Tina Lien Barken

• Mikkelsen, Hilde Elisabeth Timenes; Barken, Tina Lien; Rohde, Gudrun E.; Helseth, Sølvi & Skarstein, Siv (2026). Parental health literacy in parents of adolescents aged 16–19: a qualitative study. BMC Public Health. 26(1). doi: 10.1186/s12889-026-26471-9. Fulltekst i vitenarkiv Vis sammendrag

  Background: Parental health literacy is crucial for adolescent health outcomes — particularly during late adolescence, when teenagers take on greater health responsibility. There is a need for further research into parental health literacy and how parents access, understand, appraise, and apply health information, as this is vital for assisting their adolescents in making well-informed health decisions. This study aims to provide a deeper understanding of how parents of late-stage adolescents perceive their parental health literacy and to explore their experiences in transferring responsibility for health-related decisions to their adolescents. Methods: A study with a qualitative design was carried out using individual semi-structured interviews with 15 Norwegian parents of adolescents aged 16–19 years. Braun and Clarke’s reflexive thematic analysis was employed to analyze the data. Results: Three major themes were generated: (1) Transfer of health-related responsibility: from parental oversight to adolescent self-management, (2) parental health literacy and source credibility: navigating trustworthy information, and (3) enhancing parental health literacy to better support adolescents’ informed health decision‑making. Parents experience a shift as they balance their guidance with the adolescents’ growing autonomy. This involves selecting credible health information from digital platforms, healthcare professionals, and personal networks, underscoring the importance of parental health literacy in fostering adolescents’ informed decision-making and self-management of health. Conclusions: Parents of late‑stage adolescents are committed to supporting their children in managing health-related issues and to help develop adolescents’ capacity for autonomous health management, emphasizing the importance of parental health literacy. By facilitating the development of critical appraisal skills, and guiding informed decision-making, parents may contribute to strengthening adolescents’ competence and confidence in handling health-related matters more safely and independently. However, parents reported that losing access to their child’s health information after age 16 may hinder their ability to help. Empowering parents through strengthening their HL may improve individual and family health outcomes.

• Grøvle, Thorkildsen Thea; Karlsen, Cecilie & Barken, Tina Lien (2025). Sykepleieres erfaring med sykepleieteam i hjemmesykepleien – en kvalitativ studie. Sykepleien Forskning. ISSN 1890-2936. 20. doi: 10.4220/Sykepleienf.2025.100995. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn: Hjemmesykepleien står i dag overfor store utfordringer. Kombinasjonen av økende omsorgsbehov hos brukere, flere brukergrupper og kortere liggetid på sykehus stiller høyere krav til kompetansen til sykepleierne og organiseringen av tjenesten. De siste årene er forskjellige organiseringsmodeller blitt utarbeidet for å utnytte sykepleierressurser og kompetanse samt forbedre tjenestekvaliteten. Sykepleieteam er en måte å organisere hjemmesykepleien på. Det er forsket lite på erfaringer til sykepleiere som har arbeidet i sykepleieteam i hjemmesykepleien. Hensikt: Å få økt forståelse for sykepleieres erfaringer med å jobbe i et sykepleieteam i hjemmesykepleien. Metode: Studien har et kvalitativt forskningsdesign. Vi utførte semistrukturerte intervjuer av åtte sykepleiere som jobbet i sykepleieteam i prosjektperioden. Resultat: Tre hovedtemaer ble identifisert: «Oppgavedeling ga forutsigbarhet, men økt ansvar», «Definerte sykepleieoppgaver førte til bedre benyttelse av kompetanse, men ga fragmenterte pleie- og omsorgstjenester» og «Manglende ledelse og organisering førte til utfordrende samarbeid». Konklusjon: Sykepleieteam førte til forutsigbarhet ved oppgavedeling, men også økt ansvarsbyrde for sykepleierne i teamet. Kompetansen ble bedre benyttet ved at sykepleieoppgavene var bedre definert. Samtidig førte oppgavedelingen til fragmenterte pleie- og omsorgstjenester. Pasientnærheten og evnen til å kunne yte helhetlig omsorg ble utfordret. Manglende ledelse og organisering var også med på å gjøre samarbeidet i teamet krevende.

• Barken, Tina Lien & Robstad, Anja Nastasja (2023). Academic nurses transiton across an academic career: a qualitative study. Journal of Advanced Nursing. ISSN 0309-2402. doi: 10.1111/jan.15928. Fulltekst i vitenarkiv Vis sammendrag

  AimThe aim of this study was to gain a deeper understanding of nurse academics' experiences with the transition from clinical practice to academia and throughout their whole career trajectory.DesignQualitative study design.MethodsThree focus group interviews with 17 nurse academics employed at a University in Norway were conducted in May and June 2020. Data were analysed using qualitative content analysis.ResultsNurse academics experienced several diverse career transitions that continued throughout their whole career trajectory, affecting their daily life. Three interconnected themes were identified: ‘clinically confident, yet academically uncertain’, ‘balancing the academic role’ and ‘lost in academic transition’.ConclusionThis study contributes to a deeper understanding of nurse academics' experiences of transitioning into their academic role and identity. Transition was found not as separate occurrences but was described as several ongoing and concurrent processes throughout their whole career trajectory regardless of seniority level or academic experience. These transitions encompass shifts in identity, new responsibilities and increased tasks, yet often occur without adequate support. As a result, nurse academics may lack the essential skills and knowledge of the academic role.ImpactThis study provides insights into nurse academics' transition from clinical practice to academia and throughout their whole career trajectory. This is not a one-time occurrence but a continuous process that takes place throughout their entire career trajectory. This transition is embedded within a complex environment that requires careful consideration and attention. To address challenges regarding career transitions for nurse academics, universities should provide more training and preparation opportunities for all nurse academics when facing different career transitions.

• Barken, Tina Lien; Söderhamn, Ulrika & Thygesen, Elin (2019). A sense of belonging: A meta-ethnography of the experience of patients with chronic obstructive pulmonary disease receiving care through telemedicine. Journal of Advanced Nursing. ISSN 0309-2402. s. 1–12. doi: 10.1111/jan.14117. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Aim To synthesize the qualitative research in the literature addressing how patients with chronic obstructive pulmonary disease experience care received by telemedicine. Design Meta‐ethnography. Data Sources Twelve studies, published from 2013 – 2018, were identified by a search of relevant systematic databases in June 2017, including updated searches performed in June 2018. Review Methods The studies were reviewed and critically appraised independently by three researchers. The review followed the seven steps of meta‐ethnography developed by Noblit and Hare, including a line‐of‐argument synthesis. Results The synthesis revealed three second‐order constructs: presence, transparency, and ambivalence. Using a line‐of‐argument synthesis, a model was developed that showed patients’ experience of a sense of belonging when receiving care by telemedicine. Conclusion This meta‐ethnography contributes to the existing and contradictory evidence base of telemedicine to chronic obstructive pulmonary disease patients. It addresses and adds renewed understanding of who would benefit from telemedicine and why, by illustrating the interrelationship between the conditions of telemedicine care, the severity of COPD, and the need for connectedness and emphasizes that the need to belong in telemedicine care increases with the progression of illness burden and severity. Impact The present study endorses the view that the patients with a severe illness burden are likely to benefit the most when receiving care by telemedicine. However, the benefits rely on the fact that the telemedicine interventions involve emotional, social, and clinical support, including regular contact with healthcare professionals, to meet the requirements to belong.

• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2017). Advancing beyond the system: telemedicine nurses’ clinical reasoning using a computerised decision support system for patients with COPD – an ethnographic study. BMC Medical Informatics and Decision Making. 17(1). doi: 10.1186/s12911-017-0573-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Telemedicine is changing traditional nursing care, and entails nurses performing advanced and complex care within a new clinical environment, and monitoring patients at a distance. Telemedicine practice requires complex disease management, advocating that the nurses’ reasoning and decision-making processes are supported. Computerised decision support systems are being used increasingly to assist reasoning and decision-making in different situations. However, little research has focused on the clinical reasoning of nurses using a computerised decision support system in a telemedicine setting. Therefore, the objective of the study is to explore the process of telemedicine nurses’ clinical reasoning when using a computerised decision support system for the management of patients with chronic obstructive pulmonary disease. The factors influencing the reasoning and decision-making processes were investigated. Methods: In this ethnographic study, a combination of data collection methods, including participatory observations, the think-aloud technique, and a focus group interview was employed. Collected data were analysed using qualitative content analysis. Results: When telemedicine nurses used a computerised decision support system for the management of patients with complex, unstable chronic obstructive pulmonary disease, two categories emerged: “the process of telemedicine nurses’ reasoning to assess health change” and “the influence of the telemedicine setting on nurses’ reasoning and decision-making processes”. An overall theme, termed “advancing beyond the system”, represented the connection between the reasoning processes and the telemedicine work and setting, where being familiar with the patient functioned as a foundation for the nurses’ clinical reasoning process.Conclusion: In the telemedicine setting, when supported by a computerised decision support system, nurses’ reasoning was enabled by the continuous flow of digital clinical data, regular video-mediated contact and shared decision-making with the patient. These factors fostered an in-depth knowledge of the patients and acted as a foundation for the nurses’ reasoning process. Nurses’ reasoning frequently advanced beyond the computerised decision support system recommendations. Future studies are warranted to develop more accurate algorithms, increase system maturity, and improve the integration of the digital clinical information with clinical experiences, to support telemedicine nurses’ reasoning process.

• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2017). Unlocking the limitations: living with chronic obstructive pulmonary disease and receiving care through telemedicine – a phenomenological study. Journal of Clinical Nursing (JCN). ISSN 0962-1067. 27(1-2), s. 132–142. doi: 10.1111/jocn.1385. Fulltekst i vitenarkiv Vis sammendrag

  Aims and objectives: The aim of this study was to describe the lived experiences of quality of life among a group of patients living with chronic obstructive pulmonary disease (COPD) who were included in a telemedical intervention after hospitalization for disease exacerbation. Background: Patients with COPD have high symptom burden, poor control of symptoms, and a need for greater requirements in care. Telemedicine (TM) can provide benefits for patients with COPD by improving self-management. Design: Descriptive phenomenological approach. Methods: Ten in-depth interviews were conducted with COPD patients participating in a telemedical intervention. The collected data were analysed using a descriptive phenomenological research method. Results: Living with COPD was experienced as creating physical and mental limitations of the diseased body and an increasing identity as a patient, which led to impaired quality of life. Being included in the TM intervention increased accessibility to health care services and support from TM nurses. Self-measurement of health data increased participants’ clinical insight and created a mutual clinical language in dialog with TM nurses, which led to increased quality of life. However, receiving care through TM was also experienced as a dual chore. Accepted Article This article is protected by copyright. All rights reserved. Conclusions: TM can reduce the perceived limitations imposed by COPD through four key elements: 1) improving accessibility to health care services, 2) increasing support from health professionals, 3) strengthening clinical insight, and 4) developing a mutual clinical language; thus, increasing quality of life. The transparency facilitated through TM in this health care context encourages open decision-making, where the participants can increase their knowledge and improve acknowledgement of and collaboration with TM nurses. Relevance to clinical practice: TM can be beneficial when rethinking care for COPD by providing knowledge on how living with COPD can affect the experience of receiving care through TM and further determine for whom TM is useful. Keywords: chronic obstructive pulmonary disease, nursing, patient experience, phenomenology, quality of life, self-management, telemedicine

• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2016). Living with chronic obstructive pulmonary disease and being followed up through telemedicine-A phenomenological approach. Studies in Health Technology and Informatics. ISSN 0926-9630. 225, s. 926–927. doi: 10.3233/978-1-61499-658-3-926. Fulltekst i vitenarkiv Vis sammendrag

  Abstract. Chronic obstructive pulmonary disease (COPD) provides substantially reduced health related quality of life (HQoL). Telemonitoring on COPD patients appears to have a positive effect on improving HQoL. This study has a phenomenological approach, and ten informants, who were followed-up between 1 and 3 months in their own homes through telemonitoring of COPD symptoms, narrated their lived experiences of HQoL. The results show that the informants experienced safety and increased knowledge through the digital dialog (telemedicine) with expertise nurses, which indirectly improved their HQoL, and in term lead to increased mastery and control in managing their disease. Several studies show an increased HQoL, but the benefits are still limited and there is a need for further research.

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• Barken, Tina Lien; Haddeland, Kristine & Robstad, Anja Nastasja (2026). Litteraturstudie for bachelorstudenter. Cappelen Damm Akademisk. ISBN 9788202896263. 79 s. Fulltekst i vitenarkiv Vis sammendrag

  Litteraturstudie for bachelorstudenter – trinn for trinn er en arbeidsbok for deg som skal skrive bacheloroppgave med metoden litteraturstudie. Metoden er basert på vitenskapelige prinsipper og inspirert av systematikken fra forskningsmetoden systematisk litteraturstudie. Boka er bygd opp trinnvis slik at den kan brukes i arbeidsprosessen. I hvert kapittel forklares hva trinnet dreier seg om, hvorfor det er viktig å utføre dette trinnet og hvordan trinnet kan utføres. Innholdet presenteres på en kortfattet og praktisk måte, med gjennomgående eksempler. Boka er skrevet for bachelorstudenter, men kan også egne seg som støttelitteratur for masterstudenter.

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• Smaradottir, Berglind & Barken, Tina Lien (2025). Erfaringer fra VELTEK-prosjektetUtdanning på tvers av profesjoner og institusjonelle rammer. Fulltekst i vitenarkiv Vis sammendrag

  Agder satser på e-helse og velferdsteknologi og har distriktsvennlige og desentraliserte utdanningsløp på agendaen som regional kompetanseutvikling for å møte fremtidens ressursbehov med nye oppgaver og nye roller (Agder Fylkeskommune, 2019). Utdanningsprosjektet Velferdsteknologi på Agder (VELTEK) er et samarbeid mellom Fagskolen i Agder og Universitetet i Agder, med mål om å styrke kompetansen i vel-ferdsteknologi hos ansatte i kommunehelse-tjenesten. Prosjektets innovasjon er knyttet til modul-basert utdanning som gjennomføres på tvers av høyere yrkesfaglig utdanning og univer-sitet, gjennom å sette helsefagarbeidere og kandidater med 3-årig helse- og sosialfaglig bachelorutdanning i felles undervisning for å gi et samlet kompetanseløft innen velferds-teknologi.

• Grøvle, Thorkildsen Thea; Karlsen, Cecilie & Barken, Tina Lien (2025). Ny forskning: Teamorganisering gir både styrker og svakheter i hjemmesykepleien. [Journal]. Sykepleien. doi: https:/sykepleien.no/2025/08/ny-forskning-teamorganisering-gir-bade-styrker-og-svakheter-i-hjemmesykepleien. Fulltekst i vitenarkiv
• Marit, Fonn; Robstad, Anja Nastasja & Barken, Tina Lien (2024). Varsko til sykepleiere: – Noen av dere må bli sykepleielærere. [Internet]. Sykepleien.no. Fulltekst i vitenarkiv
• Barken, Tina Lien; Mikkelsen, Hilde Elisabeth Timenes; Gallefoss, Lisbeth; Haraldstad, Kristin & Andreasen, Eva Mari (2024). Ungdom trenger trygge helseråd. Fulltekst i vitenarkiv
• Barken, Tina Lien; Bonacina, Stefano; Bostad, Rune; Gabarron, Elia; Garcia, Beate Hennie & Haddeland, Kristine [Vis alle 25 forfattere av denne artikkelen] (2023). University campus as a smart technology-supported active learning arena. Septentrio Reports. ISSN 2387-4597. doi: 10.7557/7.7222. Fulltekst i vitenarkiv
• Barken, Tina Lien & Robstad, Anja Nastasja (2023). Fra sykepleier til akademiker. Fulltekst i vitenarkiv
• Barken, Tina Lien; Karlsen, Cecilie & Thygesen, Elin (2023). End conference project I2I. Fulltekst i vitenarkiv
• Barken, Tina Lien & Karlsen, Cecilie (2023). Implementering og tjenestevei KOMP i Arendal kommune. Fulltekst i vitenarkiv
• Karlsen, Cecilie & Barken, Tina Lien (2022). Digital solutions for social challenges. Fulltekst i vitenarkiv
• Karlsen, Cecilie & Barken, Tina Lien (2022). Fra ensomhet til sosial inklusjon- samskaping med eldre i Arendal kommune. Fulltekst i vitenarkiv
• Barken, Tina Lien & Karlsen, Cecilie (2022). Workshop med fokus på evaluering av komp og videre arbeid/implementering i regi av I2I prosjektet. Fulltekst i vitenarkiv
• Karlsen, Cecilie & Barken, Tina Lien (2022). Fra ensomhet til sosial inklusjon. Fulltekst i vitenarkiv
• Barken, Tina Lien (2022). Kvalitativ metode. Fulltekst i vitenarkiv
• Karlsen, Cecilie; Dugstad, Janne Herholdt; Barken, Tina Lien & Holmesland, Marianne (2021). Velferdsteknologiens ABC - Fra brukerbehov til ny løsning. I Standal, Kristin; Karlsen, Cecilie & Dugstad, Janne H (Red.), Velferdsteknologiens ABC. B: Fra brukerbehov til ny løsning. Nasjonalt velferdsteknologiprogram (KS Helsedirektoratet, Direktoratet for e-helse og Norsk helsenett). ISSN 9788293100942. Fulltekst i vitenarkiv
• Karlsen, Cecilie; Dugstad, Janne Herholdt; Eide, Tom & Barken, Tina Lien (2021). Velferdsteknologiens ABC - Etikk, lovverk, informasjonssikkerhet og personvern. I Standal, Kristin; Karlsen, Cecilie & Dugstad, Janne H (Red.), Velferdsteknologiens ABC. C: Etikk, lovverk, informasjons- sikkerhet og personvern. Nasjonalt velferdsteknologiprogram (KS Helsedirektoratet, Direktoratet for e-helse og Norsk helsenett). ISSN 9788293100959. Fulltekst i vitenarkiv
• Barken, Tina Lien (2021). Veiledning på kvalitativ metode på bachelor og masternivå. Fulltekst i vitenarkiv
• Barken, Tina Lien (2018). The disclosing dialogue of telemedicine care - COPD patients and nurses experience of telemedicine care. Fulltekst i vitenarkiv
• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2018). Å leve med KOLS og få oppfølging med telemedisin. BestPractice. Lungemedisin. 8, s. 13–15. Fulltekst i vitenarkiv
• Barken, Tina Lien (2017). Presentation PhD consortium SHI 2017. Fulltekst i vitenarkiv
• Barken, Tina Lien (2016). Deltakende observasjon på telemedisinsk sentral - mine erfaringer. Fulltekst i vitenarkiv
• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2016). Living with chronic obstructive pulmonary disease and being followed up through telemedicine – a phenomenological approach. Fulltekst i vitenarkiv Vis sammendrag

  Abstract. Chronic obstructive pulmonary disease (COPD) provides substantially reduced health related quality of life (HQoL). Telemonitoring on COPD patients appears to have a positive effect on improving HQoL. This study has a phenomenological approach, and ten informants, who were followed-up between 1 and 3 months in their own homes through telemonitoring of COPD symptoms, narrated their lived experiences of HQoL. The results show that the informants experienced safety and increased knowledge through the digital dialog (telemedicine) with expertise nurses, which indirectly improved their HQoL, and in term lead to increased mastery and control in managing their disease. Several studies show an increased HQoL, but the benefits are still limited and there is a need for further research.

• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2016). Nursing practice with triage decision making for COPD patients of a telemedicine centre – An ethnographic approach. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: The collaboration reform has increased the responsibility of Norwegian municipalities for health care services for patients with chronic diseases; whereas chronic obstructive pulmonary disease (COPD) represents a large group [1]. This change, associated to the reform, requires establishing new clinical pathways. Telemedicine (TM) has demonstrated potential in advanced nursing practice in terms of efficacy and quality of care [2]. Through TM, nurses can determine patient’s health status and follow-up supported by a decision aid software program. To date, there is little research investigating how nurses working in municipal health care services make clinical decisions based on a triage to assess COPD patient’s health status. This research presents an ethnographic study with three nurses working in a telemedicine center (TMC) in Southern Norway as part of a European project, namely United4Health. Patients used a tablet at home with video camera for video consultations and a pulse oximeter device for transference of clinical measurements (oxygen saturation and heart rate). The aim of the study was to investigate how nurses in a TMC using video consultations made decisions on COPD patient’s health status using triage as part of the decision making process. Methods: The data collection was made through participatory observations, field notes and focus group interview including three nurses working in a TMC from October 2015 to February 2016 in southern Norway. The collected data is currently being analysed using qualitative content analysis [3]. Results and discussion: Preliminary results showed that nurses working in the TMC found the triage useful as part of the decision making process that allowed identifying health problems and prioritising the patients need for help. However, the nurses often used workarounds and made decisions according to their own knowledge and experience when interpreting the software recommendation; in these cases, the triage model was seen just as guidance. In addition, this interpretation was not only based on the daily triage assigned to each patient, but also on the content of past triaging and earlier nurses’ documentation for each patient. This indicated that triaging a chronic patient is complex, time consuming and relies on the nurses’ previous knowledge concerning both patients’ medical history and life. Furthermore, video consultation was important for the nurses as a visualisation of the patient, and it was a significant additional component to the triage recommendation and nurses’ own decision. Video consultation follow-up was often replaced by telephone calls because of frequent technical problems. This led to important visual information for the decision making process was not possible to be observed by nurses, which could have negatively influenced the decision outcome. References: [1] Report No. 47. The Coordination Reform: Proper treatment – at the right place and right time 2008-2009: Oslo: Ministry of Health and Care Services. [2] Reed K. Telemedicine: Benefits to Advanced Practice Nursing and the Communities They Serve. Journal of the American academy of nurse practitioners 2005: 17(5) 176-180. [3] Graneheim UH and Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 2003: 24: 105112.

• Barken, Tina Lien; Thygesen, Elin & Söderhamn, Ulrika (2016). Nursing practice with triage decision making for COPD patients of a telemedicine centre – An ethnographic approach. International Journal of Integrated Care (IJIC). 16(5), s. S3–S3. doi: 10.5334/ijic.2547. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: The collaboration reform has increased the responsibility of Norwegian municipalities for health care services for patients with chronic diseases; whereas chronic obstructive pulmonary disease (COPD) represents a large group [1]. This change, associated to the reform, requires establishing new clinical pathways. Telemedicine (TM) has demonstrated potential in advanced nursing practice in terms of efficacy and quality of care [2]. Through TM, nurses can determine patient’s health status and follow-up supported by a decision aid software program. To date, there is little research investigating how nurses working in municipal health care services make clinical decisions based on a triage to assess COPD patient’s health status. This research presents an ethnographic study with three nurses working in a telemedicine center (TMC) in Southern Norway as part of a European project, namely United4Health. Patients used a tablet at home with video camera for video consultations and a pulse oximeter device for transference of clinical measurements (oxygen saturation and heart rate). The aim of the study was to investigate how nurses in a TMC using video consultations made decisions on COPD patient’s health status using triage as part of the decision making process. Methods: The data collection was made through participatory observations, field notes and focus group interview including three nurses working in a TMC from October 2015 to February 2016 in southern Norway. The collected data is currently being analysed using qualitative content analysis [3]. Results and discussion: Preliminary results showed that nurses working in the TMC found the triage useful as part of the decision making process that allowed identifying health problems and prioritising the patients need for help. However, the nurses often used workarounds and made decisions according to their own knowledge and experience when interpreting the software recommendation; in these cases, the triage model was seen just as guidance. In addition, this interpretation was not only based on the daily triage assigned to each patient, but also on the content of past triaging and earlier nurses’ documentation for each patient. This indicated that triaging a chronic patient is complex, time consuming and relies on the nurses’ previous knowledge concerning both patients’ medical history and life. Furthermore, video consultation was important for the nurses as a visualisation of the patient, and it was a significant additional component to the triage recommendation and nurses’ own decision. Video consultation follow-up was often replaced by telephone calls because of frequent technical problems. This led to important visual information for the decision making process was not possible to be observed by nurses, which could have negatively influenced the decision outcome. References: [1] Report No. 47. The Coordination Reform: Proper treatment – at the right place and right time 2008-2009: Oslo: Ministry of Health and Care Services. [2] Reed K. Telemedicine: Benefits to Advanced Practice Nursing and the Communities They Serve. Journal of the American academy of nurse practitioners 2005: 17(5) 176-180. [3] Graneheim UH and Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today 2003: 24: 105112.

• Barken, Tina Lien (2015). Telemedisinsk oppfølging av pasienter med KOLS - relevans for helseforskning. Fulltekst i vitenarkiv
• Barken, Tina Lien (2015). Telemedisinsk oppfølging av pasienter med KOLS. Fulltekst i vitenarkiv
• Barken, Tina Lien; Söderhamn, Ulrika & Thygesen, Elin (2019). The humanistic perspective of telemedicine care - COPD patient' and nurses' expereiences of receiving/providing telemedicine care. Universitetet i Agder. ISSN 9788271179427. Fulltekst i vitenarkiv Vis sammendrag

  Background: Chronic obstructive pulmonary disease (COPD) is a serious and progressive disease, entailing chronic, acute and life-threatening illness occurrences with considerable negative impacts on those living with the disease. For patients, nurses and health care systems (HCSs), this disease demands increased care and support in terms of continued, coordinated and routine followup. Telemedicine (TM) has shown to have a positive influence on the COPD care; however, there are still contradictions in its use. As TM plays a great role in the global health care delivery, it will be important to develop a strong knowledge base and to further explore how patients with COPD and nurses experience receiving/providing TM care. Aim: The overall aim of this thesis was to explore and contribute to new knowledge and increase our understanding of the experiences of the patients suffering from COPD and nurses receiving/providing care through TM. Design and methods: Three papers were conducted using several qualitative research methods. In Paper I, ten in-depth interviews were conducted with COPD patients receiving care through TM. The data were analysed using a descriptive phenomenological research method. Paper II used an ethnographic approach, combining different data collection methods, such as participatory observations, the think-aloud (TA) technique and a focus group interview with TM nurses. The collected data were analysed using qualitative manifest and latent content analysis. Papers I and II were carried out according to the framework of a TM intervention. A meta-ethnographic approach was used in Paper III to collect and synthesise the qualitative papers containing the COPD patients’ experiences of receiving care through TM. Twelve papers, published from 2013 to 2018, were included. Findings: The patients with COPD experienced a sense of belonging when receiving care through TM, which was grounded in two fundamental conditions: presence and transparency, providing emotional, social and clinical support. The experience of the TM nurses showed that the fundamental development of ‘knowing the patient’, gained through reasoning and decision-making processes, directly impacted the care and guidance of the patients. Hence, the experiences of the patients with COPD and the TM nurses in the receiving/providing care process of TM were based on the relational connection made possible by the TM ii technology. The TM technology provided a close nurse-patient connection. The human-to-human connection in the TM care was fundamental, whereby the dialogue was necessary to increase the COPD patients’ experience of belonging and for the TM nurses to advance their clinical and personal knowledge, with a view to strengthening the nurse-patient relationship. However, the patients with severe and/or unstable/progressive COPD were found to benefit most from the TM care. Conclusions: The human-to-human connection was identified as an essential element for the patients’ experience of belonging in the TM care and for the TM nurses to acquaint themselves with the patients. Hence, this thesis offers three main conclusions. First, high severity of COPD increased the need for connection and belonging in the TM care. This is an important contribution to the existing, albeit contradictory, evidence base, as it contributes to a renewed understanding of who would benefit from TM and why. Second, the TM technology enabled close yet distant TM encounters, where nurses and patients learnt from each other through dialogue, contributing to the well-being and more-being of the COPD patients and increasing the clinical and personal knowledge of the TM nurses. Finally, a humanistic connection of care was obtained by the dialogical act of nursing through the TM care; hence, the dialogue became the caring act of the TM care.

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