The life expectancy in Sweden is higher than ever, and the share of the population that is over 65 years old is steadily increasing. Also on the rise in Sweden is the number of persons over 65 years old that abuse alcohol. To handle this growing problem the authorities of Sweden need to cooperate efficiently. This paper aims to study how social workers within the social services and the elder care in the two municipalities Botkyrka and Haninge experience cooperation inbetween their organisations, and what they experience to be the key elements to succesful cooperation. Axelsson and Axelssons theoretical model of cooperation, coupled with previous studies are used to formulate themes which in turn are used for a thematic analysis of the gathered empirical data consisting of 12 interviews. The results indicate that Botkyrkas social workers experience a lower amount of cooperation than Haninges and that communication, information, distinct rules and a sufficient, common budget are the key elements to succesful cooperation. / Livslängden i Sverige är högre än någonsin, och andelen av befolkningen som är över 65 år ökar stadigt. Antalet personer över 65 år som missbrukar alkohol stiger även det i Sverige. För att hantera detta växande problem måste Sveriges myndigheter samarbeta effektivt. Syftet med denna uppsats är att studera hur socialarbetare inom socialtjänsten och äldrevården i de två kommunerna Botkyrka och Haninge upplever samarbete mellan sina förvaltningar och vad de upplever vara de viktigaste förutsättningarna för ett framgångsrikt samarbete. Axelsson och Axelssons teoretiska samverkansmodell kombinerad med tidigare forskning används för att formulera teman som i sin tur används för en tematisk analys av de samlade empiriska data som består av 12 intervjuer. Resultaten tyder på att Botkyrkas socialarbetare upplever mindre samverkan än Haninges och att kommunikation, information, tydliga regler och en tillräcklig gemensam budget är de viktigaste förutsättningarna för framgångsrik samverkan.

Abstract The aim of the study was to determine nursing staff’s self-assessment of how they adhere to guidelines on safe medication administration during the medication process in long-term elderly care. In the first phase of this quantitative study, a Safe Medication Management Scale was developed and its reliability was evaluated. A panel of experts (n = 7) determined the scale’s content and the structure of its items. A pilot study was conducted with nursing staff from long-term elderly care wards in one town in northern Finland. The response rate was 24 % (n = 69). In the second phase, a cross-sectional study was conducted among nursing staff from long-term elderly care wards in one hospital district in Finland. The response rate was 39 % (n = 492). The majority of the nurses reported always adhering to guidelines during the medication process. However, one third of the nurses stated that they do not always follow guidelines when preparing medication, and approximately half stated that they do not always follow guidelines when administering medication. Shortcomings were identified in medication documentation, especially in the recording of the effects of medicine and the reason for administration. Routine checks were not always performed at different stages of the medication administration process. Also, patient involvement in the medication administration process was not always completed. Statistically significant associations were detected between the responses and the nurses’ self-assessment of how well they follow recommendations in general, as well as their knowledge of pharmacology and infection control, and their skill in performing medication calculations. A statistically significant association was detected in the age of the nurses; older age groups followed guidelines more thoroughly than younger age groups. When nurses self-assessed their activities in general at a higher level, they seemed to also follow guidelines better. Deviation from instructions and recommendations relating to the administration of medicines often leads to a medication error or creates an opportunity for errors to occur. The results of this study can be used to improve medication safety in long-term elderly care through the development of medication administration processes in organizations as well as the attitudes and competence of nursing staff so that medication is always given in accordance with instructions and recommendations. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää lääkehoidon turvallista toteuttamista ikääntyneiden pitkäaikaishoidossa lääkehoitoon osallistuvan hoitohenkilöstön näkökulmasta. Tämän kvantitatiivisen poikkileikkaustutkimuksen ensimmäisessä vaiheessa kehitettiin lääkehoidon turvallisen toteuttamisen itsearviointimittari ja arvioitiin sen luotettavuutta. Mittarin sisällön validiuden arvioinnissa hyödynnettiin asiantuntijapaneelia (n = 7). Esitestaus tehtiin yhden kuusikkokunnan kunnallisissa ikääntyneiden pitkäaikaishoidon yksiköissä (n = 18). Vastausprosentti oli 24 % (n = 69). Toisen vaiheen perusjoukon muodostivat yhden sairaanhoitopiirin kunnallisten ikääntyneiden pitkäaikaishoidon yksiköiden lääkehoitoon osallistuvat hoitohenkilöstöt. Vastausprosentti oli 39 % (n = 492). Suurin osa hoitajista toteutti lääkehoitoa turvallisesti. Kuitenkin kolmannes hoitajista arvioi, että he eivät aina saata lääkkeitä käyttökuntoon ohjeiden ja suositusten mukaisesti. Lähes puolet arvioi poikkeavansa ohjeista ja suosituksista koskien lääkkeiden antamista ja lääkehoidon vaikutusten seurantaa ja arviointia. Kirjaamisessa havaittiin puutteita erityisesti lääkehoidon vaikutusten ja lääkkeen antamisen syiden kirjaamisessa. Rutiininomaisia tarkistuksia ei aina tehty lääkehoidon prosessin vaiheissa. Potilaan osallistaminen lääkehoidon prosessiin ei arviointien mukaan myöskään aina toteutunut. Mitä paremmin hoitaja koki hallitsevansa farmakologian, infektioiden torjunnan ja lääkelaskennan, sitä paremmin hän myös näytti toteuttavan lääkehoitoa. Hoitajan iällä havaittiin tilastollisesti merkitsevä yhteys lähes kaikkien osa-alueiden kanssa; iältään vanhemmat toteuttivat lääkehoitoa huolellisemmin suosituksia ja ohjeistuksia noudattaen kuin nuoremmat. Mitä paremmaksi hoitajat itsearvioivat toimintansa yleisesti, sitä paremmin he näyttivät vastausten perusteella toteuttavan lääkehoitoa. Kun lääkehoidon ohjeista ja suosituksista poiketaan, aiheuttaa se usein lääkityspoikkeaman tai sen mahdollisuuden. Poikkeama voi aiheuttaa myös lääkehaittatapahtuman. Tässä tutkimuksessa tuotetun tiedon avulla ikääntyneiden pitkäaikaishoidon lääkitysturvallisuutta voidaan parantaa kehittämällä sekä yksikön lääkehoidon toteuttamisen prosesseja, että hoitohenkilöstön lääkehoidon asenteita ja osaamista sellaisiksi, että lääkehoitoa toteutetaan kaikissa tilanteissa ohjeistusten ja suositusten mukaisesti.

<p>The overall purpose with this study was to examine the influence elderly people have over their granted home help. Specifically, the aim was to examine in what extent the image of the elderly as a <em>unique individual</em> emerges in the plans where the home help is described [“genomförandeplaner”]. A plan which is personally designed is used as an indicator of personal influence. A text analysis inspired by Michel Foucault’s discourse concept, was carried out and the study adopts the concepts <em>standardization</em> and <em>categorization</em> as well as the theory of “Sense of coherence”. The result showed that the content of the plans mainly lacks a personal imprint, which is to be understood as a form of standardization. Furthermore, the analysis reveals that the content that is excluded and included creates an image of the elderly as someone who is not a unique individual. This study highlights the value of establishing more salutogenic infused plans. Also other studies, emphasize that elderly in need of care wants to be able to predict and influence the help they receive, which in turn is a condition for the elderly to achieve a Sense of coherence.</p>

<p>The progress of the health among the elderly has a major meaning for the needs of care, nursing and social services. The health of the elderly has improved but fall and fall accidents are a major problem. Acute diseases, activities and environment risks are often related to fall accidents. The aim of the study was to describe health care staffs’ opinions about fall risk and fall prevention. The study had a qualitative approach with a descriptive design. Twelve persons from a primary healthcare centre, a hospital and a community elder care unit in the middle of Sweden were interviewed. The material was analyzed through qualitative content analysis and data from the interviews resulted in two categories; The category “Factors contributing to falls” was formulated from the subcategories; The older persons health status and their care needs, Physical environment, Lack of competence among staff, Lack of time, stress and insufficient staffing, Staffs’ responsibilities and not followed routines and Insufficient cooperation between professional groups. The category “Factors preventing falls” was formulated from the subcategories; Physical environment and physical aid, Competence and fall risk assessment instruments, Different professionals’ responsibilities and Cooperation between different professionals. The results showed that the health care staff viewed several factors, which according to them contributed to falls as well as prevented falls. Cooperation between different professionals, increased competence and use of systematic fall risk assessment instruments were mentioned resulting in advantages for the patient.</p> / <p>Utvecklingen av de äldres hälsa har stor betydelse för behoven av vård och omsorg. Hälsan för äldre har förbättrats men fall och fallskador är ett stort problem och akuta sjukdomar, aktiviteter och omgivningsfaktorer är ofta utösande orsaker till fall. Syftet med denna studie var att beskriva vårdgivares uppfattning om fallrisker och fallprevention. Metoden var en kvalitativ intervjustudie med en beskrivande design. Tolv personer har intervjuats från hälsocentral, sjukhus och kommunalt äldreboende i ett län i Mellansverige. Resultatet redovisas utifrån två kategorier. Kategorin ”Faktorer som kan bidra till fall” framkom ur subkategorierna; Patientens tillstånd och omvårdnadsbehov, Fysisk miljö, Brist på kunskaper hos vårdpersonalen, Tidsbrist, stress och otillräcklig bemanning, Personalens ansvar och att inte följa rutiner samt Otillräcklig samverkan mellan yrkesgrupper och vårdnivåer. Kategorin ”Faktorer som kan motverka fall/fallprevention” framkom ur subkategorierna; Fysisk miljö och hjälpmedel, Kunskaper och utveckling av ett systematiskt arbetssätt, Ansvaret hos olika yrkeskategorier samt Samverkan. Resultatet i studien visade att det finns flera olika faktorer kring en patient som kan bidra till fall och som kan motverka fall. Samverkan mellan olika vårdnivåer, kunskaper och utveckling av ett systematiskt arbetssätt framkom som viktiga faktorer till fördel för patienten.</p>

<p></p><p>BAKGRUND: Antalet multisjuka äldre personer ökar och ett omfattande vårdbehov kan skönjas. Vårdens organisation och hur den fylls med innehåll påverkar relationen till patienten. Ledarskapsstilen påverkar upplevd arbetstillfredsställelse och den kultur som vårdpersonalen skapar tillsammans avgör livskvalitet och vårdandets kvalitet för patienten. SYFTE: Syftet med studien är att utifrån semistrukturerad observation beskriva arbetsinnehållet och ledarskap för en första linjens chef inom kommunal äldreomsorg. METOD: En fallstudie, a single case study, med semistrukturerad observation av en första linjens chef inom kommunal äldreomsorg. Studien hade en deskriptiv design med en kvalitativ ansats. Observatörens nedskrivna texter analyserades med latent innehållsanalys. RESULTAT: Utförande av arbetsuppgifter hade genomgående karaktär av ledarskap. Administration och organisering av arbete var en stor del av arbetsuppgifterna och övervägande var oplanerade. Ansvarstagande, problemlösning, bekräftelse, tjänstvillighet och organisering av arbete där personlighet, kunskap och yrkeserfarenhet påverkade ledarskapet och informantens upplevelse av utförandet av arbetsuppgifter. SLUTSATS: En första linjens chefs arbetsuppgifter är mångfacetterande och spänner sig över kvalificerat arbete där specifik utbildning krävs och till att serva boende och däremellan ge direktiv och organisera för att få arbetet utfört samt medverka vid möten med ledning och chefsgrupp. En dialog som exempelvis öppet informerar om förändringar och varför samt att medarbetare accepterar och samarbetar för att underlätta arbetet där perspektivet utgår från den boende vilket skulle påverka vårdkulturen i positiv riktning och öka möjligheten till en kreativ och livsbejakande miljö kring den boende.</p>

<p>In the Swedish elderly-care sector the institutions are of different character and the kind of care and food-supply they offer vary in scope and intensity. The aim of this study was to analyse how food and meals were handled and provided to the elderly living within those situations and in this context, how food was expressed as a substance or/and in symbols. This study focus on the social organisation that embraces the diet of the elderly and shapes the provisions of their meals, on the norms, values and behaviours of the different social identities in the organisation. The empirical work included in-depth interviews and participant observations in four different residential care homes, including various hierarchical levels, i.e. politicians and different personnel, in the organisation of food-supply to the elderly. In each care home different types of care and food-supply were studied, i.e. elderly having their meals in 24hour care, partime day care and those who ate in the restaurants. Generally, provision of meals was routine and meals were planned, prepared and served with little or no attention to what substanse and symbol it brought to the elderly. The elderly had limited possibilities to influence their own meals and those with the largest need of care, being the most fragile and sick had the least influence. The views of politicians and different personnel indicated that they considered themself powerless, which resulted in a "freedom of responsibility". It was obvious that there existed a clear discrepancy between how the informants considered the provision of food and meals should be organised and carried out, in comparison to reality. The current unsatisfactory provision of meals to the elderly is attributed to the marginalisation of specifically three areas: the symbolic value of food, the life and needs of the elderly and the traditional knowledge and experiences of women in their role as housewife and carer of the family.</p>

In the Swedish elderly-care sector the institutions are of different character and the kind of care and food-supply they offer vary in scope and intensity. The aim of this study was to analyse how food and meals were handled and provided to the elderly living within those situations and in this context, how food was expressed as a substance or/and in symbols. This study focus on the social organisation that embraces the diet of the elderly and shapes the provisions of their meals, on the norms, values and behaviours of the different social identities in the organisation. The empirical work included in-depth interviews and participant observations in four different residential care homes, including various hierarchical levels, i.e. politicians and different personnel, in the organisation of food-supply to the elderly. In each care home different types of care and food-supply were studied, i.e. elderly having their meals in 24hour care, partime day care and those who ate in the restaurants. Generally, provision of meals was routine and meals were planned, prepared and served with little or no attention to what substanse and symbol it brought to the elderly. The elderly had limited possibilities to influence their own meals and those with the largest need of care, being the most fragile and sick had the least influence. The views of politicians and different personnel indicated that they considered themself powerless, which resulted in a "freedom of responsibility". It was obvious that there existed a clear discrepancy between how the informants considered the provision of food and meals should be organised and carried out, in comparison to reality. The current unsatisfactory provision of meals to the elderly is attributed to the marginalisation of specifically three areas: the symbolic value of food, the life and needs of the elderly and the traditional knowledge and experiences of women in their role as housewife and carer of the family.

The overall purpose with this study was to examine the influence elderly people have over their granted home help. Specifically, the aim was to examine in what extent the image of the elderly as a unique individual emerges in the plans where the home help is described [“genomförandeplaner”]. A plan which is personally designed is used as an indicator of personal influence. A text analysis inspired by Michel Foucault’s discourse concept, was carried out and the study adopts the concepts standardization and categorization as well as the theory of “Sense of coherence”. The result showed that the content of the plans mainly lacks a personal imprint, which is to be understood as a form of standardization. Furthermore, the analysis reveals that the content that is excluded and included creates an image of the elderly as someone who is not a unique individual. This study highlights the value of establishing more salutogenic infused plans. Also other studies, emphasize that elderly in need of care wants to be able to predict and influence the help they receive, which in turn is a condition for the elderly to achieve a Sense of coherence.

 BAKGRUND: Antalet multisjuka äldre personer ökar och ett omfattande vårdbehov kan skönjas. Vårdens organisation och hur den fylls med innehåll påverkar relationen till patienten. Ledarskapsstilen påverkar upplevd arbetstillfredsställelse och den kultur som vårdpersonalen skapar tillsammans avgör livskvalitet och vårdandets kvalitet för patienten. SYFTE: Syftet med studien är att utifrån semistrukturerad observation beskriva arbetsinnehållet och ledarskap för en första linjens chef inom kommunal äldreomsorg. METOD: En fallstudie, a single case study, med semistrukturerad observation av en första linjens chef inom kommunal äldreomsorg. Studien hade en deskriptiv design med en kvalitativ ansats. Observatörens nedskrivna texter analyserades med latent innehållsanalys. RESULTAT: Utförande av arbetsuppgifter hade genomgående karaktär av ledarskap. Administration och organisering av arbete var en stor del av arbetsuppgifterna och övervägande var oplanerade. Ansvarstagande, problemlösning, bekräftelse, tjänstvillighet och organisering av arbete där personlighet, kunskap och yrkeserfarenhet påverkade ledarskapet och informantens upplevelse av utförandet av arbetsuppgifter. SLUTSATS: En första linjens chefs arbetsuppgifter är mångfacetterande och spänner sig över kvalificerat arbete där specifik utbildning krävs och till att serva boende och däremellan ge direktiv och organisera för att få arbetet utfört samt medverka vid möten med ledning och chefsgrupp. En dialog som exempelvis öppet informerar om förändringar och varför samt att medarbetare accepterar och samarbetar för att underlätta arbetet där perspektivet utgår från den boende vilket skulle påverka vårdkulturen i positiv riktning och öka möjligheten till en kreativ och livsbejakande miljö kring den boende.

The aim of this study is to describe and analyse three different discourses on elderly care, as they emerge in statements from care staff and research. Each discourse centres on a sign, or pair of signs: care, education/professional competence, and the elderly/ageing. Drawing its main inspiration from Laclau and Mouffe, and Foucault, the analysis is made with regard to how the discourses are constructed, what they include and exclude. The discourse on care interconnects family, homeliness and mutuality. Empathy, a good attitude, family ideals endow elderly care with distinctly feminine connotations. Theoretical concepts such as rationality of care and an almost exclusive research focus on women’s work have tended to construct the same nexus. Unknowingly, or sometimes despite intentions, the discourse in this way reproduces conservative gender roles. A discourse on ‘anti-care’, exemplified by disorganisation and incompetent management, is also created and invested with responsibility for shortcomings. The discourse on education and professional competence centres on claims to medical and executive tasks by nurses, the struggle against deprofessionalisation of assistant nurses, and the attempt of nurse aids to resist categorisation as ‘anybody’. Education/training are considered important to raise work status, but also leading to an instrumental attitude and distance from the core of the occupation – care. The discourse on the elderly and ageing characterises them as lonely and depressed. Also being violent and ungrateful, their behaviour undermine the notion of mutuality. Social interaction and outdoor walks are presented as means to improve their situation. Fundamental to the discourse is an ambiguous approach to ageing as both natural and something to be deferred. Ageing is further presented as decivilisation process, in which gradual loss of control over the body is also a loss of human-ness. The body is, paradoxically, what both defines and disqualifies the elderly as fully human. The depersonalising and biographing procedures of elderly care, sequential but overlapping, display its proximity to Goffman’s total institution and Foucault’s panopticon. Conversation plays an important disciplinary part in encouraging the elderly to want to do right, i.e., be socially active, and avoid amoral or asocial habits like drink, sex or solitude.