Home care is a vital component of the United States healthcare delivery system. The demand for home care has steadily increased over the past decade and it is projected that this increase will continue over the next several decades. Moreover, the utilization of Medicaid waiver home and community-based care services has expanded to provide an alternative to the more costly institutional placement. In order to meet this growing demand while maintaining the cost-savings, the system relies primarily on the minimally trained, healthcare paraprofessionals known as Personal Care Assistants (PCAs). The present study examined the career commitment and job satisfaction of PCAs who provide Medicaid waiver home and community-based care services and participated in a 40-hour training intervention. Specifically, the study evaluated differences in pre- and post-training levels of career commitment as measured by the Career Commitment Measure (CCM), in terms of overall career commitment and the three subscales: career identity, career planning, and career resilience; and job satisfaction as measured by the Minnesota Satisfaction Questionnaire (MSQ), in terms of overall job satisfaction and the two subscales: extrinsic job satisfaction and intrinsic job satisfaction, between age groups and groups based on extrinsic job satisfaction. Additionally, the study examined the interaction of age and extrinsic job satisfaction as a moderator on the influence of the training intervention to produce a change in career commitment and the three subscales of career commitment, career identity, career planning, and career resilience job satisfaction. The results of analyses were varied across groups and measures. Specifically, there were no statistically significant differences across age group in terms of changes in career commitment or job satisfaction as a consequence of the training; however, post-hoc examinations revealed statistically significant within group changes. A decrease in the overall, intrinsic, and extrinsic job satisfaction score from pre- to post-training for the 40-49 age group was found. Likewise, the 50-59 age group showed a statistically significant decrease in the extrinsic job satisfaction scores from pre- to post-training. The PCA’s level of extrinsic job satisfaction did have a statistically significant differential effect on changes in overall career commitment and career planning scores as a consequence of the training. The exploration of the interaction of age and extrinsic job satisfaction to influence changes in career commitment as a consequence of the training found statistically significant main effects with respect to levels of extrinsic job satisfaction for overall career commitment, career identity, career planning, and career resilience. However, no main effects for age and no interaction effects were obtained. These study findings have important implications for future research, and the development of training curricula and evaluation. Results provide critical information about this largely overlooked group of healthcare paraprofessionals, which have practical application in more effectively improving job satisfaction through training initiatives, thereby increasing the recruitment and retention of the paraprofessional healthcare workforce.

Denna studies Syfte var att beskriva hur omvårdnadspersonal och sjuksköterskor på två särskilda boenden i en kommun i Mellansverige uppfattar sin egen och varandras yrkesroll, däribland uppfattningen av sjuksköterskors ledarskap. Detta syfte har speglats utifrån designen kvalitativ ansats där resultatet är övergripande beskrivande och Metoden för studien var halvstrukturerade, ämnesfokuserade intervjuer som analyserats genom kvalitativ innehållsanalys. Resultatet som framkommer i studien var att rollerna är svåra att definiera, de generella beskrivningarna är att sjuksköterskans ansvar ligger i det sjuka och förebygga ohälsa samt att omvårdnadspersonalens huvudansvar vilar i den basala omvårdnaden men båda yrkesgrupperna anser sig dela det preventiva arbetet, omvårdnadsteknik är omvårdnadspersonalens arbetsuppgift - men anses valbar och förväntningarna på respektive yrkesgrupp skiljer sig. Varken sjuksköterska eller omvårdnadspersonal anser att sjuksköterskan har några specifika uppgifter som ledare utöver att de ska fungera som handledare och stå för kompetenshöjning på avdelningen, däremot framkommer åsikter om att det finns en naturlig ledarroll inom den medicinska vården vid specifika situationer. Slutsatser i studien var att sjuksköterskorna uppvisar bredare kunskap om arbetsuppgifterna inom yrkesrollerna än vad omvårdnadspersonalen gör, förväntningarna på varandras ansvarsområden skiljer sig och båda grupperna verkar ovetandes om ansvaret sjuksköterskor har i ledanderollen. / The aim of this study was to describe how health care assistants and registered nurses perceive their own and each other’s work roles and also how they perceived registered nurses role as a leader. A qualitative descriptive design was used. The used method was semi-structured, topic-focused interviews that were analyzed through qualitative content analysis. The result of the study shows that it was difficult to define respectively work role, the general description is that the registered nurses responsibility lies within the area of diseases and prevention of illness. The health care assistant’s main responsibility is in the area of basic nursing care and also technical care, but both occupational groups considered preventive work as a shared responsibility and the expectations on respectively occupational group differ. Neither the registered nurses nor the healthcare assistants considered registered nurses as a leader, except in the role of a mentor and the responsibility to increase competence within the healthcare assistants group when needed. But it was found that registered nurse have a natural role as a leader regarding the medical care in specific situations. The conclusions of the study was that the registered nurses has a broader knowledge of the work tasks within the work role of the two professions compared to the health care assistants, the expectations of each other’s responsibilities differ and both groups seem unaware of the leading role that is incorporated in registered nurses responsibility.

The care of incurable ill seems to be a current topic because of modernization of health care curing today the states and diseases from which people used to die much earlier than today. From this reason, there is more and more incurably ill people and the role of nurse counsellor for the incurably ill is more and more significant. The nurse counsellor´ s task should be especially to be near the incurable ill and their families, to help them to orient themselves in this demanding situation, to provide important information and as the case may be to help them in the provision of more suitable care. Goals C1 have been set for this work ``To find out the idea the laic public has about the care in the situations after having found out that they would have been incurably ill``; C2: ``To find out the care assistant staff opinion on the possibility of utilizing the nurse counsellor in the care of incurably ill``; C3: ``To find out the possibilities of utilizing the nurse counsellor in the care of incurably ill`` and C4: `` To find out who should be the provider of counselling care after the client finds out that he is incurable ill``. Furthermore, hypotheses have been set H1: The counsellor nurse is able to intervene based on the problematic of the care being expressed by laic public in case of finding out an incurable illness``. H2: ``The care assistant staff does not consider the counsellor nurse´s role real because of not specified competences in the relevant legislation``. H3: ``The care assistant staff confuses the educator nurse´s role and the counsellor nurse´s role``. Qualitative-quantitative investigation has been conducted. In the qualitative part, the research set for the interview consisted of 4 nurses from oncological, surgical, out-patient and neurological department and 4 lays. The research set of the research investigation quantitative part consisted of 116 respondents: nurses from the subsequent care, out-patient, surgical, neurological and oncological department at the hospital Nemocnice České Budějovice, a. s. and at the St. J.N.Neumanna hospice in Prachatice; and further 112 respondents-lays. From the evaluated results, it can be concluded that both the nurses and lays are interested in a counsellor nurse whose utilization would be, however, problematic because of not specified competences in the legislation. Further on it is necessary to emphasise the dominant value ensued from the research investigation {--} the family``.

Syftet med studien var att undersöka och beskriva manliga undersköterskor och vårdbiträdens upplevelse av aktivitetsbalans. En kvalitativ design användes för att fokusera på individers levda erfarenheter och tankar. Insamlingen av data gjordes genom semistrukturerade intervjuer och analyserades med kvalitativ innehållsanalys. Totalt ingick tio deltagare i studien varav åtta undersköterskor och två vårdbiträden. Analysen resulterade i tre kategorier: Pandemins påverkan på aktivitet, Skiftarbetet sätter ramarna och Krav och egna val av aktiviteter. Resultatet visade att deltagarna över lag upplever en god aktivitetsbalans som kopplas till tillfredsställelsen av de aktiviteter som ingår i deras aktivitetsrepertoar samtidigt som de upplever sig ha tid till att genomföra dessa aktiviteter. Det som har påverkat deltagarnas aktivitetsbalans negativt har varit brist på tid för återhämtning mellan arbetspass i och med varierande arbetsschema samt den pandemin som pågick under studiens gång som lett till en förändring i aktivitetsmönstret. Författarna anser att mer forskning av mäns aktivitetsbalans utanför arbetet, med fokus på familjeliv och kravfyllda aktiviteter utanför arbetet behövs för att få en bättre bild av männens aktivitetsbalans. Författarna anser att kunskapen från denna studie kan vara till gagn för arbetsterapeuter som möter denna målgrupp för att förebygga ohälsa. Resultatet kan även vara till nytta för arbetstagare och arbetsgivare inom vården, politiker eller andra beslutsfattare för att få en bild av olika faktorers inverkan på aktivitetsbalans och hälsa.

The need for Registered Nurses (RNs) in the long-term care of older people is being questioned, particularly in the context of nursing shortages, while suggestions for 'professionalising' Care Assistant (CA) roles are emerging. Despite ongoing debates about the importance of their work, research has so far been unable to provide an evidence-base for the outcomes of the work of either RNs or CAs in UK care homes. Using a multi-method interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer, this qualitative research sought to illuminate the distinct contributions made by RNs and CAs to outcomes for older people in care homes. RNs and CAs from around the UK contributed 'significant' examples of their work for Phase 1 of the study and Phase 2 comprised researcher fieldwork (observation, interviews and documentary analysis) in three care homes around England. Participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. The findings offer a rich and detailed analysis of the realities of the work, much of which takes place 'behind closed doors' and has been described to a limited extent in the literature. They suggest that the CAs' daily support helps residents to function and to feel valued, and that close, reciprocal, family-type relationships develop. The health knowledge and clinical expertise of good RNs is critical in determining residents' health outcomes, particularly in the long-term, and RNs' 24-hour 'perceptual presence' can make life or death differences in acute or emergency situations. RNs also influence the environment, atmosphere and quality of care in the home. In the context of the literature, the findings offer new insights into the role and contribution of RNs and CAs, the outcomes of their work and the priorities of residents. The study produced new models of RN and CA roles in care homes, encompassing dimensions not previously acknowledged in the literature or their job descriptions, and a new framework within which the outcomes of care for older people could be evaluated. The research offers a positive image of work with older people in independent sector care homes.

Intern kriskommunikation syftar till kommunikation som sker inom en verksamhet i samband med en kris. Utan förberedelser för en välfungerande intern kriskommunikation, ökar risken för att krisen resulterar i stora konsekvenser för både verksamheten och dess anställda. Syftet med studien är att undersöka anställdas upplevelse av den interna kriskommunikationen under covid-19-pandemin, samt hur upplevelsen relateras till eventuella psykologiska kontraktsbrott. 12 semistrukturerade intervjuer med undersköterskor och vårdbiträden inom äldreomsorgen utfördes. Resultatet om informanternas upplevelse av den interna kriskommunikationen kan sammanfattas i tre teman; Motstånd eller samförstånd, Värdelös eller värdefull samt Reaktiv eller proaktiv. Beroende på hur den interna kriskommunikationen upplevts av den anställde, kan relationen till psykologiska kontraktsbrott sammanfattas i de två teman Bortglömd eller uppskattad samt Individ eller verksamhet. Resultaten diskuteras i relation till tidigare forskning om intern kriskommunikation och psykologiska kontraktsbrott, och bidrar med ny kunskap inom området.

Abstract The purpose of the study was to examine how personal assistants experience their psychological contract and how the psychological contract was fulfilled against their supervisor or manager.A qualitative method was used and seven interviews were conducted with personal care assistants from various workplaces. The interviews were analysed with thematic analysis and resulted in five main themes. Expectations, personal but not private, what really stands in the contract, how people look at the profession and fulfilment. In conclusion, the main result was that the personal care assistants experienced that the internal psychological contract consisted of the relation to the supervisor or manager and the accessibility to the employer. The personal care assistants felt that the contents of the external psychological contract consisted of the work duties, employment security, working hours and the attractiveness of the profession. The majority of the respondents felt that the internal and external psychological contract was fulfilled. None of the respondents considered that the internal and external psychological contract was not fulfilled at all.

This Diploma work consists of two parts, theoretical and practical. The theoretical part deals with characteristic features of ageing and changes connected with it. I also describe the adolescent development and complete this part with information of the study course called Health Care Assistant. The practical part is focused on research. The aim of this work has been to find out ambivalent attitudes of secondary health care school students to seniors. A technique of the semantic diferential was used in the field data collection. The students were asked to define their opinions and attitudes toward seniors in the scale of odd-numbered categories of lexically ambiguous word pairs, e.g. quick {--} slow, old {--} young.They were also free to express their opinions about seniors. Although there were significant differences in responds of 3ZA and 4ZA classes, the total findings have proved both hypotheses stated at the beginning. The students of secondary health care schools perceive seniors positively, on the other hand they consider them as sick people. It is obvious from the survey information that older students perceive seniors more positively than the younger ones who reported more negative attitudes toward seniors. The differences in student perception can be connected with the fact that four-year students have already passed their professional training in health care facilities. The research findings are supposed to be benefitial for professional subject teachers at secondary health care schools and for professional training mentors at health care facilities. The findings should lead to reconsidering methodical approaches to professional subject teaching and the subsequent implementation into the school educational programmes.

Titel: Attraktivt arbete inom äldreomsorgen - Vad kännetecknar en attraktiv arbetsplats för undersköterskor och vårdbiträden? Bakgrund och problematisering: Inom de närmaste åren kommer fler människor vara i behov av omvårdnadsinsatser. Detta på grund av att människan lever längre och därmed också har flera sjukdomsbilder och är i behov av en mer omfattande omvårdnad. Likväl som det finns behov av att rekrytera för att ersätta en stor pensionsvåg de närmaste åren, räknat till år 2026. Det finns en utmaning i att både behålla och attrahera nya medarbetare till äldreomsorgen, då yrket är kopplat till hårda arbetsförhållanden och låga löner. Vad som får medarbetarna att stanna inom yrket är att de ser det meningsfulla i arbetet med att hjälpa andra människor och är engagerade i sitt arbete. Syfte: Syftet med studien är att undersöka vilka faktorer som kännetecknar en attraktiv arbetsplats, för undersköterskor och vårdbiträden inom äldreomsorgen för att förklara och tills del kunna få förståelse hur de kan attraheras till samt behållas inom omvårdnadsyrket. Teoretisk referensram: Studien har inspirerats av modellen för attraktivt arbete. Modellen baseras på faktorer som anses av vikt för en attraktiv arbetsplats. Då modellen i grunden är omfattande har författarna till denna studie valt ut lämpliga delar som lämpar sig till att studera attraktiva faktorer inom äldreomsorgen. Tidigare forskning: Studien tar upp tidigare forskning som berör äldreomsorgens historia, olika synsätt, dess utmaningar och styrkor. Fokus för tidigare forskning berör undersköterskor och vårdbiträdens roll samt förutsättningar och vad som är bra och kan förbättras för att skapa en attraktiv arbetsplats som både kan behålla och attrahera nya medarbetare. Metod: Till studien har en kvantitativ metod använts, som har inspirerats av två andra studier som även de berör faktorer för en attraktiv arbetsplats och dess modell. Resultat och slutsatser: Studiens resultat visar på att relationer till kollegor och brukare värderas högt och gör att medarbetarna trivs på sin arbetsplats. Personalen känner engagemang i arbetet, samtidigt som det uppkommer känslor av otillräcklighet och stress. Studien visar på attraktiva faktorer som anses värdefulla. Faktorer som kan få medarbetare att stanna kvar i äldreomsorgen är; att det erbjuds större delaktighet i beslut, ett schema som medarbetaren känner sig bekväm med och högre lön. Det är också viktigt att känna en yrkesstolthet och att samhällets syn på att det är ett lågstatusyrke förändras och att det visas hur betydelsefulla och komplexa arbetsuppgifter som undersköterskor och vårdbiträden utför. / Title: Attractive work within elderly care – What characterizes an attractive workplace for assistant nurses and care assistants? Background and problematisation: Within a few years more elderly will be in need of some type of nursing care. This due to that mankind lives longer and have multiple diagnoses renders the need of more qualified nursing care. There is also a need to recruit new employees due to the large number of retirements coming up to the year 2026. There is a challenge in retaining and attract new employees to the elderly care though the profession has tough working conditions and low salaries. What makes employees stay in the profession is that they see the meaningfulness in helping other people and that they are well invested in their work. Purpose: The purpose with this study is to explain and to some extent grasp what characterize an attractive workplace for assistant nurses and care assistants within the elderly care to get an understanding how they can be attracted and retained in the elderly care profession. Theoretical reference frame: This study has been inspired by the model for attractive work. The model is based on factors that constitutes an attractive workplace. Due to the extensiveness of the mode, this study has chosen applicable factors to use within the elderly care system. Previous research: This study shows previous research that touches on the history, different approaches, challenges and strengths. Focus in on assistant nurses and care assistant's role and prerequisites. The study also looks at what perceives as good and what can be changed to the better to create an attractive workplace that can retain and recruit new employees. Method: This study has been inspired to use a quantitative method due to two other studies that used the model attractive work. Results and conclusions: The results show that the relationship between work colleges and caretakers are ranked high and is the cause to that employees thrive at the workplace. The employees feel commitment to the work but at the same time have emotions of insufficiency and stress. The study points to factors considered valuable for an attractive workplace. The factors could potentially make employees retain in elderly care if they are offered - greater participation in decisions, a work schedule that the employee fells comfortable with and higher salaries. It is also important to feel a professional pride and that the public view of a low status work is changed so they understand the importance and the complexity of the task that assistant nurses and care assistants within the elderly care performs

<p>Abstract</p><p>This essay is an investigation where I try to gain an increased knowledge of the three assistants’ (in the mentally disability profession) opinion about their education and their first years in their profession. I have also tried to answer the questions whether the course mentally disability/functional gives the students a good start in their profession, if there are any flaws or if something is missing in the course or if they can think of any improvements to make the course better.</p><p>This investigation is performed as a qualitative interview study where three women were interviewed about their education and their first years as assistants’ (in the mentally disability profession). All the interviewed women have been working in the care activity for two or three years since they graduated. The investigation shows that there is a great need for practical training for students on the mentally disability/functional disability course, since it leads to a better start in their profession. Since working as a assistant in the mentally disability is a profession which could be difficult to get accustomed to, the instructor plays an important role since the student really needs to learn how to take responsibility and participate as much as possible in the daily work which concerns mentally disabled people during their practical training.</p><p>Keyword: Vocational training, socialization* transition* that’s combine with care assistant, care nurse, practical nurse, secondary nurse, mental health and nurse assistant.</p> / <p>Sammanfattning</p><p>Denna uppsats är en undersökning där jag vill få en ökad förståelse kring tre omsorgsassistenters uppfattningar om utbildningen på omvårdnadsprogrammet och deras första tid i yrket. Jag har även försökt besvara frågorna om kursen utvecklingsstörning/funktionshinder ger studenterna en god start i yrket, om det finns några brister eller om något saknas samt om studenterna kan ge förslag på förbättringar som kan göra kursen bättre.</p><p>Denna undersökning är utförd som en kvalitativ intervjustudie där tre kvinnor intervjuas kring utbildningen och vidare ut i yrkeslivet. Samtliga av de intervjuade kvinnorna har arbetat i omsorgsverksamheten under två till tre år sedan slutförd utbildning. Undersökningen visar att det finns ett stort behov av praktik för studenter som väljer kursen med inriktningen utvecklingsstörning/funktionshinder, eftersom det leder till en god start i yrket. Då yrket som omsorgsassistent kan vara svårt att komma in i så har även handledaren en viktig roll, studenten behöver verkligen få lära sig att ta ansvar och delta så mycket som möjligt i det dagliga arbetet med utvecklingsstörda under sin praktik.</p><p>Nyckelord: Yrkesutbildning, socialization* transition* vilket kombinerats med care assistant, care nurse, practical nurse, secondary nurse, mental health och nurse assistant.</p>