Lykkeslet, Else & Michaelsen, Ragnhild K A [Show all 11 contributors for this article] (2013). Vulnerability in health care – reflections on encounters in every day practice. Nursing Philosophy. ISSN 1466-7681. 14(2), p. 127–138. doi: 10.1111/j.1466-769X.2012.00558.x. Show summary

  Vulnerability is a human condition and as such a constant human experience. However, patients and professional health care providers may be regarded as more vulnerable than people who do not suffer or witness suffering on a regular basis. Acquiring a deeper understanding of vulnerability would thus be of crucial importance for health care providers. This article takes as its point of departure Derek Sellman's and Havi Carel's discussion on vulnerability in this journal. Through different examples from the authors' research focusing on the interaction between health professionals and patients, existential, contextual, and relational dimensions of vulnerability are illuminated and discussed. Two main strategies in the professionals' interactions with patients are described. The strategy that aims at understanding the patients or families from the professional's own personal perspective oftentimes ends in excess attention to the professional's own reactions, thereby impairing the ability to help. The other strategy attempts to understand the patients or families from the patients' or families' own perspective. This latter strategy seems to make vulnerability bearable or even transform it into strength. Being sensitive to the vulnerability of the other may be a key to acting ethically.

• Michaelsen, Ragnhild K. A.; Vatne, Solfrid & Hollingen, Anne (2011). The plan became different : users’ experiences of working with web-based individual plan in community mental health care. Tidsskrift for psykisk helsearbeid. ISSN 1503-6707. 8(3), p. 217–226. Show summary

  This article focuses on user participation in the work with web-based individual plan, and is based on results from interviews of 9 users, who received the same education and support in the plan process as their professional coordinators. The project was a follow up of a larger study. The findings show that users who worked on their own pc experienced the training as future-oriented, and that they developed knowledge and skills that empowered them. Through this process, the individual plan became both like the instructions and different from them. The difference was that the plan contained a type of selfreflection, related to the users’ individual therapy that created more continuity in the therapy. Notes in the plan about difficult feelings and experiences also functioned as self-therapy. This can, according to the literature, be described as self-empowerment. The research material is small and we recommend that these findings are followed up in a more rigorous study.

• Michaelsen, Ragnhild Astad; Vatne, Solfrid & Hollingen, Anne (2007). Koordinatorrollen ved individuell plan i psykisk helsearbeid : fokus på brukermedvirkning og samarbeid. Norsk tidsskrift for sykepleieforskning. ISSN 1501-4754. 9(4), p. 15–28. Show summary

  This article presents findings from a study that focused on challenges professional coordinators met in collaboration with users of the health care and professionals from community mental health services. The aim was to facilitate user participation in the development and use of individual plans. Thirty-seven users with severe mental disorders and 19 coordinators (mental health nurses) in three small municipalities in the western part of Norway participated. The study was conducted within a participatory action research design, involving close collaboration between the researchers and the participants of the study. A subgroup of nine users together with their coordinators was educated to use internet-based individual plan software. Twelve of the coordinators, devided into three groups, were councelled by two of the researchers in monthly sessions. Data from these meetings were analysed using Kvale's content analysing method for qualitative data. Data from the users were collected through a survey. The coordinators expressed the presence of both qualitative and quantitative flaws concerning collaboration within the actual community service and between their psychiatric community services and the psychiatric institutions. The coordinators experienced obstacles to collaboration in terms of a conflict between their role as a mental health nurse and their role as a coordinator for the individual plan. They reported difficulties in motivating the users and in changing to a "non-expert" role as a mental health nurse. They also failed to fully acknowledge the rationale for using individual plans. Educating users in the data program and giving them support during the plan process, appeared to improve their participation and involvement

• Michaelsen, Ragnhild Astad & Vatne, Solfrid (2007). Det er enklere å være fri. In Gjengedal, Eva & Hanestad, Berit Rokne (Ed.), Å leve med kronisk sykdom : en varig kursendring. Cappelen Damm Akademisk. ISSN 978-82-02-24659-4. p. 261–272.
• Michaelsen, Ragnhild Astad (2001). Tilbake til samfunnet : psykiatriske langtidspasienters erfaringer i forbindelse med utflytting fra institusjon til egen bolig, Å leve med kronisk sykdom : en varig kursendring. Cappelen Damm Akademisk. p. 241–252.

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• Larsen, Hege; Kristoffersen, Steinar; Rokne, Berit; Haugen, Kjetil K. & Michaelsen, Ragnhild (2020). Høgskolen i Molde flørter med Høgskulen på Vestlandet. [Newspaper]. Khrono.no. Show summary

  Styret ved Høgskolen i Molde vedtok å gå videre med samtaler med Høgskulen på Vestlandet om fusjon eller samarbeidsavtale. Professor er skeptisk: — Det er ikke noe vits i å gifte seg nedover, sier han.

• Bachmann, Liv; Michaelsen, Ragnhild Karen Astad & Vatne, Solfrid (2017). "Would it be different if I was not there anymore?" Vulnerability described by a young person afflicted of anxiety and depression.
• Gjengedal, Eva; Bachmann, Liv; Ekra, Else Mari Ruberg; Høye, Magnhild Mjåvatn; Jørgensen, Else & Lykkeslet, Else [Show all 12 contributors for this article] (2017). Vulnerability as an existential challenge in chronic illness : a balance between self and others.
• Bachmann, Liv; Michaelsen, Ragnhild K A & Vatne, Solfrid (2016). Ensnared in the talk of the "They". Health professionals experiences of vulnerability in mental health services.
• Bachmann, Liv; Michaelsen, Ragnhild K A & Vatne, Solfrid (2016). Ensnared in the talk of the They. Milieu-therapists experiences of vulnerability in everyday practice in a mental health care context .
• Bachmann, Liv & Michaelsen, Ragnhild K A (2016). Sårbarhet hos miljøterapeuter i samhandlingssituasjoner.
• Bachmann, Liv; Michaelsen, Ragnhild K A & Vatne, Solfrid (2015). Health Care Professionals Vulnerability in Mental Health Care.
• Bachmann, Liv; Michaelsen, Ragnhild K A & Vatne, Solfrid (2015). Health Care Professionals Vulnerability in Mental Health Care.
• Michaelsen, Ragnhild K A; Skrondal, Torill Helene & Thylén, Ingela (2014). Implementering av forskningsbasert bacheloreksamen i sykepleie : prosess og erfaring. Nordisk tidsskrift for helseforskning. ISSN 1504-3614. 10(2), p. 160–170. Show summary

  Implementation of a research-based bachelor thesis in nursing – process and experiences Background: Ability to ensure quality and to evaluate own practice of nursing, is essential in order to practice a research based health care. An increase of research skills among future nurses, are thus central. The aim of this paper is to describe experiences connected with implementation of a new research-based model for examination of bachelor thesis in bachelor degree in nursing at Molde University College, Norway. Results: The curriculum has gained a clearer focus on science and research, and informative guidelines have been developed. The final bachelor thesis is now consisting of a systematic literature review based on scientific articles. The auditorium as a learning arena in the form of a thesis defence contributes to awareness of importance of research for nursing. Conclusion: The introduction of a new research based model for the bachelor thesis has strengthened the academic environment. Currently, Bachelor of Nursing has a clear focus on research and development. Newly qualified nurses are well placed to work knowledge based and to participate in development of clinical practice.

• Gjengedal, Eva; Lykkeslet, Else; Orøy, Aud Jorunn; Michaelsen, Ragnhild K A; Sundal, Hildegunn & Skrondal, Torill Helene [Show all 8 contributors for this article] (2010). Vulnerable groups’ experiences as basis for health care interaction. In Krycka, Kevin C (Eds.), 29th International Human Science Research Conference : Giving Voice to Experience. Seattle University, August 4-8, 2010. Seattle University College of Arts and Sciences. p. 17–17. Show summary

  Vulnerability is a characteristic of human existence. Therefore, it plays an important part in almost all human interaction, in particular with "significant others", like family members and health care workers. In the context of the health care system some patient groups are regarded as particularly vulnerable, and therefore represent a challenge for health care providers. For example, major mentally ill patients are regarded as a particularly vulnerable group. Research in mental health care has indicated that the professionals try to avoid conflicting situations with these patients, using various subtle or covert coercion strategies. Such strategies may be regarded as indistinct and non-therapeutic. An alternative approach would be to rely on empathy, self-reflection and self-limitation. Similar strategies may be found in other situations with other groups. The aim of the panel presentation is to give voice to the experiences of different groups who are considered as vulnerable and to professionals who are interacting with such groups. Potential patterns in the experiences across the groups will be elaborated. Finally, the aim is to discuss how knowledge about these experiences can contribute to improved interaction. There will be given a short presentation of four phenomenological qualitative studies of interactions with vulnerable groups along the lifespan. These groups are hospitalized children and their parents, persons with dementia, hospitalized mentally ill persons, and intensive care providers’ interaction with families to donor patients. Some findings from these studies will be presented as condensed descriptions illustrating experience of vulnerability and fragility as well as challenges related to interaction. Further, experiences with interactions across the different groups that seem to both fail and succeed will be visualized. Preliminary results indicate that taking vulnerable patients’ experiences into consideration may ease their situation and improve quality of health care. These preliminary findings will be further elaborated in the presentation.

• Berg, Jogeir; Michaelsen, Ragnhild Astad; Stavik, Gerd Unni & Berge, Dag Magne (2002). Mot dialog og deltakelse : foreldreerfaringer med ungdomsposten ved Psykiatrisk storavdeling, Sjukehuset i Molde. Møreforsking Molde. ISSN 82-7830-046-1. Show summary

  Rapporten tar opp og systematiserer foreldres erfaringer med Avdeling for yngre ved Psykiatrisk storavdeling, Molde sykehus. Den tar opp erfaringer gjort både før, under og etter innleggelse. Disse erfaringene tyder på at sykehuset har et forbedringspotensiale når det gjelder informasjon, dialog og samarbeid med pårørende. Funnene i rapporten vil bli brukt i et pågående videreutviklingsarbeid ved posten.

• Vatne, Solfrid; Berg, Jogeir; Michaelsen, Ragnhild; Stavik, Gerd Unni & Rød, Oddny (1999). "Det er enklere å være fri" : evaluering av livskvalitet hos tidligere langtidsinnlagte brukere av det psykiske helsevernet som nå bor i egen bolig. Møreforsking Molde. ISSN 82-7830-029-1.

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