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published_or_final_version / Gerontology / Master / Master of Social Sciences

Denna studie har undersökt professioners lärande inom äldreomsorg, förskola och musikskola i det tillfälliga nätverket "sång- och musikstunden" som är en del av projektet "Barn och äldre sjunger tillsamman". Studien är inspirerad av Aktör-nätverksteorin. Studiens är kvalitativ och data har insamlats med hjälp av intervjuer och observationer. Studien har studerat samspelet mellan mänskliga och icke-mänskliga aktanter och hur dessa påverkat det tillfälliga nätverket. Resultatet visar på att aktanterna har betydelse för hur kommunikationen uppstår i det tillfälliga nätverket. Studien har också visat att det tillfälliga nätverket bidragit till lärande hos professionerna som deltagit. / This study examined professions learning in elderly care, kindergarten and music school in the temporary network "song- and music time" as part of the project "Children and the elderly are singing together" The study is inspired by actor-network theory. The study is qualitative and the data was collected through interviews and observations. The study has studied the interaction between human and non-human actants and how these affected the temporary network. The results show that the actants are important for how communication occurs in the temporary network. The study has also shown the temporary network contributed to the learning needs of the profession who participated.

The overall aim of this thesis is to describe perception of conscience, stress of conscience (stress related to troubled conscience) and burnout, to explore their relationships and to illuminate meanings of the lived experience of troubled conscience in one’s work among registered nurses (RNs) and nurse assistants (NAs) in municipal residential care for the elderly. The thesis comprises four studies; studies I-III are based on questionnaire data from 50 RNs and 96 NAs and study IV is based on interview data from 6 RNs and 6 NAs selected from the participants in the questionnaire study. Questionnaire data was analysed with multivariate statistics (I-III). Narrative interviews were interpreted with a phenomenological hermeneutic method (IV). Study I showed two relationships explaining a noteworthy amount of the shared variance by themselves (25.6% and 17.8%). One relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to external demands which was interpreted as having to deaden one’s conscience in order to be able to collaborate with co-workers. The other relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to internal demands which was interpreted as having to deaden one’s conscience in order to be able to feel like a good healthcare professional. Study II showed a relationship between stress of conscience and burnout (43.6% explained variance) indicating that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout. The relationship between perceptions of conscience and burnout (33.9% explained variance) indicated that having to deaden one’s conscience in order to keep working in healthcare is strongly related to burnout. Study III showed that both RNs and NAs perceived conscience mainly as an asset and a guide and not as a burden in their work. Lack of time and high demands of work influencing home life were the situations related to the highest stress of conscience for both RNs and NAs. The predictive pattern for RNs was interpreted as RNs showing sensitivity to expectations and demands and NAs using their conscience as a guide in their work. Study IV showed that meanings of the RNs’ lived experience of troubled conscience in their work are of being trapped in feelings of powerlessness and a sense of being inadequate. They feel they are failing to live up to expectations from residents and their families, colleagues and themselves because of feelings of powerlessness, cowardice and incompetence. Meanings of NAs’ lived experience of troubled conscience in their work are a sense of being hindered in providing the level of care they would like to provide because of pre-determined conditions and by feelings of being inadequate. They are betraying the residents and themselves by accepting perceived inadequate working conditions and through their own perceived sense of cowardice and negligence. The conclusion of these studies is that stress of conscience is related to burnout among RNs and NAs in municipal residential care for the elderly. Experiences of inadequacy, powerlessness and feelings of being hindered are shown in situations where they have troubled conscience. When the norms of others and/or the pre-determined conditions do not correspond to their own values and norms it may result in the feeling that they cannot perceive themselves as good healthcare professionals.

Andelen äldre personer i Sveriges befolkning ökar, vilket leder till större behov av väl fungerande äldreomsorg. Kommunerna har ansvar för äldreomsorgen oberoende om den utförs i offentlig eller privat regi. Den 1 januari 2009 trädde lagen om valfrihet i kraft som bland annat syftar till att öka individens möjlighet att välja hemtjänstutförare. Idag har privata aktörer större möjligheter att etablera sig inom hemtjänsten. Kontrakten som tecknas mellan kommunen och en privat utförare är den enda direkta legala möjligheten för den ansvariga kommunen att påverka kvaliteten i verksamheterna. Därför är det viktigt att kraven som ställs i kontrakten tydligt beskriver vad kommunen vill att de privata aktörerna ska utföra och vilken kvalitet dessa tjänster ska ha. Syftet med studien var därför att undersöka om och hur kommunernas kontrakt med de privata utförarna fångar upp centrala aspekter av omsorgskvalitet inom hemtjänsten. En kvalitativ deduktiv ansats användes och en innehållsanalys genomfördes för att besvara frågeställningarna. Med hjälp av en utformad analysmodell besvarades vilken typ av kvalitetskrav som ställs i kontrakten. Resultaten visade att majoriteten av de identifierade kvalitetskraven i kontrakten beskrev hur omsorgstjänsterna ska utföras. Kraven utifrån de sex kategorierna, som ingick i analysmodellen, diskuterades i kontrakten. De flesta av kraven som ställdes i kontrakten var specificerade och uppföljningsbara. Dock visade det sig att det inte gick att mäta i vilken grad kraven var uppnådda. Utifrån studiens resultat verkar svårigheterna för kommunerna vara att formulera tillräckligt omfattande och mätbara krav, vilket kan försvåra styrningen av kvaliteten inom äldreomsorgen. / The elderly population in Sweden is growing, which means that more efforts by the home care services are needed. The municipality is responsible to ensure that their population gets the services they need by public or private home care agencies. In January 2009 the law of system of choice was introduced. One aim of the law was to give the individual more freedom to choose home care provider. The only legal way for the municipality to control the quality in private services is to establish a contract between them. Therefore it is important that the contract is well written, and that the municipality clearly expresses what quality they expect the home care provider to perform. The aim of this study was to examine how the contracts are written and what kind of quality the text expresses. A qualitative deductive approach was used and a content analysis was made to examine the contracts. A model for analysis was developed with the purpose to examine the contracts. The results showed that the majority of the text about the quality in the contracts described specific how the services should be performed. The six categories, included in the model of analysis, were represented in the contracts. However, the requirements described in the text were not designed to be measurable. The results showed that it seems difficult for the municipality to formulate requirements that are measurable. This can be a reason for the difficulties for the municipality to control the quality in the elderly care.

The aim of this study is to understand first line managers experiences of the impact leadership have on the health of employees. The study focuses on leadership behaviours and actions, experienced by first line managers working in elderly care, with either positive or negative outcomes on the employees health. To answer the purpose of the study a qualitative method was used and the data was collected through seven individual interviews. The analyse was conducted using theories of transformational, transactional and laissez-faire leadership. To enable a broader dimension to the study the concept of health-promotion leadership was also used in the analysis. The first line managers experiences showed that communication, motivation and relationships were important parts of a leadership that could affect the employees health both positive and negative. Overall a leaders communication should be clear and meaningful, a leader should motivate the employees by showing interest in their work and a leader should build a relationship with the employees that are based on equality.

Visioner om IT lovar många och positiva förändringar i samhället. Detta gäller inte minst inom svensk äldreomsorg där IT ses som ett verktyg för att utveckla och förbättra äldreomsorgen. Genom att datorisera äldreomsorgen finns förhoppningar om goda effekter som bättre tillgång till information i samband med möte med den äldre, förbättrad samverkan över organisationsgränser samt bättre uppföljning. Den här avhandlingen handlar om datorisering av äldreomsorg, de aktörer genom vars intressen och värden IT-system utvecklas, och de värden som IT-systemen skapar. Då värden styr handlande, prioriteringar, beslut samt hur vi värderar det vi upplever påverkar värden utveckling och utvärdering av IT-system. Därmed studeras effekter som spår av värden. Detta är en kvalitativ studie som illustrerar hur fyra administrativa och äldreomsorgsstödjande IT-system i tre svenska kommuner har utvecklats genom olika aktörsgruppers värden och vilka värden dessa IT-system uppfattas stödja. Avhandlingsarbetet har en stark empirisk bas som har utvecklats genom att jag har deltagit i upphandling samt utveckling av IT-system för äldreomsorg i Örebro samt Linköpings kommun. Dessutom har jag studerat upplevda effekter av att använda IT-system som stöd för arbete inom äldreomsorg i Göteborg stad och Linköpings kommun. Avhandlingens resultat visar att datorisering av äldreomsorg drivs av och värderas utifrån fyra värdeområden: förvaltningsvärden, integrationsvärden, omsorgsvärden och professionsvärden. Förutom ovanstående resultat presenteras datoriseringsprocessernas aktörs-grupper och deras värden samt en jämförelse av värden som drivkrafter eller konsekvenser. Sju sammanfattande resultat avslutar beskrivningen av avhandlingens kunskapsbidrag.

Sweden has one of the best elderly cares in Europe and the Swedish care work is also one of the best in terms of quality, compared to other European countries. In recent years, higher demands have been set on the care work and the number of privatizations of public services has increased. In 2009 a new law came into force, the Act on System of Choice (LOV) which increased individual’s right to a greater participation and a free choice in the selection of health and social care providers. This paper aims to highlight the impact of the law, system of choice. By using the method of qualitative surveys and interviews with care managers, and an exploration of relevant studies and reports, I was able to complete this study. With institutional theory and other sociological concepts such as isomorphism and street-level bureaucracy, I made an analysis of both the care managers and also at an organizational level. In the conclusions I argue that the system of choice has had a greater impact at an organizational level rather than on the care managers. The paper also highlights the fact that the knowledge of processes of implementation and political governance has had a significant role. The three main issues are how the law has influenced care managers work, how organizations have changed, how and if the active choices work in practice.

Diss. Stockholm : Stockholms universitet, 2004.

Diss. Stockholm : Handelshögskolan, 2009.