Background: In Utah, all major hospital facilities have employee vaccination policies. However, the presence of health care worker vaccination policies in the Utah outpatient oncology setting was unknown. Objectives: The objectives were to identify Utah oncology outpatient employee vaccination policies and to identify what consequences, if any, were present for unvaccinated employees. Methods: This was a cross-sectional, descriptive study design in which clinic managers from outpatient oncology clinics in Utah were asked, via questionnaire, to describe the clinic's employee vaccination policy and the consequences for refusing the policy. Findings: Most vaccination policies applied to employees primarily assigned to work in the back office area. Most commonly, influenza and Hepatitis B vaccines were required as part of the vaccination policy. Most managers offered free vaccinations to employees, although most managers also allowed employees to refuse to follow the vaccination policy for medical, religious, or personal reasons.

A organização do trabalho passou por diversas mudanças, sendo a mais recente e atual a da gestão flexível, que contém várias práticas que podem ocasionar, dependendo da forma como são geridas, malefícios à saúde mental do(a) trabalhador(a) e estresse, principalmente se ele(a) for líder, em razão das responsabilidades inerentes à posição. As empresas brasileiras, em torno da década de 1990, começaram a adotar algumas características da gestão flexível para se adequarem às novas demandas econômicas, políticas e sociais. Tal processo ocorreu em paralelo com a transformação de alguns escritórios de advocacia brasileiros, que adentraram no pós-profissionalismo em detrimento do clássico modelo (profissionalismo) tendo como uma de suas características a implantação de grandes bancas advocatícias. Essas bancas, por sua vez, possuem algumas práticas da gestão flexível, que, dependendo da forma com que são organizadas e dos recursos da pessoa para lidar com as demandas exigidas, podem levar a situações potencialmente estressoras. Assim, o estudo teve como objetivo identificar os potenciais estressores ocupacionais autopercebidos pelos(as) advogados(as) líderes de duas unidades de uma grande sociedade de advogados(as) e analisar os impactos dos mesmos em suas vidas. Para tanto, foram realizados estudos de casos múltiplos com 9 advogados(as) líderes das unidades de São Paulo e Rio de Janeiro. Para a análise das entrevistas utilizou-se a técnica de análise de conteúdo de Bardin (1977/2009). Foram encontrados como estressores potenciais autopercebidos fatores ligados ao reconhecimento; foco somente nos resultados; sobrecarga e ritmo de trabalho; cultura da urgência; conflito de papeis; falta de controle; imprevisibilidade; decidir com o(a) cliente o trabalho e o tempo de realização do caso, sem antes checar a disponibilidade do(a) advogado(a) que fará o serviço; metas; equipe júnior. Tais potenciais estressores podem levar à frustração e sentimento de injustiça; medo de errar; desequilíbrio entre o lazer e o trabalho; e falta de autonomia. Apesar de todos os potenciais estressores apontados, a maioria dos(as) advogados(as) não se percebe com estresse. Além disso, a maioria julga possuir autonomia. Porém, foi analisado que a autonomia e diversos direitos que os(as) advogados(as) possuíam no profissionalismo parecem não mais existir nas relações de trabalho contemporânea, com base no escritório pesquisado, devido ao formato da organização que leva à maior aproximação dos(as) advogados(as) como funcionários(as). Nas considerações finais, foi apontado que os estressores potenciais autopercebidos relacionam-se ao modelo da gestão atual, demonstrando as formas de atuação contemporânea dos escritórios, distantes do perfil clássico, e as consequências que podem acarretar. Tais potenciais estressores não são eventos isolados, fazem parte da rotina diária da maioria dos(as) entrevistados(as) e aparentam ter como ponto central as metas e o reconhecimento. Espera-se contribuir com pesquisas futuras sobre o estresse dos(as) advogados(as) e ter contribuído para a reflexão sobre as relações de trabalho da advocacia contemporânea e as consequências que essas podem acarretar à vida pessoal e profissional dos(as) advogados(as) associados(as) líderes, principalmente à sua saúde / The work organization passed through many changes, which the most recent and actual is the flexible management. This has many different practices and can provoke, depending on how it´s managed, various mental harms on the workers and stress. Mainly if the person is a leader, because of the responsabilities due to the position. Brazilians companies, around of 1990´s, start to adopt some characteristics of the flexible management to adapt to new economic, political and social demands. This process occurred in parallel to the transformation of some law firms, which entered to the postprofessionalism over to the classical model (professionalism) which is noticed with development of big law firms and the adoption by them of some aspects of flexible management. Depending on how these aspects are managed and dealt by each worker, they can drive to many stressful potentials situations. Thereby, the study had as a target to identify self-perceived potential occupational stressors by leaders lawyers of two units of a big law firm and analyze impacts of them in their lives. Therefore, study of multiple cases was realized with 9 leaders lawyers of São Paulo and Rio de Janeiro. For the analysis of the interviews it was used the technique of Bardin´s content analysis.There were found as self-perceived potential occupational stressors some factors related to recognition, focus just on results, overload and pace of work, culture of urgency, conflicts of rolls, lack of control, unpredictability, decision about work with clients and time to do the work without checking availability of lawyers, goals, team with lack of experience. These potential stressors can cause frustration and feeling of injustice, fear of mistake, unbalance of leisure and work and lack of autonomy. Despite of all potential stressors indicated, the majority of lawyers don´t recognize that have stress. Besides that, most of them think have autonomy, It the other hand, it was analyzed that many rights and autonomy that lawyers had had in the professionalism seem that don´t exist anymore in the relationship of contemporary work of big law firms, based on the law firm researched, because of the mold of the organization that lead lawyers nearer to employees. In the last considerations, it was pointed that self-perceived potential occupational stressors are related to the actual management, demonstrated at actual forms of contemporary law firms, far from the classical profile, and the consequences that can result. Such potential stressors are not isolated events, are part of daily routine of the majority of the interviewers and look like that goals and recognition are central points. This work is expected to contribute with future researches about stress of lawyers and to had contributed to reflection about work relationships of contemporary advocacy and the consequences that can result in personal and professional life of leaders lawyers, especially in their health

Medicinos darbuotojai dėl kasdieninio kontakto su žmogaus organizmo skysčiais priskiriami didžiausios biologinių veiksnių rizikos grupei. Incidentų – mikrotraumų ir ekspozicijos krauju, rizika yra susijusi su kraujo keliu plintančiomis infekcijomis (HBV, HCV, ŽIV). Darbo tikslas: Nustatyti medicinos darbuotojų profesinių biologinių veiksnių riziką ir paplitimą Kauno medicinos universiteto klinikų chirurgijos profilio skyriuose. Tyrimo metodika. Vykdytas retrospektyvinis tyrimas 2006 m. 1-6 mėnesių, duomenys rinkti Kauno medicinos universiteto klinikų chirurgijos profilio skyriuose. Atlikta anketinė apklausa. Išdalintos 347 anoniminės anketos, atsako dažnis 89,6 % (311). Statistiniam duomenų apdorojimui naudotas SPSS 11.0 programinis paketas. Rezultatai. 64,5% respondentų patyrė mikrotraumą, 71,1 % – ekspoziciją biologiniais skysčiais, mikrotraumą, ir ekspoziciją patyrė 39,6% darbuotojų. Visais mikrotraumų atvejais buvo sužeistos rankos, ekspozicijų metu 63% respondentų apsitaškė sveiką odą, 20% – akis. Dažniausiai darbuotojai apsitaškė krauju (60%). Gydytojai mikrotraum��� dažniausiai patyrė operacijų metu (79,3%), slaugytojos – apruošdamos instrumentus (35,1%), pagalbiniai darbuotojai – tvarkydami atliekas (75,8%). Gydytojai dažniausiai susižeidė chirurgine adata (72,4%), slaugytojos – injekcine adata (72,4%), pagalbiniai darbuotojai – stiklu (60,6%). 86% respondentų nebuvo pasiskiepiję HB vakcina. Mikrotraumų metu 14,5%, ekspozicijų metu 5% respondentų asmeninių apsaugos... [toliau žr. visą tekstą] / The health care workers are attributed to the highest biological factors risk group, as they daily come into contact with fluids of human body. Risk of incidents – sharps injuries and blood exposure – is related to the infections, spread by blood (HBV, HCV, HIV). Aim of the study. Determine the professional biological risk factors for health care workers and their incidence in the surgical departments of Kaunas Medical University Hospital. Methods. Retrospective study of 1-6 months of year 2006 was performed; data was collected in the surgical departments of Kaunas Medical University Hospital. Anonymous questionnaire survey was performed. 347 questionnaires were distributed; rate of response was 89.6% (311). SPSS 11.0 software was used for statistical data processing. Results. 64.5% of respondents had experienced sharps injury, 71.1% were exposed to the biological fluids, and 39.6% of workers had experienced the injury and the exposure. The hands were injured during all the sharps injury cases; 63% of respondents were drabbled by blood on the healthy skin and 20 % were drabbled into the eyes during the blood exposure. In most cases worker were drabbled by blood (60%). Physicians mostly experience the sharps injury during the surgery (79.3%), nurses – during the preparation of instruments (35.1%), supporting staff – disposing the waste (75.8%). Commonly physicians were injured by the surgical needle (72.4%), nurses – by needlestick (72.4%), and the supporting staff – by glass... [to full text]

Bakgrund: En vårdande relation är inte detsamma som en vänskapsrelation, men förutsätter ändå närhet och engagemang. Personligt engagemang är också nödvändigt för att utvecklas som vårdare. Sorg är en naturlig reaktion vid förlust av relationer, men det är inte självklart att vårdare vet om de får eller bör känna och uttrycka sorg när patienter dör. Det saknas en samlad bild av vårdares sorg över döende och avlidna patienter. Syfte: Syftet var att beskriva hur vårdares egen sorg över döende och avlidna patienter gestaltar sig. Metod: Beskrivande litteraturöversikt av elva artiklar som analyserades med en form av kvalitativ innehållsanalys. Resultat: Vårdarens sorg gestaltar sig i form av inre känslor som att känna smärta och tyngande känslor samt skuld och ilska. Sorgen kan även visa sig i form av yttre uttryck där vårdaren exempelvis gråter eller känner sig rastlös. Den kan också yttra sig i ett tidsperspektiv där vårdarens sorg över en specifik patient förändras med tiden samt ett längre perspektiv där vårdarens tidigare erfarenheter påverkar hur han eller hon upplever sorgen. Klinisk betydelse: Denna studie kan vara ett stöd för vårdare som undrar om de får eller bör känna och uttrycka sorg över döende och avlidna patienter. Den kan också användas av vårdare som nått expertstadiet och som fungerar som handledare. Vid denna nivå av expertis bör enligt denna studies resultat uppmuntran och stöd ges till mindre erfarna vårdare, för att hjälpa dem att våga känna och uttrycka sin sorg. / Background: A caring relationship is not the same as a friendship relationship, but still requires intimacy and commitment. Personal commitment is also necessary to develop as a health care worker. Grief is a natural reaction to loss of relationships, but caregivers do not necessarily know if they are allowed to or should feel and express grief when patients die. There is no complete picture of health care workers’ grief over dying and deceased patients. Objective: The objective was to describe how health care workers’ own grief for the dying or deceased patients manifests itself. Method: A descriptive literature review of eleven articles, analyzed with a form of qualitative content analysis. Findings: Health care workers’ grief manifests itself as inner feelings such as pain, burdensome feelings, and guilt and anger. Grief can also manifest itself as an outward expression where the caregiver for example cries or feels restless. It can also manifest itself through time, when the health care worker’s grief for a particular patient is changing over time, but also in a life-time perspective, when the health care worker’s past experiences affect how he or she experiences the grief. Clinical significance: This study may provide support to health care workers who are wondering if they are allowed to or should feel and express grief for dying and deceased patients. It can also be used by health care workers who have reached the expert stage and are supervisors themselves. At this level of expertise, according to the results of this study, encouragement and support should be given to less experienced health care workers, to help them gain the courage to feel and express their grief.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-06T17:02:05Z No. of bitstreams: 1 DISSERTAÇÃO ANA LECIA COSTA. 2014.pdf: 579239 bytes, checksum: 5e92e1e55c37b019b7638854f4501f80 (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-07T14:14:23Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO ANA LECIA COSTA. 2014.pdf: 579239 bytes, checksum: 5e92e1e55c37b019b7638854f4501f80 (MD5) / Made available in DSpace on 2014-10-07T14:14:23Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO ANA LECIA COSTA. 2014.pdf: 579239 bytes, checksum: 5e92e1e55c37b019b7638854f4501f80 (MD5) / A questão dos recursos humanos tem sido considerada bastante complexa, na medida em que envolve problemas relativos à formação e à disponibilidade das diversas categorias de trabalhadores que podem realizar as ações de Vigilância Sanitária nas diversas regiões, estados e municípios. Este estudo teve como objetivo geral descrever e analisar o perfil do trabalhador de Vigilância Sanitária na esfera estadual da Bahia em relação às necessidades do processo de trabalho. E como objetivos específicos, identificar as necessidades do processo de trabalho em VISA no que tange ao perfil profissional, identificar as lacunas existentes e demandas de formação na VISA e identificar os cursos nos quais os trabalhadores da VISA participaram e as suas respectivas áreas temáticas. Trata-se de um estudo descritivo e exploratório. Os dados do estudo foram oriundos da análise de documentos e de entrevistas com informantes-chave. Os documentos analisados foram o Relatório de Gestão da Secretaria de Saúde do Estado da Bahia SESAB/RAG-2010, o Plano Estadual de Saúde - PES 2008/2011, os Relatórios de Gestão da Diretoria de Vigilância Sanitária – DIVISA e da Superintendência de Vigilância à Saúde – SUVISA, os dois últimos editais dos concursos públicos da SESAB e o Plano de Cargos, Carreira e Vencimentos – PCCV/SESAB. O estudo constatou que o número de trabalhadores de VISA lotados na SESAB é insuficiente para atender à demanda de trabalho, principalmente no que diz respeito à ausência de determinadas categorias profissionais que não aquelas consideradas “grupo ocupacional serviços públicos de saúde” a exemplo de arquiteto e físico. Identificou-se também a ausência de um modelo organizacional similar para a DIVISA (nível central) e para as DIRES (nível regional), além da coerência entre os processos de formação/atualização promovida pela DIVISA/SESAB e as necessidades do serviço. / The issue of human resources has been considered quite complex , in that it involves issues concerning training and the availability of different categories of employees who can perform the actions of Sanitary Surveillance in the various regions , states and municipalities. This study had as main objective to describe and analyze the profile of the Health Surveillance worker at state of Bahia to the needs of the labor process. And how specific goals, identify the needs of the labor process VISA regarding the professional profile, identify gaps and training demands on VISA and identify the courses in which workers participated VISA and their respective subject areas. This is a descriptive, exploratory study. Data for the study came from the analysis of documents and interviews with key informants. The documents analyzed were the Management Report of the Secretary of Health of the State of Bahia SESAB/RAG-2010, the State Health Plan - PES 2008/2011 , the Management Report of the Board of Health Surveillance - MOTTO and the Superintendency of Surveillance health - SUVISA, the last two notices of public tenders SESAB and Career Plan , Career and Salaries - PCCV / SESAB . The study found that the number of workers in crowded VISA SESAB is insufficient to meet the demand for labor , especially with regard to the absence of specific professions than those considered " occupational group public health services " example of the architect and physical . Also identified the absence of a similar to MOTTO (central level) and for DIRES ( regional level ) organizational model , beyond the coherence between the processes of formation / update sponsored by MOTTO / SESAB and service needs.

A organização do trabalho passou por diversas mudanças, sendo a mais recente e atual a da gestão flexível, que contém várias práticas que podem ocasionar, dependendo da forma como são geridas, malefícios à saúde mental do(a) trabalhador(a) e estresse, principalmente se ele(a) for líder, em razão das responsabilidades inerentes à posição. As empresas brasileiras, em torno da década de 1990, começaram a adotar algumas características da gestão flexível para se adequarem às novas demandas econômicas, políticas e sociais. Tal processo ocorreu em paralelo com a transformação de alguns escritórios de advocacia brasileiros, que adentraram no pós-profissionalismo em detrimento do clássico modelo (profissionalismo) tendo como uma de suas características a implantação de grandes bancas advocatícias. Essas bancas, por sua vez, possuem algumas práticas da gestão flexível, que, dependendo da forma com que são organizadas e dos recursos da pessoa para lidar com as demandas exigidas, podem levar a situações potencialmente estressoras. Assim, o estudo teve como objetivo identificar os potenciais estressores ocupacionais autopercebidos pelos(as) advogados(as) líderes de duas unidades de uma grande sociedade de advogados(as) e analisar os impactos dos mesmos em suas vidas. Para tanto, foram realizados estudos de casos múltiplos com 9 advogados(as) líderes das unidades de São Paulo e Rio de Janeiro. Para a análise das entrevistas utilizou-se a técnica de análise de conteúdo de Bardin (1977/2009). Foram encontrados como estressores potenciais autopercebidos fatores ligados ao reconhecimento; foco somente nos resultados; sobrecarga e ritmo de trabalho; cultura da urgência; conflito de papeis; falta de controle; imprevisibilidade; decidir com o(a) cliente o trabalho e o tempo de realização do caso, sem antes checar a disponibilidade do(a) advogado(a) que fará o serviço; metas; equipe júnior. Tais potenciais estressores podem levar à frustração e sentimento de injustiça; medo de errar; desequilíbrio entre o lazer e o trabalho; e falta de autonomia. Apesar de todos os potenciais estressores apontados, a maioria dos(as) advogados(as) não se percebe com estresse. Além disso, a maioria julga possuir autonomia. Porém, foi analisado que a autonomia e diversos direitos que os(as) advogados(as) possuíam no profissionalismo parecem não mais existir nas relações de trabalho contemporânea, com base no escritório pesquisado, devido ao formato da organização que leva à maior aproximação dos(as) advogados(as) como funcionários(as). Nas considerações finais, foi apontado que os estressores potenciais autopercebidos relacionam-se ao modelo da gestão atual, demonstrando as formas de atuação contemporânea dos escritórios, distantes do perfil clássico, e as consequências que podem acarretar. Tais potenciais estressores não são eventos isolados, fazem parte da rotina diária da maioria dos(as) entrevistados(as) e aparentam ter como ponto central as metas e o reconhecimento. Espera-se contribuir com pesquisas futuras sobre o estresse dos(as) advogados(as) e ter contribuído para a reflexão sobre as relações de trabalho da advocacia contemporânea e as consequências que essas podem acarretar à vida pessoal e profissional dos(as) advogados(as) associados(as) líderes, principalmente à sua saúde / The work organization passed through many changes, which the most recent and actual is the flexible management. This has many different practices and can provoke, depending on how it´s managed, various mental harms on the workers and stress. Mainly if the person is a leader, because of the responsabilities due to the position. Brazilians companies, around of 1990´s, start to adopt some characteristics of the flexible management to adapt to new economic, political and social demands. This process occurred in parallel to the transformation of some law firms, which entered to the postprofessionalism over to the classical model (professionalism) which is noticed with development of big law firms and the adoption by them of some aspects of flexible management. Depending on how these aspects are managed and dealt by each worker, they can drive to many stressful potentials situations. Thereby, the study had as a target to identify self-perceived potential occupational stressors by leaders lawyers of two units of a big law firm and analyze impacts of them in their lives. Therefore, study of multiple cases was realized with 9 leaders lawyers of São Paulo and Rio de Janeiro. For the analysis of the interviews it was used the technique of Bardin´s content analysis.There were found as self-perceived potential occupational stressors some factors related to recognition, focus just on results, overload and pace of work, culture of urgency, conflicts of rolls, lack of control, unpredictability, decision about work with clients and time to do the work without checking availability of lawyers, goals, team with lack of experience. These potential stressors can cause frustration and feeling of injustice, fear of mistake, unbalance of leisure and work and lack of autonomy. Despite of all potential stressors indicated, the majority of lawyers don´t recognize that have stress. Besides that, most of them think have autonomy, It the other hand, it was analyzed that many rights and autonomy that lawyers had had in the professionalism seem that don´t exist anymore in the relationship of contemporary work of big law firms, based on the law firm researched, because of the mold of the organization that lead lawyers nearer to employees. In the last considerations, it was pointed that self-perceived potential occupational stressors are related to the actual management, demonstrated at actual forms of contemporary law firms, far from the classical profile, and the consequences that can result. Such potential stressors are not isolated events, are part of daily routine of the majority of the interviewers and look like that goals and recognition are central points. This work is expected to contribute with future researches about stress of lawyers and to had contributed to reflection about work relationships of contemporary advocacy and the consequences that can result in personal and professional life of leaders lawyers, especially in their health

Master of Public Health - MPH / Gay men and other men who have sex with men (MSM) and a subset within this group who are people who inject drugs (PWID) face difficulties when trying to access humanimmune deficiency virus (HIV)/ anti-retroviral treatment (ART) services and adhere to ART, due to the intersecting forms of oppression they face. Current interventions to address adherence to ART are mostly bio-medical in nature, and support the presumption that individual-level factors are the most pertinent barriers to adherence to ART. This mini-thesis presents findings from a qualitative study that explored individual, health systems and structural factors that shape experiences of adherence to ART amongst gay men and other MSM and a subset within this group who are PWID

Background: Many health care facilities enforce strict dress code policies prohibiting visible body modifications, including tattoos, piercings, and vibrant hair colors. As popularity of body modifications among young adults surges, facilities may be forced to adapt policies as these workers enter the workforce. While some evidence exists related to patient perceptions of health care workers with body modifications, there is little about how nursing students perceive them. This study aimed to describe undergraduate, pre-licensure nursing students’ perceptions of health care worker appearance on compassion, skill, knowledge, and trustworthiness. Methods: Using cross-sectional design, an on-line Likert-type survey was used to collect data from 137 undergraduate, pre-licensure nursing students in Northeast Tennessee. Participants viewed photos of male and female workers with various body modifications. Data were analyzed using descriptive and inferential statistics. Results: There were statistically significant differences between groups across all four variables. Male and female health care workers without body modifications were rated highest on all four variables. Male and female with tattoos were rated the second highest. Male and female with facial piercings were rated lowest. The female health care worker color, irrespective of body modification type, was rated higher than the male counterpart across all variables. Conclusion: Results suggest that nursing students may perceive health care workers without body modifications to be the most compassionate, skilled, knowledgeable, and trustworthy. Students may perceive tattoos as more acceptable in the workplace than facial piercings or vibrant hair colors. Students may perceive body modifications as more acceptable for females than males.

Detta är en uppsats där normer och värderingar om vårdbiträdet i hemtjänst undersöks genom kritisk diskursanalys. Datamaterial omfattar SOU-rapporten I den äldres tjänst. Äldreassistenten – ett framtidsyrke samt två fokusgruppsintervjuer med omsorgspersonal från en hemtjänstenhet. Diskursanalysen utförs i förhållande till och i samspel med sekundärlitteraturen. Utöver den språkliga analysen tas även kulturella och sociala dimensioner med i studien. För att ringa in rådande diskurser studeras centrala termer och formuleringar genom att undersöka hur ofta och upprepat de förekommer, samt vilken inkludering och exkludering som görs. I spänningsfältet som uppträder mellan den statliga diskursen och den praktiknära diskursen framträder stridigheter om de brister som äldreomsorgen tillskrivs. På politisk statlig nivå framträder en normerande bild av vårdbiträdet som den bristande länken i lagarbetet kring den äldre. På praktiknära nivå framhålls en förklaringsmodell där organisering och ledning är centrala bristkomponenter. Praktiker-diskursens faktorer bemötande och lön konkurrerar med de överordnade faktorerna som återges i SOU-diskursen; utbildning och validering. / This study is a discourse analytical study of norms and values in the Swedish public home health care sector. The discourse is studied at two different levels in Swedish society: the political and the practical. Information is collected through focus-group interviews at the practical level and at the political level from a report in the Swedish Government Official Reports Series (SOU 2008:126), appointed by the Ministry of Health and Social Affairs.   Government-sponsored publications and reports are used as a basis for executive and legislative decision-making in the parliament and the government. The governmental study is an important template for the formation and maintenance of norms and valuations. Elder care workers constitute Sweden's largest labor force and a majority of them are employed by municipalities. The SOU report motivates competence-reform in light of pending waves of retirements within the elder care work force, increased demand for elder care, and decreasing high-school enrollment in care and service programs. The discourse analysis is executed in relation to and in concert with the secondary literature.   The theoretical and methodological perspective in this study takes its starting point in Fairclough's critical discourse analytical theory and method. This provides dialectic of structures and practices, where discourse has an influence on and is influenced by social structures. In Fairclough's view, discourse practices are an important form of social practice that contributes to the forming of identities and relationships. The study investigates discursive practices in the report in order to uncover their role in the perpetuation of an unequal balance of power, so called ideological effects.  The study reveals contradictions within the SOU report and discordance between the report and home health care workers. Despite a societal eagerness to professionalize the home health aide, the political discourse relegates the aide to the bottom of the care hierarchy, by excluding issues such as compensation and subordinating questions concerning the organization and management. Discourses and action-space for workers in the home health care environment can be investigated in light of current deficiencies in top-down guidance and limited opportunities for peer-group meetings, especially since an increasing number of home health care workers have Swedish as a second language. Interactive research with both workers and management could be investigated and developed with pedagogical tools as a part of process of reform. Because Swedish society places such a high value on government reports, it is of continuing importance to scrutinize through critical-discourse analysis the entity of governmental research.

In the first part of the thesis I address the theoretical basis of the issue of social work, lifelong learning, the burnout syndrome and the ethical code of a social worker. Of health social worker help the others who face a problematic situation. They help people in order to enable them to exist and function in interaction with their social environment at a socially appreciated level. In the practical part of the thesis, the objective of the research that I set myself was to ascertain whether the health social workers have the competences to exercise their profession and what techniques they use to prevent the burnout syndrome. I decided for a written anonymous questionnaire to collect the data. The research was conducted in health and social facilities in 8 regions of the Czech Republic. 160 questionnaires were distributed altogether. The total research set consisted of 106 respondents. I examined two hypotheses. The first one was: A majority of health social workers does not have sufficient education to exercise the profession. The second one was: Of health social workers realize the risks of the burnout syndrome.