Syftet med denna studie var att studera sjukvårdsledares upplevelser av beslutsfattande under påfrestande förhållanden inom den prehospitala särskilda sjukvårdsledningen. Frågeställningarna bestod av vilka aspekter sjukvårdsledare upplevde som ogynnsamma respektive gynnsamma för beslutsfattande under påfrestande förhållanden. Totalt har 13 sjukvårdsledare intervjuats semistrukturerat med stöd av Critial Decision Method. Intervjumaterialet har databearbetats genom tematisk analys. Detta resulterade i två huvudteman samt sju subteman som redogör ogynnsamma samt gynnsamma aspekter för sjukvårdsledares beslutsfattande under påfrestande förhållanden. Den huvudsakliga slutsatsen i denna studie är att erfarenhet är gynnsamt för beslutsfattande under påfrestande förhållanden. De andra ogynnsamma och gynnsamma aspekterna står i kontrast gentemot varandra. / The purpose of this study was to study medical incident commanders experiences of decision-making under demanding conditions within the special major incident medical management- and support team. The research questions consisted of which aspects medical incident commanders experienced as unfavorable and favorable for decision-making under demanding conditions. A total of 13 medical incident commanders were interviewed semi-structured with the support of the Critial Decision Method. The interview material has been data processed through a thematic analysis. This resulted in two main themes with seven subthemes that describe unfavorable and favorable aspects of medical incident commanders decision-making under demanding conditions. The main conclusion of this study is that experience is beneficial for decision making under demanding conditions. The other unfavorable and favorable aspects stand in contrast to each other.

<p>Surface electromyography (sEMG) has been used to monitor muscle activity and predict fatigue in the workplaces. However, objectively measuring fatigue is challenging in complex work with unpredictable work cycles, where sEMG may be influenced by the dynamically changing posture demands. The sEMG is affected by various variables and substantial change in mean power frequencies (MPF), and a decline over 8-9% is primarily considered musculoskeletal fatigue. These MPF thresholds have been frequently used, and there were limited efforts to test their appropriateness in determining musculoskeletal fatigue in live workplaces (which predominantly consist of complex tasks). In addition, the techniques that consider both muscular and postural measurements that incorporate dynamic posture changes observed in complex work have not yet been explored. The overall objective of this work is to leverage both postural and muscular cues to identify musculoskeletal fatigue in complex tasks/jobs (i.e., tasks involving different levels of exertions, durations, and postures). The work was completed in two studies.</p> The first study aimed to (1) predict subjective fatigue using objective measurements in non-repetitive tasks, (2) determine whether the musculoskeletal fatigue thresholds in non-repetitive tasks differed from the previously reported threshold, and (3) utilize the empirically calculated thresholds to test their appropriateness in determining musculoskeletal fatigue in live surgical workplaces. The findings showed that the multi-modal measurements indicate better sensitivity than single-modality (sEMG) measurements in detecting decreases in MPF, a predictor of fatigue. In addition, the results showed that the thresholds in dynamic non-repetitive tasks, like surgery, are different than the previously reported 8% threshold. Additionally, implementing muscle-specific thresholds increased the likelihood of more accurately reporting subjective fatigue. The second study aimed to develop a multi-modal fatigue index to detect musculoskeletal fatigue. A controlled laboratory study was performed to simulate the non-repetitive physical demands at different postures. A series of experiments were conducted to test the effectiveness of various metrics/models to identify subjective fatigue in complex tasks. Next, the composite fatigue index (CFI) function was developed using the time-synced integration of both muscular signals (measured with sEMG sensors) and postural signals (measured with Inertial Measurement Unit (IMU) sensors). The variables from sEMG (amplitude, frequency, and the number of muscles showing signs of fatigue) and IMU (the prevalence of static and demanding postures and the number of shoulders in static/demanding posture) sensors were integrated to generate the CFI function. The prevalence of static/demanding postures was developed using the cumulative exposures to static/demanding postures based on the material fatigue failure theory. The single value fatigue index was obtained using the resultant CFI function, which incorporates both muscular and postural variables, to quantify the muscular fatigue in dynamic non-repetitive tasks. The findings suggested that the propagation of musculoskeletal fatigue can be detected using the multi-modal composite fatigue index in complex tasks. The resultant CFI function was then applied to surgery tasks to differentiate the fatigued and non-fatigued groups. The findings showed that the multi-modal fatigue assessment techniques could be utilized to incorporate the muscular and postural measurements to identify fatigue in complex tasks beyond single-modality assessment approaches.

De senaste åren har flera fall av skolattacker och grova våldsdåd i skolan inträffat i Sverige. Dödligt skolvåld utgör en särskild problematik för skolan eftersom elevers och personalens liv och hälsa hotas. Det ställer därmed stora krav på ledarskapet att hantera en sådan påfrestande situation, både under och efter händelsen. Trots detta saknas i stor utsträckning forskning på området, både i en internationell och skandinavisk kontext. Den här studien bidrar till ökad kunskap inom det här forskningsfältet. Syftet med den här studien var att undersöka ledarskapsrelaterade krav och utmaningar som lärare och skolledare har upplevt vid dödligt skolvåld i Sverige. En kvalitativ forskningsmetod användes, där datainsamlingen skedde genom semistrukturerade intervjuer och analyserades med en tematisk analys. Genom att ha intervjuat fem skolledare och en lärare har fyra olika teman identifierats som belyser ledarskapsrelaterade krav och utmaningar vid dödligt skolvåld. Dessa teman är organisering av krisarbete, kommunikation, anpassa ledarskapet samt hantera konsekvenserna. Slutsatser från studien är att många av de krav och utmaningar som ställs på ledarskapet återfinns i tidigare forskning om ledarskap under påfrestande förhållanden. Den tidigare forskningen fokuserar dock på ordinarie krishanteringsaktörer som polis och räddningstjänst. Till skillnad från ordinarie krishanteringsaktörer saknar dock många skolledare och lärare övning och utbildning i krishantering, samt upplever bristande organisatoriska förutsättningar och otydliga ansvarsförhållanden. Andra utmärkande aspekter av ledarskap vid dödligt skolvåld är att media upplevs som en stor utmaning att hantera och att efterarbetet kan pågå i flera år efter den aktuella händelsen. / In recent years, Sweden has experienced several incidents of lethal school violence. However, there exist a knowledge gap in the research literature concerning leadership in stressful and demanding situations in relation to a severe school crisis. This study contributes to fill this gap by examine leadership demands and challenges that teachers and school leaders have experienced during and after an incident of lethal school violence in Sweden. A qualitative method has been used in the study. Data collection was made through semi-structured interviews and analyzed using a thematic analysis method. By interviewing five school leaders in management positions (e.g. principal) and one teacher, four different themes has been identified; organization of crisis management, communication, adapt the leadership and handle the consequences. The result of the study indicates that many of the leadership demands and challenges that teachers and school leaders experience in situations of lethal school violence are similar to those that have already been identified in previous studies regarding leadership in stressful and demanding situations. However, most of the previous research have been focusing on ordinary crisis management actors such as the police. An important difference in relation to ordinary crisis management actors is that many school leaders and teacher do not have the prerequisites to handle such a demanding crisis due to a lack of practice and training. Organizational conditions and unclear responsibilities are other challenges. Additionally, many interviewees found the media coverage and handling of it very demanding. Noteworthy is also the aspect of time, where the consequences of the crisis can take years to recover from.

Text in Afrikaans / Psychology / D.Litt. et Phil (Psychology)

Text in Afrikaans / Psychology / D.Litt. et Phil (Psychology)

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