Over the last two decades, more and more elderly care nurses, specialists and untrained, have chosen to go into temporary agency work rather than insitutionalized care. This qualitative study investigated the factors that attract elderly care nurses to temporary employment and possible adjustments organizations can make, to enhance their competitiveness over agencies. A structured literature review and the Job Demand-Resource Theory were used as the backdrop for qualitative interviews with temporary agency nurses, temporary agents and leaders of elderly care homes. The factors that attract elderly care nurses in Germany to temporary agency work are expectations of greater flexibility, higher salaries and a different balance of demands and resources. The expected flexibilities are however limited and higher salaries arequestionable. Temporary agency nurses are engaging in a form of job crafting behavior that has larger implications for the field. Organizations might enhance their competitiveness with changes to internal structures, in large part changes to internal communication, and external changes the organizations might support / In den letzten zwei Jahrzehnten haben sich immer mehr Altenpfleger*innen, sowohl Fachkräfte als auch Ungelernte, dafür entschieden, in der Zeitarbeit statt der stationären Pflege zu arbeiten. Diese qualitative Studie untersuchte die Faktoren, die Altenpfleger*innen zur Zeitarbeit bewegen, und mögliche Anpassungen, die Unternehmen vornehmen können, um ihre Wettbewerbsfähigkeit gegenüber Agenturen zu verbessern. Eine strukturierte Literaturrecherche und die Job Demand-Resource Theorie dienten als Grundlage für qualitative Interviews mit Zeitarbeitspflegekräften, Disponent*innen von Zeitarbeitsagenturen und Leiter*innen von Altenpflegeheimen. Die Faktoren, die Altenpflegeri*innen in Deutschland zur Zeitarbeit bewegen, sind die Erwartung größerer Flexibilität, höhere Gehälter und ein anderes Gleichgewicht von Anforderungen und Ressourcen. Die erwartete Flexibilität ist jedoch begrenzt und die finanziellen Vorteile sind fraglich. Zeitarbeitskräfte üben eine Form des Job Crafting aus, die weitreichende Auswirkungen auf die Pflege als Profession und Arbeitsfeld hat. Unternehmen könnten ihre Wettbewerbsfähigkeit durch Änderungen der internen Strukturen, größtenteils eine Anpassung der Kommunikation, und durch externe Veränderungen, die sie unterstützen könnten, verbessern.

This study shows the investigation of physical activeness among the nurses whowork in night shifts in hospitals and motivates them to do physical activities in theform of gamification in their working place. A qualitative approach is applied forgathering the data in the form of interviewing nurses to inquiry the problems andtried to find out the real opinions and scenarios related with physical inactivenessbased on the nurse’s interpretation. Working-time, working-loads, leisure-time,behaviors towards physical activity, laziness, less knowledge about voluntarymovements are coming out from the findings of this study. This paper suggests someactions such as walking, doing physical exercises, playing games etc. to encouragenurses to do more physical activities in a fun way in the workplace. A fun game,called ‘Healthy steps’ is designed based on the suggested actions in the form ofgamification is presented in this paper to promote physical activity at workplace andto encourage the nurses to participate lo lead a healthy lifestyle. / Denna studie visar undersökningen av fysisk aktivitet bland sjuksköterskorna somarbetar på nattskift på sjukhus och motiverar dem att göra fysiska aktiviteter i formav gamification på sin arbetsplats. En kvalitativ metod tillämpas för att samla in datai form av intervjuande sjuksköterskor för att undersöka problemen och försökte tareda på de verkliga åsikterna och scenarierna relaterade till fysisk inaktivitet baseratpå sjuksköterskans tolkning. Arbetstid, arbetsbelastning, fritid, beteende mot fysiskaktivitet, lathet, mindre kunskap om frivilliga rörelser kommer fram från resultatenfrån denna studie. Denna uppsats föreslår några åtgärder som att gå, göra fysiskaövningar, spela spel etc. för att uppmuntra sjuksköterskor att göra mer fysiskaaktiviteter på ett roligt sätt på arbetsplatsen. Ett roligt spel, kallat ‘Healthy steps’ ärutformat baserat på de föreslagna åtgärderna i form av gamification, presenteras idenna uppsats för att främja fysisk aktivitet på arbetsplatsen och för att uppmuntrasjuksköterskorna att delta för att leva en hälsosam livsstil.

Det traditionella perspektivet i hälso- och sjukvården behöver förändras, från en levererad produkt till co-production mellan sjukvårdspersonal och patienter. Patienter som drabbas av en höftfraktur lider vanligen av hög smärta och innan transport till sjukhus krävs bedömning och smärtlindring av ambulanspersonal. Lokalt inom ambulanssjukvård är det däremot inte utvärderat om patienten är involverad i bedömning och behandling enligt co-production. Motsvarande är inte heller kvaliteten av den medicinska riktlinjen för höftfrakturer systematiskt utvärderad lokalt. Målet med detta förbättringsarbete var att mäta och öka journalförda smärtskattningar samt att möjliggöra en reviderad version av den medicinska riktlinjen med ökad kvalitet. Förbättringsåtgärder skapades utifrån hörnstensmodellen. En kvalitativ studie undersökte personalens uppfattningar av förbättringsarbetet för co-production i vården. Intervjuer med personal i fokusgrupper analyserades med en deskriptiv ansats och med ramverket co-production cycle. Resultatet visar på en signifikant ökning av journalförd smärtskattning och en ökad kvalitet av den medicinska riktlinjen. Studien visar på en motivation att fråga, snarare än att anta nivån av patienternas smärta. Slutsatsen är att det är möjligt att mäta medicinska riktlinjers kvalitet och därmed deras förbättring. Genom att visualisera det journalförda vårdarbetet, jämlikt hörnstensmodellen, skapas en motivation till förändring gentemot co-production i vården. / The traditional perspective of healthcare needs transformation, from a delivered product to a co-produced service between healthcare professionals and patients. When a patient sustains a hip fracture it is often characterized with severe pain and requires an ambulance for assessment and pain relief before transportation to a hospital. However, in context of the ambulance service it is not evaluated if the patient is involved and co-produces in the assessment and treatment. Neither is the quality of the medical guideline for treatment of hip fracture systematically evaluated in the local context. The aim of this improvement work was to measure and increase the documented pain assessment, as well to measure the quality of the medical guideline so it can be revised with an improved quality. Interventions was formed using the cornerstone model as a framework. A qualitative study was performed to analyse effects of the improvement work experienced by the personnel for co-producing care with patients. Focus groups interviews with the personnel was conducted using a descriptive approach and the co-production cycle as framework. The results show a significant increase in the documentation of the pain assessments and an increased quality in the medical guideline. The study shows a motivation to ask, rather than assume patient’s pain assessment. In conclusion it is possible to measure the quality of a medical guideline and therefore so is improvement. Visualising documented care to the personnel in accordance with the cornerstone model, creates a motivation for change towards co-producing care.

This thesis investigates the access to IVF-treatment for people with psychiatric disabilities who intend to carry the child themselves. It explores how the Swedish welfare state resonates around people with psychiatric disabilities wanting to become parents, and how their reproductive rights might differ from others seeking the same treatment. Therefore, different official reports from the Swedish government and documents from the National Board of Health and Welfare that deals with the legal framework and state-sanctioned guidelines for medical professionals regarding IVF has been examined in a qualitive discourse analysis. Two interviews with two medical professionals working with IVF has also been conducted. The focus has been on the psychosocial interviews every treatment-seeking individual has to go through to determine if they are fit as parents. The main body of theory consists of work surrounding feminist disability studies, crip theory, discourse analysis, repronormativity and critical studies of the welfare state. This thesis set out to investigate how the demand from the government to put the best interest of the child first when deciding over who gets access to IVF are used to resonate around if people with psychiatric disabilities can be seen as fit parents. It also seeks to understand what these state-sanctioned guidelines and the way medical professionals interacts with them can say about the reproductive politics of the Swedish welfare state regarding people with psychiatric disabilities. The general conclusion is that the welfare state has implemented tools for reproductive control over the group that has been studied (particularly women and trans people) since at least the 1930’s, and while there has been significant change, the gatekeeping practises surrounding IVF can be seen as another tool for reproductive control. It is evident that people with psychiatric disabilities have to prove themselves in order to be seen as fit parents, and it is assumed that there is a risk trying to combine their psychiatric disabilities with the best interest of the child. While there is no legal framework denying this group access to IVF outright, this thesis shows that they face challenges to gain that access that people without psychiatric disabilities does not.

Covid-19 har efter utbrottet i slutet av 2019 medfört omfattande konsekvenser på såväl ekonomiska som sociala aspekter. Ett stort antal individer har smittats och många har avlidit till följd av viruset, vilket resulterat i kostnader i form av minskad livskvalité, sjukhusvistelse, produktionsbortfall i och med sjukfrånvaro samt förlorade levnadsår. Detta arbete ämnar värdera delar av kostnaderna för covid-19 för hälso- och sjukvården i region Värmland 2020–2021. Analysen utförs genom en cost-of-illness studie (COI) vilket beaktar indirekta och direkta kostnader. Indirekta kostnader från covid-19 som analyseras är förlorad kvalitetsjusterande levnadsår (QALY) till följd av försämrad livskvalité genom sjukdom och förlorad QALY för dödsfall. Samt produktionsbortfall vid frånvaro från arbete. Direkta kostnader är kostnader som överskridit budget för inhyrd personal, material samt vaccination, provtagning och analys samt kostnader för varje enskilt vårdtillfälle. Utöver detta har covid-19 påverkat utbud och efterfrågan på övrig vård, vilket genererat ett uppdämt vårdbehov. Denna studie lyfter det monetära värdet av vårdkö. Studien begränsas till värdet av att invänta planerad åtgärd för två typer av ingrepp, gallstensoperation och höftledsoperation. Därav framkommer i studiens resultat skilda totala kostnader beroende på vilken operation som beaktats. Gallstensoperation representerar minimivärdet som ger en total kostnad på 4 668 miljoner kr varav indirekta kostnader uppgår till 3 452 miljoner kr. Medan höftledsoperation representerar maximivärdet och i sin tur ger en total kostnad på 4 691 miljoner kr där indirekta kostnader uppgår till 3 475 miljoner kr. Slutligen visar resultatet att direkta kostnader till följd av covid-19 uppgår till 1 216 miljoner kr oberoende av vilken åtgärd som patienten väntar på. / Following the outbreak at the end of 2019, COVID-19 has had extensive consequences on both economic and social aspects. A large number of individuals have been infected and many have died as a result of the virus, resulting in costs in form of reduced quality of life, hospitalization, loss of production due to sick leave and lost life years. This work aims to evaluate parts of the costs of COVID- 19 for healthcare in Värmland 2020–2021. The analysis is performed through a cost-of-illness study (COI) which takes indirect and direct costs into account. Indirect costs from COVID-19 analyzed are lost quality-adjusted life years (QALYs) due to impaired quality of life through illness and lost QALYs for death. As well as loss of production due to absence from work. Direct costs are costs that exceed the budget for hired staff, materials, vaccination, sampling and analysis, as well as costs for each individual care session. In addition, COVID-19 has affected the supply and demand for other care, which has generated a suppressed need for care. This study highlights the monetary value of waiting lists. The study is limited to the value of waiting for planned action for two types of surgery, gallstone- and hip replacement surgery. Therefore, the results of the study show different total costs depending on the operation considered. Gallstone surgery represents the minimum value, which gives a total cost of SEK 4.668 million, of which indirect costs amount to SEK 3.452 million. While hip replacement surgery represents the maximum value and in turn gives a total cost of SEK 4.691 million where indirect costs amount to SEK 3.475 million. Finally, the results show that direct costs as a result of covid-19 amount to SEK 1.216 million, regardless of which action the patient is waiting for.

The perception of how sexed bodies should behave and look has shifted throughout history and today we see a rise in discussions about bodily autonomy and the opportunity for diverse bodies to co-exist and flourish in modern society. Human rights activists and organisations led by people born with intersexual variations of sex characteristics (IVSC) have persistently critcized health care regulations for “fixing” intersex bodies without the consent of the individual. This study investigates how the Swedish National Board of Health and Welfare (NBHW) intend to protect intersex infants from invasive surgeries and interventions performed early in life. The study also adresses the pathological aspects of how intersex conditions are being described by medical discourses as well as how current legislations manage to secure the rights and integrity of people with IVSC. By using Faircloughs critical discourse analysis I delve into the updated guidelines presented by the NBHW to review if significant changes in the recommendations for medical practice of intersex health appear in line with the organisations’ requests. This essay takes on a poststructuralist perspective with support from Judith Butler’s body and gender based theories as the main theoretical framework.Previous studies have concluded that most medical practises regarding intersex remain unchanged. They show that there is a tendency to rationalize normalizing interventions with a primary focus on the looks of genitalia. There seems to be an underlying lack of communication between the medical world and the human rights organisations, these conclusions were brought to light by authors such as Erika Alm and Surya Monro. The results of this study show that a traditional and pathological definition of intersex dominates the medical discourse and that progressive terminology is only discussed on a doctor-patient level and not on a structural scale. These results impart on the current legal inconsistencies which weaken the protection of intersex integrity as they remain unchanged. While the importance of patient integrity is addressed, the NBHW argue that there is lack of evidence based knowledge to implement more resolute restrictions and they express a lack of ambition to investigate further into these matters.

Bakgrund: Årligen drabbas cirka 5000 personer i Sverige av ett hjärtstopp utanför sjukhus. Tidig start av hjärt- och lungräddning är en förutsättning för ökad överlevnad vid ett hjärtstopp, samtidigt visar forskning på att ambulansens framkörningstid har ökat. I väntan på ambulans har sms-livräddare implementerats för att påbörja livräddande åtgärder. I dagsläget finns få studier gjorda på sms-livräddares erfarenheter och insatser vid accepterat hjärtstoppslarm, för att synliggöra hinder och eventuella fysiska och psykiska påfrestningar som de kan möta. Vid ett hjärtstopp arbetar ambulanssjuksköterskan och sms-livräddare tillsammans i team, detta gör det viktigt för ambulanssjuksköterskan att ha en ökad förståelse för sms-livräddares erfarenheter.  Syfte: Studiens syfte var att beskriva sms-livräddares erfarenheter och insatser i samband med ett accepterat hjärtstoppslarm. Metod: En blandad metod enkätstudie med en explorativ sekventiell design användes. Materialet utgick från 1231 enkäter som samlats in av Heartrunner Sweden. Materialet analyserades i tre faser. Resultat: Resultatet visade på att sms-livräddare möttes av flera hinder som medförde att deras insatser försvårades eller uteblev. Resultatet resulterade i fyra kategorier: Erfarenheter av utlarmning, Hjärtstartare, Samverkan i team och emotionella reaktioner. Sms-livräddare upplevde många känslor i samband med larmet som visade på ett eventuellt behov av debriefing. Slutsats: Trots negativa erfarenheter var 99,9% av sms-livräddarna motiverade att fortsätta sina insatser i framtiden. Resultatet tyder på att sms-livräddare hade en viktig roll i samverkan med ambulans och räddningstjänst. Sms-livräddare kunde behöva mer bekräftelse för deras insatser och stöttning för eventuella känslor som kunde uppkomma vid larm om misstänkt hjärtstopp utanför sjukhus. / Background: Every year, approximately 5000 people in Sweden suffer an out-of-hospital cardiac arrest. Early start of cardiopulmonary resuscitation is a prerequisite for increased survival in a cardiac arrest, while research shows that ambulance arrival time has increased. While waiting for an ambulance, mobile-phone dispatch of laypersons has been implemented to initiate life-saving measures. At present, few studies have been conducted on the experiences and interventions of mobile-phone dispatch of laypersons in the event of an accepted cardiac arrest alarm, in order to highlight obstacles and any physical and psychological stresses that they may face. In a cardiac arrest, the ambulance nurse and mobile-phone dispatch of laypersons work together in teams, this makes it important for the ambulance nurse to have an increased understanding of mobile-phone dispatch of laypersons ' experiences. Aim: The aim of the study was to describe mobile-phone dispatch of laypersons experiences and interventions in connection with an accepted cardiac arrest alarm. Method: A mixed method survey study with an explorative sequential design was used. The material was based on 1231 questionnaires collected by Heartrunner Sweden. The material was analysed in three phases. Results: The results showed that mobile-phone dispatch of laypersons were faced with several obstacles that made their interventions difficult or absent. The study resulted in four categories: Experience in emergency response, defibrillators, teamwork and emotional reactions. Mobile-phone dispatch of laypersons experienced many emotions in connection with the alarm, indicating a possible need for debriefing. Conclusion: Despite negative experiences, 99.9% of mobile-phone dispatch of laypersons were motivated to continue their interventions in the future. The result suggests that mobile-phone dispatch of laypersons had an important role in collaboration with ambulance and rescue services. Mobile-phone dispatch of laypersons could benefit from more acknowledgement of their interventions and support for any emotions that may arise when a suspected cardiac arrest is reported outside a hospital.

Vård och omsorg är en komplex verksamhet att schemalägga då det ofta medför krävande arbetsschema för medarbetarna samtidigt som hänsyn måste tas till medarbetarnas hälsa, hållbara organisationer samt att det ska vara en god och säker vård som ges till patienterna. Schema är en viktig del för den enskildes vardag och det förekommer olika schemaläggningsmetoder. Syftet med studien är att undersöka effekter av olika schemaläggningsprinciper inom vård och omsorg. Studien genomfördes som en strukturerad integrativ litteraturstudie med inslag av systematisk metod och induktiv ansats. Sökningar genomfördes i databaserna Healthcare Administration Database och Medline som resulterade i 252 artiklar. Efter urval och kvalitetsgranskning kvarstod 16 artiklar av både kvantitativ och kvalitativ metod som ingår i resultatet. Nattarbete ger negativa konsekvenser på hälsan hos medarbetare inom vård och omsorg. Såväl negativa som positiva effekter ses vid schemaläggningsprinciperna skiftarbete, arbete med långa pass eller önskeschema när det gäller effekter på organisatoriska klimatet, hälsoeffekter hos medarbetarna och patientsäkerhet och patientomhändertagande. Skiftarbete påverkar medarbetaren hälsa på ett negativt sätt från flera aspekter. De kan även leda till en obalans mellan arbetsliv och familjeliv samt mindre tid till fritidsaktiviteter. Långa arbetspass kan också ha ett samband med av medarbetaren upplevt värde mellan arbete och privatliv, work life balance. Att som medarbetare lägga önskeschema kan ibland medföra att verksamhetens behov inte tillgodoses. När det gäller negativa effekter av nattarbete kan detta oftast härledas till att dygnsrytmen störs. Ledarens närvaro och stöd kan bidra till bättre förutsättningar för medarbetaren att klara av skiftarbete. Den största utmaningen för arbetsgivaren inom vård och omsorg är att finna den rätta strukturen för att utarbeta ett hälsoschema som tar vara på medarbetarnas hälsa. / Health and care sector is a complex business to schedule as it often entails a demanding work schedule for the employees at the same time as the employees' health, sustainable organizations must be taken into account and it must be good and safe care that is given to the patients. Scheduling is an important part of the individual's everyday life and there are different scheduling methods. The purpose of the study is to investigate the effects of different scheduling principles in health and care. The study was conducted as a structured integrative literature study with elements of systematic method and inductive approach. Searches were performed in the Healthcare Administration Database and Medline databases which resulted in 252 articles. After selection and quality review remained16 articles of both quantitative and qualitative methods that are included in the result remained. Night work has negative consequences for the health of employees in health and care. Both negative and positive effects are seen in the scheduling principles of shift work, work with long shifts or wish lists in terms of effects on the organizational climate, health effects for employees and patient safety and patient care. Shift work affects the employee's health in a negative way from several aspects. They can also lead to an imbalance between work and family life as well as less time for leisure activities. Long work shifts can also have a connection with the value experienced by the employee between work and private life, work life balance. As an employee, laying out a wish list can sometimes mean that the needs of the business are not met. When it comes to the negative effects of night work, this can usually be attributed to the circadian rhythm being disturbed. The manager's presence and support can contribute to a better condition for the employee to cope with shift work. The biggest challenge is to find the right structure to prepare a health scheme that safeguards the employee's health.

Läkarens arbetsmiljö har satts alltmer i fokus de senaste åren. Karasek och Theorells krav-kontroll-stöd modell beskriver hur kraven i arbetet, kontrollen eller inflytande som arbetstagare har över sitt arbete och det sociala stödet som ges på arbetsplatsen kan vara avgörande för upplevelser av den psykosociala arbetsmiljön. Syftet med studien var att kartlägga hur ST-läkare i allmänmedicin upplever sin psykosociala arbetsmiljö utifrån krav-kontroll-stödmodellen. En webbenkät skickades till 310 ST-läkare i allmänmedicin i områdena Göteborg och Södra Bohuslän i februari och mars 2022. Totalt svarade 104 läkare på enkäten som ger svarsfrekvens på 33,5%. Allmänt upplever deltagarna höga krav och högt socialt stöd. De skattar sin hälsa bra trots hög stressnivå och att många upplever konflikt mellan arbete och privatliv. Majoriteten är tillfredsställd och engagerad i sitt arbete. De som upplever höga krav har signifikant sämre hälsa och upplever mer konflikt mellan arbete och privatliv. Deltagare som har mycket kontroll och bra socialt stöd är mer engagerade och tillfredsställda med sitt arbete. Det finns inget samband mellan kön och den psykosociala arbetsmiljön men deltagare som arbetar på privata vårdcentraler är mer engagerade och upplever mindre konflikt mellan arbete och privatliv än deras kollegor på offentliga arbetsplatser. Resultat är förenligt med tidigare studier kring läkarens arbetsmiljö. Dessa har också rapporterat höga krav, hög stressnivå och bristande inflytande över arbetet men även de konsekvenser som obalans mellan krav, kontroll och socialt stöd kan ha. Resultatet av denna studie ger insikt i ST-läkarens arbetsmiljö och skapar möjligheter för att arbeta vidare med gruppens arbetsmiljö och förhållningssätt till arbetet. / Over the last years there has been an increasing focus on the physician´s work environment. Karasek & Theorell´s demand-control-support model describes how the work demands, control or influence that employees have over their work and the social support provided in the workplace can be decisive for experiences of the psychosocial work environment. The purpose of the study was to explore how GPs in training in certain areas in Sweden experience their psychosocial work environment. A web-survey was sent to 310 GPs in training in Gothenburg and the southern part of Bohuslän in Sweden in February and March 2022. A total of 104 doctors responded to the survey, which gives a response rate of 33,5%. In general, the participants experience high demands and high social support. They estimate their health to be good despite high levels of stress and that many experience conflicts between work and private life. The majority are satisfied and committed to their work. Those who experience high demands have significantly poorer health and experience more conflict between work and private life. Participants who have a lot of control and good social support are more committed and satisfied with their work. The study found no relationship between gender and experiences of the psychosocial work environment but participants who work in privately run health centers are more committed and experience less conflict between work and private life than their colleagues in publicly run health centers. The results from this study are consistent with previous studies on physician´s work environment. These have also reported high demands, high levels of stress and a lack of influence over work. These have also reported the consequences that an imbalance between demands, control and social support can have. The results of this study provide insight into the work environment of GPs in training and create opportunities to continue working with physician´s work environment and how they approach their work.

The future of healthcare is increasingly digital, which includes a shift towards more personalised services that allow for more patient-centred and transparent patient care. These services are defined as PeHS and although there are great potential benefits of these services, there are also challenges regarding infor[1]mation security and privacy related to providing this type of services. This thesis project aims to examine the state of ISMS related to PeHS, which would also involve an examination of considerations taken regarding privacy in PeHS. The data collection methods for this thesis project were a systematic literature review and qualitative interviews.In total 18,667 publications published between 2017 and 2022 were found during the database searches. When the selection criteria had been applied 17 publications from the search process and 1 publication from the backward snowball process were accepted. The accepted publications were analysed by applying thematic analysis. Furthermore, two interviews with three participants were conducted after the literature review had been completed. The interview material was analysed by applying the analysis method of qualitative content analysis. The results showed that there are several challenges regarding ISMS and privacy related to PeHS. For example, there is a lack of knowledge within the organisations on why they should be applying the methods and tools available to ensure the security of the information flow through the healthcare services. Another example is the challenge of keeping up with the pace of digitalisation and adjust the ISMS to ensure sufficient information security of the services.