The overall aim of the study is to understand and describe the phenomenon ‘atmosphere in care settings’ as experienced by patients, significant others and health care staff. The study consists of four papers, each of which illuminates various aspects of the phenomenon. Data consisted of observations and interviews with patients, significant others and staff (n=126) within a hospice, a geriatric, a medical and an oncology setting, and community care settings for older people. Narrative analysis, grounded theory, and phenomenological hermeneutics were used in a triangular fashion to analyse the data. The findings illuminate the phenomenon ‘atmosphere in care settings’ as being constituted by two interacting and interwoven dimensions: the physical environment and people’s doing and being in the environment. The physical environment is the first dimension, and five aspects were illuminated, namely the physical environment as a symbol; as containing symbols; as influencing interaction; as facilitating a shift of focus from oneself to the environment, and; as containing scents and sounds influencing experiences of at-homeness or alienation. People’s doing and being in the environment is the other dimension, and five aspects were illuminated, namely the experience (or absence of experience) of a welcoming; of seeing and being seen; of a willingness to serve; of a calm pace; and of safety. It was understood that people’s doing and being influences experiences of the physical environment and that the physical environment influences experiences of people’s doing and being. The comprehensive understanding illuminated that the phenomenon is not merely subtle qualities of the place for care, but an active part of care. Both the physical environment and peoples doing and being conveys messages of caring and uncaring. The atmosphere of a care setting can at best support experiences of at-homeness in relation to oneself, others and the surrounding world.

Stroke is one of the leading causes of death and disability in Sweden and in the Western world. Despite this, stroke with focus on elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. The objectives in this thesis were to analyse from a gender, age and socioeconomic perspective how women were affected by stroke compared with men. The focus was on what it meant for elderly women and men to live with stroke and to explore various gender constructions among men and women. The study also included aspects such as incidence, medical treatment and case fatality after stroke. Both quantitative and qualitative methods were used. During a two-year period (15 October 2000–14 October 2002), uniform information was collected for all cases of first-ever and recurrent (>28 days) stroke occurring in people of all ages living the region of Umeå, admitted to the University Hospital. Five different registers were used to achieve maximum coverage; the Riks-Stroke (RS) register, the Hospital Discharge Register (HDR), the Cause of Death Register, the northern Sweden WHO MONICA study, and one case-finding study in nursing homes and homes for elderly performed for this thesis. For the qualitative study a maximum variation sampling procedure was used to retrieve participants for in-depth interviews in a follow-up study. Nine women and seven men were interviewed about their experiences of treatment and care after suffering a stroke, as well as about their perceptions and experiences of help from others (health care personnel, relatives and home help personnel). The first-ever incidence of stroke was higher among low-educated than high educated men and women. Our study showed that there was an education-related age-dependent difference in stroke incidence, where elderly women had the highest incidence of stroke. The 28-day case fatality was shown to be associated with low educational level in patients above 75 years, after controlling for sex, risk factors and acute care variables. The elderly stroke patients experienced subordination in their contacts with health care personnel and the medical context. The participants used different ways to negotiate in the subordinate position, and some of these negotiations were interpreted as being gendered. We have also shown how the elderly stroke patients minimized their own needs of help, strove for independence and accepted help. The men and the women differed in their perceptions and experiences of help from others. Also, the participants expressed multiple types of needs. The elderly stroke patients’ perceptions and experiences of help from others must be studied in relation to their life circumstances and expectations from society. Further analyses of the patients’ perceptions and experiences of help from others were interpreted as being different examples of constructions of masculinities and femininities. Stroke with a focus on the elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. With further community-based stroke incidence studies including elderly men and women and with the development of appropriately targeted interventions, the burden of stroke in the population could be reduced. More research is needed where both qualitative and quantitative methods are used, as this can provide a richer and perhaps more authentic description of the issue under investigation.

Industrial selling processes are complex phenomena. The involvement of diverse persons and the prevalence of service elements in integrated sales offerings have meant that collaboration and dialogue are now essential aspects of any successful selling process. The present study is based on the premise that these essential aspects of contemporary industrial selling processes have not been sufficiently conceptualised in the extant literature and that new concepts are therefore required. In particular, relevant new concepts that are based on the personal experiences of the actors involved in the selling process are urgently needed. Grounded-theory methodology was chosen for this inductive study because this approach is especially suitable for the development of empirically based concepts derived from the real-life experiences of involved actors who are addressing their issues of concern. The substantive theory that is subsequently produced by this grounded-theory approach posits a core category of ‘business manoeuvring’ as the basic social process whereby the involved actors resolve their main concern—which is the conduct of effective business. This resolution is achieved within the core category of ‘business manoeuvring’ by the judicious management of mutually dependent and complementary activities, which are reflected in the other categories of the substantive theory—(i) ‘business standardisation’; (ii) ‘business fraternisation’; (iii) ‘personalisation’; and (iv) ‘probationary business rationalisation’. A comparison of the present study’s substantive theory with alternative models in the literature reveals that the broader scope and integration of the proposed substantive theory provides it with greater explanatory power than extant models; however, it is acknowledged that the proposed theory lacks the detailed depth of other models. The successful development of a substantive theory that grasps the main concern of the involved actors and adequately describes its continuous resolution means that this study has achieved its primary purpose of developing empirically based, actor-related concepts that provide an enhanced understanding of the theory and practice of complex selling processes in contemporary industrial markets.

The proposed Grounded Theory has been derived from how experienced teachers and their pupils, in four different teaching contexts, have used ’The Witting method’ to maximize literacy development among their pupils. The theory has been grounded through repeated comparisons and analysis of the empirical data. The specific aim of the thesis is to conceptualize and generate a theory about what four teachers and their pupils (n=40, over the period of the research), in different contexts, and over a number of years, actually do when working with The Witting method. A wider goal is to apply the implications of the derived grounded theory to general and special education theory in helping to alleviate reading and writing difficulties and prevent pupils from failing. The results show that the teachers have systematically strived to ensure each pupil’s reading and writing development and they do this through what is labeled ‘didactic arranging’. They also show an ability to adapt to situations, materials and spaces without losing their long-term aims. They are in charge of three competencies: ’me’, ’you’, and ’we’ - expressing this competence in documentation, by reflection and always in close collaboration with pupils and their families. The observed use of The Witting method would seem to enable a diagnostic mode of teaching as it contains tools that allow a teacher to follow each pupil’s reading and writing development. Teachers, pupils and the didactic procedures are shown to be in constant interaction. It was also found to be important that teachers believe that every pupil can learn. These teachers’ collective motto could be summed up as follows: never stop giving support and never stop assessing progress.

Syftet med studien var att undersöka hur föräldrar vars barn blivit medlemmar i föreningsidrott tidigt upplever att barnet utvecklats – motoriskt, psykiskt samt socialt. Studien genomfördes i form av semistrukturerade intervjuer med fyra familjer, strategiskt utvalda. Resultaten visar att föräldrarna som intervjuats i studien uppfattar att barnen utvecklats normalt till snabbt motoriskt sett. Föräldrarna upplever att barnen utvecklat sin kompetens gällande den aktuella idrotten samt att barnen generellt sett blivit mer aktiva sedan de började idrotta. Föräldrarna upplever även att detta beror på barnets personlighet, och inte att det skulle ha med idrottandet att göra. Alla barn i studien har äldre syskon som idrottar, samma eller liknande den idrott som de yngre syskonen utövar, vilket föräldrarna upplever som positivt då barnen uppfattas ha fått mycket gratis – kamrater, kompetens inom idrotten, självförtroende och godare kroppsuppfattning.

This thesis focuses on palliative cancer care in acute care hospitals and home care settings. The overall aim was to generate a grounded theory explaining the latent patterns of behavior of patients, relatives and nurses. The thesis includes one population-based study with cross-sectional design and four classic grounded theory studies. Study I was conducted in two acute care hospitals. In this 5-year follow-up study, the proportion of hospitalized palliative cancer patients had decreased. The patients were older with more symptoms and care needs per patient. In both years, the most common symptoms were pain and deterioration and the most common cancer sites were prostate and colorectal. The results showed that associations between symptoms, care needs and cancer site were mostly weak. In study II, striving for emotional survival emerged as the pattern of behavior through which nurses in acute care hospitals deal with their main concern, the risk of being emotionally overloaded. Striving for emotional survival involves emotional shielding, emotional processing and emotional postponing. In study III, doing good care emerged as the pattern of behavior through which nurses in home care deal with their main concern, their desire to give good care. Doing good care involves three different caring behaviors: anticipatory caring, momentary caring and stagnated caring.     In study IV, living on hold emerged as the pattern of behavior through which patients and relatives deal with their main concern, being put on hold. Living on hold involves three modes: fighting, adjusting and surrendering. The overall theory, deciphering unwritten rules, explains how patients, relatives and nurses are dealing with the uncertainty of how to act and behave.   Deciphering unwritten rules involves figuring out, deliberating, maneuvering and evaluating. In conclusion, this thesis demonstrates the complexities of palliative cancer care and the importance of knowledge, resources and counseling. Patients should be cared for at the right care level according to their care needs and the care focus should be on treating symptoms irrespective of the diagnosis. The palliative care approach therefore needs to be implemented in all caring contexts with dying people.

Background In Sweden, 20% of female patients have reported lifetime experiences of abuse in any health care setting. Corresponding prevalence among male patients is estimated to be 8%. Many patients report that they currently suffer from these experiences. Few empirical studies have been conducted to understand what contributes to the occurrence of abuse in health care. Objectives To understand what factors contribute to female patients’ experiences of abuse in health care. Design Constructivist grounded theory approach. Settings Women's clinic at a county hospital in the south of Sweden. Participants Twelve female patients who all had reported experiences of abuse in health care in an earlier questionnaire study. Methods In-depth interviews. Results The analysis resulted in the core category, the patient loses power struggles, building on four categories: the patient's vulnerability, the patient's competence, staff's use of domination techniques, and structural limitations. Participants described how their sensitivity and dependency could make them vulnerable to staff's domination techniques. The participants’ claim for power and the protection of their autonomy, through their competence as patients, could catalyze power struggles. Conclusions Central to the participants’ stories was that their experiences of abuse in health care were preceded by lost power struggles, mainly through staff's use of domination techniques. For staff it could be important to become aware of the existence and consequences of such domination techniques. The results indicate a need for a clinical climate in which patients are allowed to use their competence. / <p>Funding Agencies|Swedish Research Council|2009-2380|</p>

Background: Women and men in Sweden are in paid work to almost the same extent, but are found in different occupations and positions in the labour market. Still, women perform the bulk of the unpaid domestic work at home. Gendered inequalities in these respects leave women and men exposed to different work environments and responsibilities, which in turn can have gendered health consequences. In public health research there is a lack of studies on domestic work that include women and men, as well as a lack of qualitative studies exploring individuals’ experiences of domestic work and mental health. At the workplace level, few attempts have been made to analyse how several dimensions of gender equality at workplaces are related to health status and there is a lack of studies with a contextual approach combining many different variables that are at play simultaneously. Because of the cross-sectional design of previous studies on paid and domestic work there is a lack of analyses taking possible health-related selection into account, which makes it difficult to ascertain whether gender equality leads to better health or if good health is a prerequisite for gender equality. Aim: The aim of this thesis was to analyse gender relations of work (at workplaces and at home) in relation to mental illness among women and men. Methods: The thesis was based on data from the Northern Swedish Cohort. The baseline survey was conducted in 1981 when the participants were 16 years old (n= 1080, 574 boys and 506 girls), with follow-up at age 18, 21, 30 and 42. The response rate was 94 % throughout the last follow-up in 2007. Data from the Northern Swedish Cohort were supplemented with register data about the employees at the participants’ workplaces. The analysis methods for the questionnaire and register data were logistic regression analysis and cluster analysis. Interviews were performed with four women and four men in the Northern Swedish Cohort and were analysed with a Grounded Theory approach. Results: Women had overall greater responsibility for domestic work. Gender inequality in responsibility for domestic work and perceptions of gender inequality in the couple relationship (after adjustments for background variables and previous psychological distress) were associated with psychological distress among women and men. However, among men the relation between domestic work inequalities and psychological distress was affected by socioeconomic position relative to the partner. Having less responsibility for domestic work and a partner with higher socioeconomic position was associated with psychological distress among men. The qualitative analysis showed that gender relations were an important part of how the domestic work was unequally organised and related to experiences of mental illness among women and men. Among women the high burden of domestic work was experienced as an obstacle to experiencing good health. Among men the experience of being trapped in an outmoded masculinity was related to feelings of stress. At the workplace level, patterns of gender inequality were associated with psychological distress among women, but not among men. However, the most gender-equal pattern was related to lower as well as more similar levels of mental illness among women and men, which supports a convergence in health when women’s and men’s work conditions become more similar. Conclusion: Gender equality at home and at work is central for reducing mental illness among both women and men, but also for achieving a good average health status in the population, which is a central public health target. When investigating social inequalities in health, gender perspectives are of great importance for deepening the understanding of how and why gender inequalities in paid and domestic work are related to mental illness. Integrating gender perspectives into public health policy could be a way to acknowledge power relations that hinder good public health. / Bakgrund: Kvinnor och män i Sverige yrkesarbetar i nästan samma sträckning, men återfinns i olika yrken och positioner på arbetsmarknaden. Samtidigt utför kvinnor merparten av det obetalda arbetet i hemmet. Könade orättvisor i dessa avseenden innebär att kvinnor och män utsätts för olika arbetsmiljöer och ansvarsområden, vilket kan medföra könade hälsokonsekvenser. Dock är det få folkhälsovetenskapliga studier om obetalt arbete i hemmet och hälsa som inkluderar både kvinnor och män. Det är också en brist på kvalitativa studier som undersöker individers upplevelser av det obetalda arbetet i hemmet och psykisk hälsa. På arbetsplatsnivå har det gjorts få försök att analysera hur olika dimensioner av jämställdhet på arbetsplatser är relaterade till hälsostatus, och det är en brist på studier med en kontextuell metod som tar hänsyn till hur flera olika variabler samspelar. Tidigare folkhälsovetenskapliga studier som undersökt förvärvsarbete och hemarbete har framförallt använt sig av en tvärsnittsdesign, vilket gjort det svårt att utreda riktningen av samband mellan jämställdhet och psykisk hälsa, det vill säga om jämställdhet leder till bättre hälsa eller om god hälsa är en förutsättning för jämställdhet. Syfte: Syftet med denna avhandling var att analysera genusrelationer i arbete (på arbetsplatser och i hemmet) i förhållande till självskattad psykisk ohälsa bland kvinnor och män. Metod: Avhandlingen bygger på data från Luleåkohorten. Baslinjeundersökningen genomfördes år 1981 då deltagarna var 16 år (n=1080, 574 pojkar och 506 flickor). Uppföljningar har genomförts vid 18, 21, 30 och 42 års ålder och svarsfrekvensen var 94% under det senaste uppföljningen år 2007. Data från Luleåkohorten kompletterades med registerdata om anställda på deltagarnas arbetsplatser. Analysmetoder för enkät- och registerdata var logistisk regressionsanalys och klusteranalys. Intervjuer har genomförts med fyra kvinnor och fyra män i kohorten och analyserats med grundad teori. Resultat: Kvinnor hade totalt sett ett större och män ett mindre ansvar för det obetalda arbetet i hemmet. Upplevelse av bristande jämställdhet i ansvar för obetalt arbete i hemmet och i parrelationen hade ett samband med psykisk ohälsa bland kvinnor och män (även efter justering för bakgrundsvariabler och tidigare psykisk ohälsa). Att ha mindre ansvar för det obetalda arbetet i hemmet och en partner med högre socioekonomisk klass hade även ett samband med psykisk ohälsa bland män. Den kvalitativa analysen visade att genusrelationer var en viktig del i en ojämställd organisering av hemarbete och relaterade till upplevelser av psykisk ohälsa bland kvinnor och män. En hög belastning av hemarbete var ett hinder för kvinnor att uppleva en god hälsa. Upplevelser av att vara instängd i en omodern maskulinitet innebar en stressfull situation bland män. Mönster av ojämställdhet på arbetsplatser hade ett samband med psykisk ohälsa för kvinnor, men inte för män. Däremot visade sig de mest jämställda arbetsplats-mönstern vara relaterade till lägre och mer liknande nivåer av psykisk ohälsa bland kvinnor och män, vilket stödjer en konvergens i hälsa när kvinnor och mäns arbetsplats förhållanden är likvärdiga. Slutsats: Jämställdhet på arbetsplatser och i hemmet är viktigt för att minska psykisk ohälsa både bland kvinnor och män, men också för att uppnå en god genomsnittlig hälsa i befolkningen, något som är ett centralt folkhälsomål. Vid analyser av social ojämlikhet i hälsa är genusperspektiv av stor betydelse för att fördjupa förståelsen om hur och varför ojämställdhet i på arbetsplatser och i hemmet är relaterat till psykisk ohälsa. Att integrera genusperspektiv i folkhälsopolicy kan vara ett sätt att ta hänsyn till de maktrelationer som förhindrar en god folkhälsa.

The aim of this thesis is to examine the archivist's professional role in public authorities and discuss if, and in what way, the profession is effected by the new swedish process oriented archival description system. The study focuses on swedish authorities and does not make any international comparisons with other institutions. Neither does it investigate archivists workingin the private sector, but centers on public institutions.The survey is performed in five swedish public authorities, using interviews and observations. Grounded theory is used as a method initially in the purpose of keeping an open mark towards the object of study. The initial results led on to questions about how well the archivists perceived that communication within the authorities served, and how this in turn prepossessed their work situation and the professional roles in which they found themselves. To answer these questions, theories from the subjects of sociology and social psychology, among other things the idea of sensemaking as it is put by Karl Weick, was used to analyze the material.The result of the analysis shows that the implementation of a new archival system has generated a change in the archivists work tasks. The archivists in the studied authorities did in some cases, out of this new situation, manage to find a professional role in which they felt comfortable, and in some cases not. The difference between these two categories seemed to stem from a difference in the ability to make sense of their situations in their workplaces respectively. In the cases where the archivists ideas of their responsibilities and provinces did not correlatewith their employers a lack of sensemaking occured and led to confusion and conflict. This discrepancy between the archivists and the employer's expectations, the thesis argues, comes from the change in the archival profession that is taking place due to the changes in society at large. The employers' traditional image of an archivist clashes with the archivists new professional role. From this it is suggested that if consent is not reached around the archivists place in the organizations, and in society, much knowledge is at risk of being lost, and much competence going to waste. This thesis is a two years master's thesis in archival science.

This thesis presents research to build and evaluate embedding of a textual form of state machines into high-level programming languages. The work entailed adding state machine syntax and code generation to the Umple model-oriented programming technology. The added concepts include states, transitions, actions, and composite states as found in the Unified Modeling Language (UML). This approach allows software developers to take advantage of the modeling abstractions in their textual environments, without sacrificing the value added of visual modeling. Our efforts in developing state machines in Umple followed a test-driven approach to ensure high quality and usability of the technology. We have also developed a syntax-directed editor for Umple, similar to those available to other high-level programming languages. We conducted a grounded theory study of Umple users and used the findings iteratively to guide our experimental development. Finally, we conducted a controlled experiment to evaluate the effectiveness of our approach. By enhancing the code to be almost as expressive as the model, we further support model-code duality; the notion that both model and code are two faces for the same coin. Systems can be and should be equally-well specified textually and diagrammatically. Such duality will benefit both modelers and coders alike. Our work suggests that code enhanced with state machine modeling abstractions is semantically equivalent to visual state machine models. The flow of the thesis is as follows; the research hypothesis and questions are presented in “Chapter 1: Introduction”. The background is explored in “Chapter 2: Background”. “Chapter 3: Syntax and semantics of simple state machines” and “Chapter 4: Syntax and semantics of composite state machines” investigate simple and composite state machines in Umple, respectively. “Chapter 5: Implementation of composite state machines” presents the approach we adopt for the implementation of composite state machines that avoids explosion of the amount of generated code. From this point on, the thesis presents empirical work. A grounded theory study is presented in “Chapter 6: A Grounded theory study of Umple”, followed by a controlled experiment in “Chapter 7: Experimentation”. These two chapters constitute our validation and evaluation of Umple research. Related and future work is presented in “Chapter 8: Related work”.