Aim: The aim of this study is to analyze how fairness and its´ components; the distributive, procedural and interactional influence job satisfaction in the Swedish Public Sector. Our examination places were nursing homes in two Mid-Swedish towns of Gävle and Tierp.  Method: The study is based on ten qualitative interviews with employees in the nursing homes within the Swedish Public Sector. We used a deductive study approach where we let the participants express themselves at the same time having specific questions derived from theory about fair HRM developed by Bowen, Gilliland and Folger (1999). We analyzed the answers question by question in order to reach to a conclusion and achieve the aim of the study. The data is reported through written text, tables, graphs and findings and implications.  Result & Conclusions: We obtained the following: that there are rules and procedures as well as communications that need to be improved, likewise the gender equality and stand-ins´ possibility to influence. The service quality and delivery is not compromised where the employees experience emotional rewards by final customers. Following issues need to be highlighted; the issue of gender equality, rules and procedures and communications.  Suggestions for future research: A study where a quantitative technique can be used to consider the direct impact between fairness and job satisfaction to check the results of qualitative study and generalize. Further research could also include the impact gender has in predominantly men or women- sectors on perceived fairness and job satisfaction as well as the views of stand-ins on topics as fairness and job satisfaction in public sectors.  Contribution of the thesis: This study contributes to theoretical knowledge development about the notions of fairness and job satisfaction within the Swedish Public Sector. The topics of interest that we recommend managers to improve are: gender equality, rules and procedures and communications at the same time as that the entry- and working conditions should be made better and easier in order to attract younger workforce into the sector.

Bakgrund: För att skapa en så bra livskvalitet som möjligt för personen med demenssjukdom behöver vården och omsorgen ges utifrån ett personcentrerat förhållningssätt med personen i fokus istället för demenssjukdomen i sig. Levnadsberättelsen är ett betydelsefullt verktyg för att lära känna personen med demenssjukdom. Syfte: Att beskriva vårdpersonalens erfarenheter av att använda levnadsberättelsen inom särskilda boenden för personer med demenssjukdom.Metod: Kvalitativ intervjustudie med vårdpersonal på särskilda boenden för personer med demenssjukdom. Resultat: Levnadsberättelsen var viktig för att lära känna personen vilket var betydelsefullt för att planera omvårdnaden och bemöta personen på bästa sätt. Den kunde bidra till att bibehålla funktioner och vanor samt vara en hjälp vid samtal som kunde stimulera och väcka minnen. Levnadsberättelsen kunde också vara en hjälp för att förebygga och lindra BPSD. Utbildning och ett gott ledarskap sågs som framgångsfaktorer för ett väl fungerande arbete med levnadsberättelsen. Slutsats: Levnadsberättelsen är en förutsättning för att kunna bedriva personcentrerad vård inom särskilt boende för personer med demenssjukdom. Den är en hjälp för att kunna respektera personens vilja och önskemål samt för att kunna planera vården och omsorgen därefter. Utbildning av vårdpersonal samt goda chefsegenskaper har kunnat ses som framgångsfaktorer för ett lyckat arbete med levnadsberättelsen. / Background: In order to create as good quality of life as possible for the person with dementia, care need to be given based on a person-centered approach with the person in focus instead of the dementia itself. The life-story is important for getting to know the person with dementia. Purpose: To describe the health professionals experience of using the life-story in nursing homes for people with dementia. Method: Qualitative interview study with healthcare professionals experience of using life-stories in nursing homes for people with dementia. Results: The life-story was important in order to get to know the person, which was important for planning nursing and responding to the person in the best way. It could help maintain functions and habits as well as help in conversations that could stimulate and wake up memories. The life-story could also help to prevent and alleviate BPSD. Education and good leadership were seen as success factors for a well-functional work with the life-story. Conclusion: The life-story is a prerequisite for being able to conduct personal care in nursing homes for people with dementia. It is a help to respect the person's will and wishes, and by acting on the basis of the life-story, then plan the care. Education of health professionals and good management skills has been seen as success factors for successful work with the life-story.

En France, 75% des établissements spécialisés dans la prise en charge des personnes dépendantes sont désormais des EHPAD. Créé dans le but de rationaliser l’offre, cet agent interroge sur sa capacité à être efficient. Dans cette thèse, le comportement des directeurs d’EHPAD est analysé de manière à identifier de nouveaux leviers d’amélioration des performances de ces établissements. L’hypothèse principale est que les directeurs adoptent des pratiques de gestion alternatives, ce qui s’explique par des différences dans leurs caractéristiques professionnelles. Une analyse exploratoire a permis de confirmer l’existence d’une grande diversité des comportements gestionnaires. Des analyses statistiques menées à partir d’une enquête originale appariée à l’enquête EHPA ont permis de dresser une typologie des modes de gestion des directeurs et de mettre en évidence l’importance de la formation de ces derniers pour expliquer leurs stratégies de gestion dans le domaine des ressources humaines. Ces résultats ouvrent de nouvelles perspectives de politique publique pour améliorer l’efficience du secteur. / In France, 75% of the establishments specialized in the care for dependant people are EHPADs. These structures were created with the aim to rationalize the offer in this sector, but remain economically inefficient. Throughout this thesis we attempt to identify how the nursing homes’ directors could be used as a lever to improve performances. We assumed that, facing similar constraints, directors adopt alternative strategies because they have different preferences, correlated with their professional characteristics. We carried out an exploratory survey that shows the directors make different management choices. The data of an original survey among a sample of EHPAD managers matched to the EHPA database was then mobilized. We identified four types of managers: the “nurses”, the “moderns”, the “bureaucrats” and the “conformists”. Finally, we focused on three management options concerning the nurses’ timetables, the bonus policy and the training policy. In all three cases, the choices are determined by the managers’ characteristics. These results open up new perspectives for public authorities to improve the efficiency of EHPADs.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Many of the elderly that lives in Nursing Homes (ILPI) have health problems, are very fragile and frequently need polypharmacy, being exposed to health risks like medical lapsing errors, dispensation or drug administration. Thus, the rational drug use in these ILPI is essentially linked to its drugs dispensary and to one adjusted Pharmaceutical Assistance. To investigate the conditions of the drugs dispensary and the Pharmaceutical Assistance, moreover, to evaluate the quality of the prescribed drugs to the elderly in ILPI in Fortaleza. A descriptive study was carried out in two ILPI (A and B) at Fortaleza-CE. On the first study, were observed and evaluated the conditions of functioning of the drug dispensary, the profile of the existing products in the dispensary, the employees and the routines related to the processes of election, acquisition, storage, control and distribution of drugs in those institutions. The data collected were inserted and analyzed on a data base developed on the Microsoft Excel 2002 program. On the second study, an analysis of the quality of medicines prescribed to the aged residents in the ILPI was carried out, considering the essentiality, the drug association in fixed doses, the pharmacological interaction potential, the drug-food interaction potential, the redundancy of pharmacotherapy and the therapeutic value of the drug. The data collected were inserted and analyzed in the statistical program SPSS 12.0 for Windows. The project was submitted to the Committee of Ethics in Research at the Hospital Complex of the Federal University of the CearÃ, receiving approval. First Study: In the dispensary of the ILPI-A there was an infestation of insects in the drugs; lack of illumination control, ventilation and temperature of the environment; and, storage of not-recommended products (cigarette, match sticks and others). Moreover, among the 776 pharmaceutical specialties found in the dispensary, 67.9% needed medical lapsing, 75.5% were monodrugs and 21.2% were essential. And, of the total of 195.177 pharmaceutical units, almost 30% were in improper conditions for consumption. The storage of the products was not standardized. The election and standardization of drugs were not realized and the acquisition of drugs was realized without logistic evaluation of supply. The collective system of drug distribution was used. The dispensary was managed by employees without training. In the ILPI-B, there was a lack of illumination control, ventilation and temperature in the environment; windows without protecting screens against the entrance of rodents and insects; and a lack of routine for cleaning the place. 104 pharmaceutical specialties were found, 51.9% needed medical lapsing, 87.5% were monodrugs and 58.7% were essential. In the 21.447 pharmaceutical units, only 1.7% was improper for consumption. The storage of the products obeyed alphabetical order for generic name, being registered the entrance and exit in proper card indices. The election and standardization of drugs were realized, and, were annually acquired. The collective system of drug distribution was used. The dispensary was managed by trained employees. Second Study: In ILPI-A, 50.8% were female, 51.6% were functional dependents individuals and 53.2% were between 60 and 75 years old. Of the 347 pharmaceuticals specialties prescribed, 5.5% were associatiated to drugs in fixed dose, 30.5% was not essential and, 34.9% was for the central nervous systems (CNS). It was observed that 25.6% of drugs presented unacceptable therapeutic value for the elderly. Among the medical lapsings with 2 or more drugs, 52.6% presented potential drug interactions. In ILPI-B, 58.3% were female, 100% were functional dependents individuals and 65% were between 60 and 75 years old. Of the 205 pharmaceuticals specialties prescribed, 2.9% were associatated to drugs in fixed dose, 32.2% was not essential and, 55.1% were to the CNS. It was observed that 36.6% presented unacceptable therapeutic value for the elderly. Among the medical lapsings with 2 or more drugs, 58.0% presented potential drug interactions. In both ILPI, the potential risks to health of the elderly, due to the drug use, were related to the lack of technician-administrative orientation concerning the drug, the dispensary management and the Pharmaceutical Assistance. The profile of the dispensaries and prescribed medicines suggests that the elderly of these ILPI are in constant risk of health, maximized or increased by incorrect and irrational use of drugs. The development of a structuralized Pharmaceutical Assistance, starting with the observance the effective good practices of the legislation in the country about the processes related to the Cycle of the Pharmaceutical Assistance, the implantation and implementation of steps of prevention as the reduction of the polypharmacy, reduction of the unacceptable drug use by the elderly, the evaluation of the quality of prescribed medicines and the practice of the Pharmaceutical Attention and the Clinical Pharmacy are fundamental. / Muitos dos idosos que vivem em InstituiÃÃo de Longa PermanÃncia para Idosos (ILPI) apresentam diversos problemas de saÃde e necessitam de mÃltiplos fÃrmacos, estando freqÃentemente expostos aos riscos à saÃde como erros de prescriÃÃo, dispensaÃÃo ou administraÃÃo de medicamentos. O uso racional de medicamentos nessas ILPI està essencialmente interligado ao seu dispensÃrio de medicamentos e a uma adequada AssistÃncia FarmacÃutica. Investigar as condiÃÃes do dispensÃrio de medicamentos e da AssistÃncia FarmacÃutica e, avaliar a qualidade dos medicamentos prescritos aos idosos residentes em ILPI do municÃpio de Fortaleza. Foram realizados estudos descritivos em duas instituiÃÃes, identificadas como ILPI-A e ILPI-B, do municÃpio de Fortaleza. No primeiro estudo, foram observadas e avaliadas as condiÃÃes de funcionamento do dispensÃrio de medicamentos, o perfil dos produtos existentes no dispensÃrio, os funcionÃrios e as rotinas relacionadas aos processos de seleÃÃo, aquisiÃÃo, armazenamento e distribuiÃÃo de medicamento nessas ILPI. Os dados obtidos foram inseridos e analisados num banco de dados desenvolvido no programa Microsoft Excel 2002. No segundo estudo, foi realizada uma anÃlise da qualidade dos medicamentos prescritos aos 124 idosos residentes na ILPI-A e aos 60 na ILPI-B, considerando a essencialidade, a associaÃÃo de medicamentos em doses fixas, a interaÃÃo farmacolÃgica potencial, a interaÃÃo medicamento-alimento potencial, a redundÃncia de farmacoterapia e o valor terapÃutico do medicamento. Os dados obtidos foram inseridos e analisados num banco de dados desenvolvido no programa estatÃstico SPSS 12.0 para Windows. O trabalho foi aprovado pelo Comità de Ãtica em Pesquisa do Complexo Hospitalar da Universidade Federal do CearÃ. RESULTADOS: Primeiro Estudo: No dispensÃrio de medicamentos da ILPI-A havia resÃduos de insetos nos medicamentos; falta de controle de iluminaÃÃo, ventilaÃÃo e temperatura do ambiente; e, armazenamento de produtos nÃo recomendados (cigarro, fÃsforo, etc). Das 776 especialidades farmacÃuticas encontradas no dispensÃrio, 67,9% necessitavam de prescriÃÃo mÃdica, 75,5% eram monofÃrmacos e 21,2% eram essenciais. Do total de 195.177 unidades farmacÃuticas identificadas, quase 30% estavam em condiÃÃes imprÃprias para consumo. A guarda dos produtos nÃo era padronizada. NÃo havia seleÃÃo e padronizaÃÃo dos medicamentos, nem tampouco controle de estoque e movimentaÃÃo dos produtos. A aquisiÃÃo de medicamentos era realizada por compra direta, sem avaliaÃÃo logÃstica de estoque. Utilizava-se o sistema de distribuiÃÃo coletivo de medicamentos. O dispensÃrio era gerenciado por um funcionÃrio de nÃvel mÃdio nÃo capacitado. Na ILPI-B, havia falta de controle de iluminaÃÃo, ventilaÃÃo e temperatura do ambiente; janela sem tela de proteÃÃo contra entrada de roedores e insetos; e falta de rotina para limpeza do local. Foram encontradas 104 especialidades farmacÃuticas, sendo que 51,9% necessitavam de prescriÃÃo mÃdica, 87,5% eram monofÃrmacos e 58,7%, essenciais. Das 21.447 unidades farmacÃuticas, apenas 1,7% estava imprÃpria para consumo. A guarda dos produtos obedecia ,à ordem alfabÃtica por nome genÃrico, sendo a entrada e saÃda registradas em fichÃrios prÃprios. Havia seleÃÃo e padronizaÃÃo dos medicamentos, bem como controle de estoque e movimentaÃÃo dos produtos. A aquisiÃÃo de medicamentos era realizada por licitaÃÃo anual, com avaliaÃÃo logÃstica de estoque. Utilizava-se o sistema de distribuiÃÃo coletivo de medicamentos. O dispensÃrio era gerenciado por um funcionÃrio de nÃvel mÃdio treinado pelo farmacÃutico, sendo este Ãltimo responsÃvel pela seleÃÃo e aquisiÃÃo dos produtos. Segundo Estudo: Na ILPI-A, 50,8% dos indivÃduos eram do sexo feminino, 51,6% eram dependentes funcionais e 53,2% estavam na faixa etÃria de 60 a 75 anos. Das 347 especialidades farmacÃuticas prescritas 5,5% eram associaÃÃo de fÃrmacos em dose fixa, 30,5% nÃo eram essenciais e 34,9% destinavam-se ao tratamento do sistema nervoso central (SNC). Em mÃdia, foram prescritas 2,8 (dp=1,5) especialidades farmacÃuticas/idoso. 25,6% dos medicamentos apresentavam valor terapÃutico inaceitÃvel para idosos. Entre as prescriÃÃes mÃdicas com 2 ou mais medicamentos, 52,6% apresentavam interaÃÃes medicamentosas potenciais (IMP). NA ILPI-B, 58,3% dos indivÃduos eram do sexo feminino, 100% eram dependentes funcionais e 65% estavam na faixa etÃria de 60 a 75 anos. Das 205 especialidades farmacÃuticas prescritas 2,9% eram associaÃÃo de fÃrmacos em dose fixa, 32,2% nÃo eram essenciais e 55,1% destinavam-se ao tratamento do SNC. Foram prescritas 3,4 (dp = 1,9) especialidades farmacÃuticas/idoso, em mÃdia. 36,6% dos medicamentos apresentavam valor terapÃutico inaceitÃvel para idosos. Em prescriÃÃes com 2 ou mais medicamentos, 58,0% na apresentavam IMP. Em ambas as ILPI, a maioria dos riscos potenciais a saÃde dos idosos das ILPI, relacionados a medicamentos, eram decorrentes da falta de orientaÃÃo tÃcnico-administrativa acerca do medicamento, do gerenciamento do dispensÃrio e da AssistÃncia FarmacÃutica. O perfil dos dispensÃrios e dos medicamentos prescritos sugere que os idosos residentes nas ILPI estudadas estÃo em constante risco de saÃde, provocado ou aumentado pelo uso incorreto e irracional de medicamentos. A estruturaÃÃo de uma AssistÃncia FarmacÃutica adequada, a comeÃar pela observÃncia da legislaÃÃo, das boas prÃticas vigentes no paÃs quanto aos processos do Ciclo da AssistÃncia FarmacÃutica, e, a avaliaÃÃo rotineira das terapÃuticas empregadas nesses idosos, bem como a implantaÃÃo e implementaÃÃo de medidas preventivas como a reduÃÃo da polifarmÃcia, reduÃÃo da utilizaÃÃo de medicamentos inaceitÃveis para idosos, a avaliaÃÃo da qualidade dos medicamentos prescritos e a prÃtica da AtenÃÃo FarmacÃutica e da FarmÃcia ClÃnica sÃo fundamentais para um bom atendimento desses idosos.

Since the late 1980s, policymakers have attempted to reduce the institutional bias of their long-term services and supports by investing in more accessible home and community-based services for older adults with long-term care needs and adults with disabilities. To further advance rebalancing discussions, this study examined the resident, facility, and state characteristics associated with the admission of community-dwelling older adults to the nursing home and the subsequent discharge of this population back to community settings. Data from the Minimum Data Set (MDS) 2.0 were used to construct episodes of care for all newly-admitted residents aged 65 and older to any free-standing U.S. nursing home. Several secondary datasets including the Online Survey, Certification, and Reporting Database (OSCAR), LTCFocus.org website, Nursing Home Compare, Nursing Home Data Compendium, and U.S. census estimates were used in the study analyses. On average, approximately 5.3% of all newly admitted nursing home residents were admitted directly from home with substantial variations across states. Most residents admitted directly from home had limited to extensive dependency in activities of daily living and moderate cognitive impairment. The most common diagnoses on admission included dementia and diabetes. While 31% of residents admitted from home remained in the facility at least 365 days after admission, 32% were discharged to the community, 15% were discharged to the hospital, and 21% died. Most residents admitted from assisted living communities, either remained in the facility or died by the end of the study. Findings from multivariate analyses suggest that resident-level factors, including demographics and health status, influenced the community transition of nursing home residents. Facility characteristics, including ownership, deficiency scores, the ratio of Medicare and Medicaid residents, and urban location were associated with discharge to the community but the effect of these factors differed according to length of stay. The commitment of a state to home and community-based services was also predictive of community discharge. Collectively, findings suggest that resident, facility, and state characteristics influence the community discharge of residents admitted from home or assisted living communities. By understanding the reasons for admission to the nursing home and the factors influencing discharge from the facility, policymakers and administrators can better anticipate and care for community-dwelling older adults with long-term care needs.

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The aim of this study is to investigate professionals’ working experience with elderly peoplewith substance use disorders and how drug or alcohol abuse affects their work with theirclients. The most important areas of focus are professionals’ views on older clients’ substanceand alcohol abuse, moral or ethical dilemmas in relation to work and the elderly’s needs forsupport and help according to professionals. To identify these problems, a qualitative methodwas used with semi-structured interviews, interviewing a total of 8 professionals in twonursing homes specializing in older clients with substance use disorder and a rehabilitationcenter aimed at ages 40 to 70. Interview data was analyzed with thematization and coding.Analysis of the material was carried out using theories such as care perspectives, ethics forsocial workers and ageism. The results of the study indicate that most professionals whowork with this target group lack the knowledge of geriatrics combined with substance abuseknowledge. A comparison is drawn between the two institutions and their organizationalrules regarding alcohol or drug consumption by clients. The study further highlights thestaff's experience of finding themselves between organizational rules, professional rules andtheir own values ​​and beliefs. The results show that professionals are struggling with the lackof rules. In addition to that the results of this study show that stereotypical perceptions ofolder people tend to influence professionals as well as other social institutions that work withthis target group. The study also addresses the issue of inadequate treatment efforts aimed atolder people and a mapping of their alcohol and drug habits.

”MAN BLIR SÅ GLAD NÄR DET KNACKAR PÅ DÖRREN…”- EN KVALITATIV STUDIE OM UPPLEVELSER AV SOCIAL SAMVARO INOM SÄRSKILT BOENDE FÖR ÄLDRELINDA STENBERGStenberg, L. ”Man blir så glad när det knackar på dörren…”. En kvalitativ studie angående äldres upplevelser av social samvaro inom särskilt boende. Examensarbete i Socialt arbete, 30 högskolepoäng. Malmö universitet: Fakulteten för hälsa och samhälle, Institutionen för Socialt arbete, 2018.Abstrakt: Syftet med uppsatsen är att undersöka äldres upplevelser och beskrivningar av social samvaro när boendeformen är ett särskilt boende. Kvalitativa intervjuer har gjorts med fem personer som bor på ett särskilt boende i södra Skåne. Resultatet visar att den sociala samvaron brister utifrån de äldres beskrivningar inom valt särskilt boende för studien. Respondenterna beskriver sin sociala tillvaro som begränsad, vilket dels beror på verksamhetens utbud av aktiviteter med sociala inslag, men också på grund av en försämrad hälsa och känslor av ensamhet. Däremot framkommer att flera av respondenterna har ett frekvent umgänge med nära familjemedlemmar, men utifrån beskrivningar nämns inga vänner eller andra relationer som är av betydelse. Vikten av sociala relationer och samhörighet med andra beskrivs mestadels utifrån minnen av personernas liv före flytten till äldreboendet. Förslag till förändringar eller framtida önskemål beskrivs vagt i förhållande till deras nuvarande situation, vilket ses som problematiskt eftersom det tros skapa en diskrepans mellan individ och verksamhet angående behovet av social samvaro. Det finns ett betydande missnöje hos respondenterna vad gäller möjligheter för social samvaro utifrån deras boendesituation. Bortsett från aktiviteterna så beskrivs det finnas svårigheter att föra samtal med varandra. Den sociala interaktionen mellan personerna uppfattas som onaturlig och framtvingad. Dessutom har de flesta svårt för att framföra sina klagomål, vilket uttrycks bero på ambivalens, dolda känslor och beroendet till rollen som omsorgstagare och äldre.Nyckelord: äldre, social, särskilt boende, sociala relationer, socialt nätverk, hälsa, äldreomsorg. / ”A KNOCK ON THE DOOR BRIGHTENS UP YOUR DAY…”- A QUALITATIVE STUDY ON EXPERIENCES OF SOCIAL INTERACTION IN SPECIAL ACCOMMODATION FOR THE ELDERLYLINDA STENBERGStenberg, L. "A knock on the door brightens up your day...". A qualitative study of older people's experiences of social life in special housing. Degree Project in Social Work, 30 credits. Malmö university: Faculty of Health and Society, Department of Social Work, 2018.Abstract: The purpose of this paper is to investigate the experiences of elderly people and descriptions of social interaction when the housing form is special accommodation. Qualitative interviews have been conducted with five people living in an elderly residence in southern Skåne.The results show that the elderly experience limitations in their social life within the chosen special accommodation for the study. The respondents describe their social lives as limited, due in part to the selected choice of activities with social elements, but also because of the deterioration of their health and feelings of loneliness. On the other hand, it appears that several respondents have a frequent relationship with close family members, but based on descriptions, no friends or other relationships are mentioned that matters. The importance of social relationships and interconnection with others is mostly described based on memories of people's lives before moving to the elderly accommodation. Proposals for changes or future requests are described vaguely in relation to their current situation, which is considered problematic because it is thought to create a discrepancy between individuals and organizations regarding the need for social exchanges.There is a significant dissatisfaction with most respondents regarding opportunities for social interaction based on their living situation. Apart from the activities described there are difficulties in making conversations with each other. The daily social communication between those interviewed is perceived as unnatural and enforced. However, most of these people find it hard to convey their complaints, which are expressed by ambivalence, hidden feelings and dependence on the role of caretakers and elderly people.Keywords: elderly, social, nursing homes, social relations, social networks, health, elderly care.