Bakgrund: Enhetschefen har inte bara ett komplext uppdrag för egen del, utan är också en viktig del för sina medarbetares och brukares välmående och miljö, samt hur verksamheten speglas och speglar sociala regler utåt. Detta sätter stora krav på förmågan att balansera många olika arbetsuppgifter i relation till människors livsvillkor och kan därmed försätta enhetschefen i etiska situationer som skapar stress. Därav finns en relevans i att undersöka etisk stress hos enhetschefer. Syfte: Syftet med studien är att undersöka hur arbetsvillkor kan medföra etisk stress hos enhetschefer inom kommunal äldreomsorg. Metod: Med studiens kvalitativa ansats har sex individuella semistrukturerade intervjuer genomförts med informanter från två olika kommuner. Intervjuerna spelades in och transkriberades för analys med tematisk ansats. Till studiens teoretiska utgångspunkter antog forskarna en sensitiv ansats till Karasek och Theorells krav- kontroll- och stödmodell samt delar av socialpedagogisk handlingsdimension där fokus lades på delaktighet, lärande och erkännande. Dessa fick fungera som analysverktyg i relation till befintlig forskning på området.  Resultat: Studien uppmärksammar en okunskap om etisk stress hos informanterna. Det framkommer hög arbetsbelastning samt begränsningar till ett närvarande ledarskap, vilket skapar stress för samtliga informanter. Informanterna har utvecklat en viss acceptans för att bibehålla och hantera sitt uppdrag. Studien resulterar i att informanterna kommer till insikt att de inte bara utmanas i etiska dilemman som skapar stress, utan också dagligen utsätts för etisk stress.

Since the 1980s, practically all of the western welfare states have developed social policies, which aim at shifting the responsibilities for welfare services from the state to the family, the civil society or to the market. In Sweden, this political transformation has particularly hit the public eldercare. In the last twenty years, the percentage of the population 65 years and older receiving public home help services in Sweden has decreased from 23 to 8 per cent at the same time as the number of beds in hospitalized eldercare has been heavily reduced. Moreover, during the course of the 2000s, the majority of the Swedish municipalities have reintroduced means testing of the eldercare based on whether the elderly have relatives or not that can perform the services. Parallel with these downsizes in the publicly financed and organized eldercare; privately produced eldercare services have increased, carried out by large and internationally own business corporations. Based on an theoretical framework, which combines the historical approach within the neo-institutional research tradition with a discursive method of analysis, this thesis explores if the period from the 1980s and onwards has been a formative moment in Swedish eldercare during which new ideas have become embedded in the institutional frameworks regulating the division of responsibility for eldercare services between the state, the family and the market. To examine if and how the municipalities, which are principally responsible for organizing and financing the public eldercare in Sweden, have implemented the change in ideas that have emerged in national politics since the 1980s, the thesis also examines how the eldercare has developed in two of Sweden’s municipalities since the 1980s. The results of the thesis demonstrates that the period from the 1980s and onwards has been a formative moment in the Swedish eldercare during which new ideas regarding the public responsibility for eldercare service have emerged and become institutionalized. Since the 1980s, senior citizens’ need for care has increasingly been re-interpreted from a public to a private issue with the consequence that today, their need for certain services, in particular those related to housework, are no longer regarded to be a public responsibility but a private matter that the elderly will have to solve, either by buying the services on the market, or, by asking relatives for help and assistance. The main problem connected with this reprivatization of senior citizens’ need for care is, however, that as the state has withdrawn its responsibility, women, in their role of being wives, daughters, or daughters-in-laws, have been forced to step in as informal and unpaid providers of care. Therefore, regardless of political reigns and modes of production, women have been forced to taken on an increasingly larger responsibility for their elderly relatives.

In recent years alcohol consumption among the elderly population in Sweden has risen. While cooperation between elder care organisations and addiction and substance abuse organisations among individual municipalities has increased, only a fifth of Swedish municipalities have revised guidelines directed toward elder care, describing how social workers are supposed to process this part of the elder population. Meanwhile, New Public Management has caused a fragmentation in social work where organisations have an increased focus on their own areas of responsibility as well as standardised aid increasing the risk of clients not getting the aid they may need. The purpose of this mixed methods study is to understand how social workers within elder care are expected to work with elders who abuse or engage in risk-filled use of alcohol. In order to accomplish this we have chosen to study guidelines for social workers specialised in elder care. The documents are developed by 30 different municipalities found through Socialstyrelsens “Öppna Jämförelser 2021” and in addition to these guidelines, the study also aims to analyse a survey directed toward social workers in the same municipalities in order to generalise the results. In conclusion, New Public Management has provided Swedish social services with specialised social workers. Working from different offices within a municipality creates cause for cooperation to which, in some municipalities, there are not sufficient guidelines describing clear proceedings when it comes to processing elders with addiction or substance abuse.

The aim of this study was to examine the level of crisis readiness within the eldercare sector. Because of the worsened security landscape in the world, crisis readiness has become a focal point on the political agenda. The crisis we explore are the types of crisis that could follow a war or the grayzone between war and peace which in Swedish is called “skymningsläge”. The crisis we focus on in the study are power failure, crisis regarding water supply, food and medicin distribution and cyber-attacks. Our survey aimed to explore the new institutional theory to gain insights into the dynamics of social work within the context of crisis management,focusing on organizations' adaptability to new security challenges. By examining the responses of frontline managers, we sought to understand the impact the organizations have on the elder care facilities. Our findings showed discrepancies between municipal and private sectors with front line managers within the private sector demonstrating a culture of greater openness to make changes for improved crisis readiness. However, in terms of crisis readiness, no significant advantage was found for private facilities. By exploring the perspectives of the first line managers we could also understand what impact the organizations have on the managers situation. Our study also showed a correlation between training in crisis management and confidence in leading during crises. The survey also showed that the organizations has taken measures to develop crisis readiness after the pandemic to be more resilient.

Välfärdsomsorg som i Sverige bedrivs enligt hälso- och sjukvårdslagen samt socialtjänstlagen är enligt lag skyldig att bedriva en systematisk kvalitetsutveckling. I denna kvalitetsutveckling inkluderas att arbeta med identifiering av brister samt risker för brister. Detta sker genom att personal i omsorgsverksamheter systematiskt ska rapportera avvikelser varpå ett avvikelsearbete påbörjas. Avvikelsearbetet leder till åtgärder i verksamheter och är därmed ett relativt omedelbart kvalitetsutvecklande. Samtidigt fyller avvikelsearbetet en funktion på en mer aggregerad nivå då det i statistiska sammanställningar kan ge fingervisning om hur verksamheter bedrivs samt att brister, och eventuella behov, tydliggörs. Statistiskt underlag samt tydliggjorda brister och behov kan i sin tur användas för att underbygga beslut som berör verksamheterna, både beslut inom verksamheter men också politiska beslut som sätter ramar och förutsättningar för organisationer och verksamheter. Således kan avvikelsearbete mynna ut i ett av de flera kvalitetsmått vilka i vårt samhälle idag är avgörande för att kunna utvärdera att offentligt bekostad välfärd dels är effektiv men också av god kvalité. Det finns idag en utbredd kritik av den samhälleliga styrmodell som kallas New Public Management. Kritiken riktar bland annat in sig på de stora krav av uppföljning och utvärdering som är både resurskrävande och riskfyllda i den mening att utvärdering och mätning av kvalité kan innehålla skevheter och föra med sig missvisande resultat. Kritik förs också fram mot att det administrativa arbetet tar över tid och resurser från kärnverksamheten, i den här studien äldreomsorg. Föreliggande studie syftar till att undersöka hur personal inom äldreomsorgens särskilda boende upplever deras avvikelsearbete utifrån begreppet organisationskultur. Det är av relevans att höra hur den personal som arbetar med avvikelsearbete upplever sitt arbete med kvalitetsutveckling. Avvikelsearbete som arbetsuppgift medför nämligen möjliga utmaningar: personal inom äldreomsorg är en av de personalgrupper i samhället som är mest belastad arbetsmiljömässigt, avvikelsearbete kan vara laddat med en känsla av utpekande av syndabockar, det finns incitament för organisationer att visa upp en yta av att kvalitetsarbete pågår. Studien har genomförts som en fallstudie med kvalitativ ansats där sju semistrukturerade intervjuer med vårdbiträden samt undersköterskor från en och samma arbetsgrupp har gjorts under våren 2018. Resultatet går i linje med tidigare forskning som lyfter fram olika aspekter som relevanta för ett framgångsrikt avvikelsearbete: kommunikation och dialog med kollegor och chef, uppmuntran från chef, tydlig struktur för hur avvikelsearbetet bedrivs. Resultatet visar också på aspekter som kan lyftas fram som brister i avvikelsearbetet: hur personal kompenserar för att hinna med sitt arbete, att avvikelser gällande vissa brister inte alltid rapporteras. För att tolka och analysera studiens resultat används socialpsykologen Edgar Scheins arbete om organisationskultur samt företagsekonomen Mats Alvessons arbete om mekanismer inom organisationer. / Welfare Care that in Sweden is given according to laws regulating health care and social services is obligated to secure systematic quality improvement. Risk management through deviation reports is a part of this quality improvement which can affect the welfare care rather immediate. Deviation reports can also be used in statistical overviews where both risks and needs within the given care can be accentuated. As a consequence, information about risk, needs and statistical overviews can also be used for decision-making in both care organisations and in policy decisions that sets the framework for the welfare care given. Hence, deviation reports can be used as one of several quality indicators that today is fundamental in the evaluation of the quality of publicly financed welfare care. Criticism of New Public Management as a control model in welfare address the heavy demands of evaluation, auditing and monitoring which implicates risks of skewness and misguiding results. Criticism also points out that the administrative work that follows with NPM takes time and resources from the welfare cares main focus which in this paper is care for the elderly. This paper aims to examine how staff within elderly care homes experience their work with deviation reports regarding the concept of organizational culture. It is of relevance to examine this since these staff are the ones producing the evidence on which decisions are based. Also, statistics shows that staff within elder care is highly over represented in regard to risk in the work environment. Deviation reporting is also filled with challenges like avoiding the sensation of pointing out a scapegoat or someone to blame. There are also incentives for organisations to keep a facade that their operations are fully functional. This study has been completed as a case study through a qualitative approach where seven semi-structured interviews with assistant nurses and nurses aides from a single work group has been made during spring 2018. The result is in line with earlier research that points out different aspects that are of relevance for successful work with deviation reports. The results also point out aspects that can be regarded as flaws within the work of deviation reports. To interpret and analyse the result of this study two main perspectives has been used; social psychologist Edgar Scheins work on organizational culture and professor of business administration Mats Alvessonswork on mechanisms within organizations.

Home First is an Ontario transition management approach that attempts to reduce the pressure on hospital and Long Term Care (LTC) beds through early discharge planning, the provision of timely and appropriate home care, and the delay of LTC placement. The purpose of this qualitative descriptive study was to obtain descriptions from South Eastern Ontario Home First clients and their family caregivers of their experiences with and thoughts about care transitions, the provision of care, and the Home First approach. The goal was to enable insight into the Home First approach, care transitions, and the provision of care through access to the perspectives of study participants. Nine semi structured interviews (and one or more follow-up calls for each interview) with Home First clients discharged from hospitals in South East Ontario and their family caregivers were conducted and their content analyzed. All participating Home First clients were pleased to be home from hospital and did not consider LTC placement a positive option. All had family involved with their care and used a mix of formal and informal services to meet their care needs. Four general themes were identified: (a) maintaining independence while responding (or not) to risks, (b) constraints on care provision, (c) communication is key, and (d) relationship matters. Although all Home First clients participating in the study were discharged home successfully, a sense of partnership between health care providers, families, and clients was often lacking. The Home First approach may be successfully addressing hospital alternative level of care issues and getting people home where they want to be, but it is also putting increasing demands on formal and informal community caregivers. There is room for improvement in how well their needs and those of care recipients are being met. Health professionals and policy makers must ask caregivers and recipients about their concerns and provide them with appropriate resources and information if they want them to become true partners on the care team. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2013-05-23 16:10:53.323