Syftet med denna uppsats var att genom ett salutogent perspektiv få en ökad förståelse för, inom äldreomsorgen verksamma, biståndshandläggares arbetssituation samt att undersöka vad som kan bidra till att biståndshandläggares arbetssituation upplevs som lättare och mindre påfrestande. Metoden som använts är kvalitativa intervjuer där sex biståndshandläggare verksamma i Värmland har intervjuats. Intervjuerna analyserades genom teman ur KASAM och resulterade i kategorier under varje tema. Under temat begriplighet framkom att biståndshandläggare får stöd från sina kollegor men att de också önskar att det fanns mer resurser för handledning. Biståndshandläggare utför mer än vad som ingår i arbetsbeskrivningen. Under temat hanterbarhet framgår att hög arbetsbelastning hanteras genom att biståndshandläggarna måste planera, strukturera och prioritera. Kollegornas stöd gör arbetet lättare att hantera då de genom att prata med varandra bearbetar känslomässigt påfrestande delar av arbetet. De uttryckte olika behov av att reflektera över sitt arbete. Biståndshandläggare har en stor frihet att planera sin egen arbetsdag och de samverkar med andra professioner. Under temat meningsfullhet framgår att biståndshandläggare finner mening i att göra skillnad för den enskilde. Vårt resultat visar att biståndshandläggarna är utsatta för stress i sitt arbete och att de också har förmåga att möta stressen, men förmågan att möta stressen minskar när arbetsbelastningen blir för hög. / The purpose of this paper was to, by using a salutogenic perspective, achieve a better understanding of eldercare, care managers’ work situation and to explore which factors contribute to the administrator's job situation being experienced as easier and less stressful. The method used were qualitative interviews where six care managers active in Värmland were interviewed. The interviews were analyzed by themes from the Sence Of Coherense and led to categories under each theme. Under the theme comprehensibility was found that care managers receive support from their colleagues but they wish for more resources for professional guidance counselling. Care managers perform more duties than what is included in their job description. Under the theme manageability it shows how administrators have to manage their, high workloads by planning, structurizing and prioritizing. The work is easier to handle when they recieve support from colleagues by talking to each other about strenuous parts of the work. They expressed different needs to reflect on their work. Care managers have a freedom to plan their own and they do collaborate and interact with other professionals. Under the theme meaningfulness the results show that care managers find meaning when they make a difference for their clients. Our results show that care managers are exposed to stress in their work and that they have their own resources cope with. The ability to handle stress is reduced when they feel that the work load is too high.

Elderly care and its first-line managers are an essential part of social work. As the demographic changes since the demands for efficiency in elderly care are increasing. The profession of the first-line managers is complex. They need to make well-balanced priorities for the good of the organizations and the wellbeing of patients and employees. Based on that our study aims at increasing the knowledge about how first-line managers of elderly care experience and handle their profession. Furthermore the study aims to explore how support around first-line managers can look like and how they achieve balance between their profession and private life. To answer the aim of the study six semi-structured interviews were performed with first-line managers, who are active in elderly care, equally many men as women. The first-line managers are active in publicly organized elderly care in three municipalities in southern Sweden. The results show that the first-line managers experience of their profession is positive, all of them experiencing a meaningfulness. However, the results show that the first-line managers are experiencing demands of availability and the management position in itself implies an exposure. Based on this study, we can conclude that the six first-line managers included in this study perceive their profession as stimulating and meaningful, which is also in line with previous research. Only two of six first-line managers have negative experiences related to their profession. The first-line managers use both work experience as well as a functioning support structure to handle the demands and expectations. In order to achieve a balance between profession and private life the professional distance to their employees is crucial.

published_or_final_version / Social Work / Master / Master of Social Work

Syftet med studien är att beskriva hur enhetschefer på äldreboenden i en svensk kommun beskriver arbetet med äldres välbefinnande och hur de konkretiserar den samma.  Studien har genomförts med en kvalitativ forskningsmetod i form av semi- strukturerade intervjuer tillsammans med 8 enhetschefer. Intervjuerna har transkriberats och kodats genom innehållsanalys. Resultatet har analyserats utifrån tidigare forskning och olika teoretiska ramar till begreppet välbefinnande. Enhetscheferna som deltog i studien valde att beskriva arbetet med personalen som det främsta sättet att bidra till äldre välbefinnande. Detta görs delvis genom utbildning i socialtjänstlagens nya värdegrund, och delvis i det dagliga arbetet då enhetscheferna tillsammans med personalen arbetar för att stärka den äldres självbestämmande och delaktighet. Slutsatsen från analysen tyder på att självbestämmande är lättare att tillgodose till de äldre som klarar av detta fysiskt och psykiskt. De äldre som inte har dessa förmågor får inte samma möjlighet till välbefinnande, eftersom delaktighet och självbestämmande då behövs göras genom personalen. Avslutningsvis behövs det mer resurser i äldreomsorgen både personalmässigt och utbildningsmässigt för att stärka äldres välbefinnande. Om de personalmässiga resurserna utökas kan detta bidra till mer värdefull individuell tid för den äldre. / The purpose of this study is to explore how managers of elderly care accommodations describes well-being for the elderly and the implementation of this. We interviewed eight managers of elderly care accommodations from a community in Sweden. A qualitative research method was used in the form of semi-structured interviews. The interviews were then transcribed and coded by content analysis. The results were analyzed based on previous research and different theoretical models explaining the concept of well-being.                                                               The managers that took part in this study described that well-being was mostly implemented by the care staff. The staffs are given courses about the guideline values for the care of elderly in special housing. This in accordance to the Social act law 5.kap §4 . The managers of elderly care also work together with their care staff to find ways to strengthen the elderly´s participation and decision making of their care. Our conclusion from this study is that the elderly’s decision making is easier to provide for those who have the physical and mentally strengthen for it. Those who haven’t got those abilities don’t get the chance to feel well-being, and the decision making and participation is then removed from the elderly to the care staff. One way to improve elderly’s well-being could be by expanding the care staff resources so that more individual time can be devoted for the elderly.

Titel: Sjukt omhändertagande - en studie om sjukfrånvaron inom den kommunala äldrevården Författare: Tuyet Pham, Hannes Skanung och Ida Söderman Handledare: Kjell Arvidsson Kurs: Företagsekonomi III - organisation, examensarbete (kandidat)   Syfte Vårt syfte med denna uppsats var att undersöka om den generellt höga sjukfrånvaron inom äldrevården i kommunal sektor har en organisatorisk koppling. I samband med uppsatsens syfte ställdes följande forskningsfråga: vilka organisatoriska faktorer bidrar till sjukskrivningarna inom den kommunala äldrevården?   Metod Denna studie är både en kvalitativ och kvantitativ studie som antagit en abduktiv ansats. Studien går under undersökningsdesignen fallstudie där det empiriska materialet består av en enkätundersökning samt kvalitativa intervjuer. I enkätundersökningen deltar 56 medarbetare och på intervjuerna deltar nio anställda på sex avdelningar under tre enheter.   Slutsatser Den empiriska och teoretiska datainsamlingen resulterade i slutsatsen att den generellt höga sjukfrånvaron inom den kommunala äldrevården har en organisatorisk koppling. Organisatoriska faktorer som vi anser påverkar sjukfrånvaron inom den kommunala äldrevården är olika uppfattningar om ansvaret för arbetsuppgifter, låg bemanning, graden av gemenskapen i olika arbetsgrupper och frånvarokultur.  Vi menar även att dessa organisatoriska faktorer påverkas av strukturella faktorer som ligger utanför organisationen. Ett exempel på detta är det långsamma vårdsystemet. / The purpose of this study was to analyze if the sickness absence in the public elderly care is due to organizational elements. This study is based on the research question:   What organizational elements contribute to the sickness absence in the public elderly care?   Method This thesis is based on a qualitative and a quantitative research and presumes an abductive approach. The empirical study consist a survey with 56 employees and interviews with nine employees in six departments within three units.   Results The empirical and theoretical study has contributed with the result that the sickness absence in the public elderly care is due to organizational elements. Organizational elements, which are affecting the sickness absence, are different views on responsibility of work tasks, low staffing, the degree of community in various working groups and absence culture. These organizational elements are also affected by structural elements in the external environment. An example of this is the inertial healthcare system

Inledning: Forskning avseende ledarskap och chefskap består av en djungel av teorier och dess diskurs är splittrad. På 1990-talet skedde kraftiga reformer inom offentlig sektor i syfte att göra den offentliga sektorn mer lik den privata. En ökad grupp av äldre och omfattande reformer har gjort chefernas arbete inom branschen mer komplex. Massmedia har framställt en bild av att äldreomsorgen under 2000-talet har befunnit sig i en stor kris i takt med den ökade privatiseringen och utvecklingen av New Public Management, vilket i sin tur ställer högre krav på cheferna. Syfte: Studien vill skapa förståelse för hur chefer inom äldreomsorgen ser på chefskap respektive ledarskap samt på krav som kan kopplas till deras roll som chefer. Studiens ambition är att ur ett individperspektiv bidra med en större förståelse för de krav som ställs på dagens chefer och komplexiteten i samband med deras chefskap. Metod: Tolkande förhållningssätt med en kvalitativ ansats, där semistrukturerade intervjuer använts för att samla empiri. Resultat/Slutsats: Chefskap och ledarskap som begrepp har genomgått omfattande förändringar. Chefskapet har blivit mer komplext i och med att rollen har förändrats och kraven har ökat. Detta till följd av ökade regleringar och kontroller i sviterna av New Public Management som till stor del kännetecknas av administration. Trots en distinkt skillnad mellan ledarskap och chefskap dras slutsatsen att krav finns på att dessa roller ska samverka och i ökad grad kommer att behöva göra det. Viktiga element i chefspositionen i enlighet med respondenterna är; coachning, motivering och stöttning av medarbetarna vilket motsvarar deras definition av ledarskap. Utifrån detta går det att dra slutsatsen att det idag inte längre räcker att agera som en traditionell chef som styr utan i chefskapet ska också ledarskapet inkluderas. / Introduction: Managership and leadership science is a jungle of theories with a fragmented discourse. Severe reforms during the 20th century was implemented with the purpose of making the public sector more similar to the private one. An increase in the number of elderly combined with several reforms has resulted in more demands put on the management. During the 21st century media portrays a crisis within the geriatric care due to increased privatization and the development of New Public Management which in turn place greater demands on the leaders within this sphere. Purpose: This paper aims to create an understanding of managership and leadership within the geriatric care from a management perspective. The results may contribute to a greater understanding of the demands put on today’s leaders and the complexity related to their managing from an individual perspective. Method: An interpretive and qualitative approach using semi-structured interviews Results/Conclusion: Managership and leadership as a concept has undergone extensive changes. Increased responsibilities and demands has made managership more complex. This is due to increased regulations and controls as a result of New Public Management which in turn has led to an increased number of administrative duties. Despite a distinct difference between managership and leadership the paper concludes that it exists demands these roles should interact and also increasingly will need to do it. According to the respondents essential elements for a manager is: coaching, motivating and supporting of the employees, which represents their definition of leadership. Consequently, it is possible to conclude there is no longer enough to act as a traditional manager which only controls but in managership should also the leadership be included.

Dagens samhälle blir allt mer mångkulturellt. Det ställer högre krav på både omvårdnaden och sjuksköterskan. Sjuksköterskans eventuella brist på kompetens om kulturskillnader kan skapa kulturkrockar, missförstånd och felaktig omvårdnad. Syftet med studien var att undersöka vilka förväntningar äldre invandrare från förre detta Jugoslavien har i möten med sjuksköterskan i Sverige samt hur sjuksköterskans kompetens kan skiljas från undersköterskor, sjukgymnaster och arbetsterapeuter. Metod: Studien är kvalitativ med en induktiv ansats och baseras på sex intervjuer med äldre invandrare som ursprungligen kom från fd. Jugoslavien. Personlig kontakt togs med informanterna om deltagande i undersökningen genom serbiska/bosniska/kroatiska/makedoniska. Författaren informerade om studien och att de som ville delta kontaktade författaren. Insamlat material analyserades systematiskt med innehållsanalys. Resultat: Det som framkom att de äldre invandrarna förväntade sig i mötet med sjuksköterskan presenteras i följande fem kategorier; Att få bekräftelse för uttalade behov; Empatisk kontakt; Kommunikation och dialog i mötet; Respekt för sina värderingar och syn på hälsa och Trygghet. Slutsatsen: omvårdnad av äldre patienter med en annan kulturell bakgrund kräver båda kulturell kompetens och professionellt förhållningssätt. Sjuksköterskan behöver kunna identifiera patientens vårdbehov och i detta fallet även övergå de språkliga barriärer och nå patienten och förstå deras behov. / Today's society is becoming increasingly multicultural which places greater demands on both the care system and the nurses involved. The nurses’ lack of knowledge incompetence of various regarding eventual cultural differences can create cultural clashes and misunderstandings that can result in and improper care. The purpose of this study was to investigate the expectations of the elder immigrants, from the former Yugoslavia, when meeting in their meetings with the nurses in Sweden professionally, Method: The study is a qualitative study, with an inductive approach, and is based on six interviews with elderly immigrants who originally came from the former Yugoslavia. Personal contact was made with the informants to participate in the investigation by Serbian / Bosnian / Croatian / Macedonian associations in southern Sweden where these compounds are. The author went to the unions and informed about the study and those who wanted to participate contacted the author. The collected materials were systematically analysed with using content analysis. Results The findings that the older immigrants expecting the meeting with the nurse are presented in the following five categories. To obtain confirmation of the expressed needs, Empathetic contact, Communication and dialogue in the meeting, Respect for their values and views on health and Safety. Conclusion: The care of older patients with a different cultural background requires both cultural competence and a professional approach. The nurses need to be able to identify patient care needs, and in this special situation case be able to cope with even pass the eventual language barriers, in order to and reach the patient and understand their needs.

Managementmodellen lean uppstod i bilindustrin men har applicerats på helt andra typer av branscher, varav offentlig sektor är en av dem. Tidigare forskning visar att lean applicerat på offentliga tjänster passar bättre när tjänsten är av mer homogen karaktär såsom sophantering och parkförvaltning. Ändå visar en kartläggning av lean i Sverige att flest kommuner har implementerat lean inom äldreomsorg - vilket är en heterogen tjänst med höga krav på individanpassning. Syftet med den här fallstudien är att undersöka om lean således är en passande managementmodell för kommunal äldreomsorg. Baserat på sju intervjuer i två svenska kommuner har studien utgått från vad som påverkar kommuners möjlighet att arbeta lean på en filosofisk nivå (lean thinking). Resultatet visar att lean thinking i sin helhet inte är passande för äldreomsorgen, vilket framför allt beror på att offentliga verksamheter utöver brukaren ser socialnämnden och skattebetalare som kunder, vilket försvårar arbetet med lean som utgår från värde enligt kundens perspektiv. Däremot visar verksamheterna att de genom att arbeta med lean framförallt förbättrar processer som inte involverar brukaren, exempelvis administration och förråds- och tvätthantering. Det frigör tid till värdeskapande aktiviteter för brukaren. Vi finner också att myndigheten som reglerar svensk äldreomsorg möjliggör för lean-inspirerat arbete inom äldreomsorg, framför allt på grund av arbetet med att utgå och anpassa tjänster till de faktiska behoven för brukaren istället för att begränsas till det redan befintliga tjänsteutbudet. / Lean was first seen in the automotive industry but has since then been applied to a number of different industries, whereof the public sector is one of them. Previous research has shown that lean has a better fit with services when applied to homogeneous services like waste disposal and maintaining parks. Yet an overview of lean in Swedish municipalities has shown that the most frequent use of the concept lean is in elderly care - which is categorized as a heterogeneous customized service. The aim of this case study is to examine the fit between lean and municipal elderly care. The study has investigated what determines the ability of adopting lean thinking based on seven interviews in two Swedish municipalities. The results show that the whole concept of lean thinking cannot be applied, primarily because of the complexity of the customer concept in the public sector. The interviewees identify several customers apart from the end-user of the service. The fact that tax payers and the social welfare board also are considered customers hinders the work with lean, since their interests may diverge from that of the end-user. However, by using lean tools, processes without involvement from the end-user have been improved, for instance services like administration, laundry and storage management. In turn, these improvements made time for value creating activities for the end-user. The results also show that the Social authority regulating the Swedish municipal elderly care, actually enables an approach inspired by lean. This is primarily due to the development towards a service production based on the actual needs of the end-user rather than being limited to the existing services.

Frente ao crescimento da população idosa no Brasil, observa-se a necessidade de cuidados de longo prazo voltados a parte desse grupo e de apoio aos seus familiares, que não conseguem mais assumir sozinhos a função do cuidado. Nesse contexto, é recente na sociedade a figura do cuidador de idoso, cuja função é classificada como ocupação pela Classificação Brasileira de Ocupações. O Projeto de Lei do Senado 284/2011 apresentou a proposta de regulamentação da profissão de cuidador de pessoa idosa que, entre outras ações, foi debatido em duas audiências públicas. A presente pesquisa teve como objetivos analisar o processo de regulamentação da profissão de cuidador da pessoa idosa ocorrido no Senado; identificar e discutir as possíveis consequências da aprovação do projeto de lei para a sociedade brasileira; analisar a relação dessa ocupação com profissões regulamentadas e identificar e analisar os encaminhamentos necessários após a regulamentação. Esta pesquisa apoiou-se epistemologicamente em pressupostos do construcionismo social e utilizou instrumental analítico-conceitual das Práticas Discursivas e Produção de Sentidos para compreender os processos de comunicação. O objeto de pesquisa foram as duas audiências públicas promovidas pelo Senado Federal para discutir o projeto de lei: a primeira realizada em Brasília (2011) e a segunda em São Paulo (2012), gravadas pela TV Senado e encaminhadas em DVDs para a pesquisadora, que as transcreveu. A análise das audiências foi quantitativa e qualitativa e, para organizá-las, foram criados quadros de categorização dos enunciados e quadros síntese temáticos. Os eixos temáticos analisados foram Políticas Públicas, Formação Profissional, Competências e Procedimentos, Direitos Trabalhistas e Responsabilidade Criminal. Em cada eixo, foram criadas subcategorias, de acordo com os assuntos abordados pelas pessoas que fizeram pronunciamentos relevantes nas audiências. Na análise de cada audiência, realizou-se a descrição do contexto em que aconteceram e foram apresentados os palestrantes e outras pessoas que se pronunciaram e tiveram suas falas incluídas na análise. Baseada nessa análise global, foram analisados os eixos temáticos quantitativamente mais relevantes em cada audiência: na 1ª audiência foram Formação Profissional, Políticas Públicas, Competências e Procedimentos e, na 2ª audiência, Formação Profissional, Competências e Procedimentos. A discussão em conjunto das duas audiências foi realizada conforme as questões norteadoras: quais são as consequências da aprovação do projeto de lei para a sociedade brasileira?; qual a relação dessa ocupação com profissões regulamentadas?; quais são os encaminhamentos necessários após a regulamentação? Os principais resultados apontaram que uma das consequências da aprovação do projeto de lei é o reforço da obrigação estatal em relação à assistência direta ao idoso e à formação do cuidador de idosos, o que tem sido realizado de maneira tímida. Quanto à relação com profissões regulamentadas, observam-se arenas de conflitos pelo mercado de trabalho, tendo em vista que a atuação de profissionais de profissões regulamentadas inclui funções que cuidadores podem realizar, gerando disputa pelo mesmo público. Em relação aos encaminhamentos necessários após a regulamentação, discutem-se dois aspectos referentes à formação dos cuidadores de idosos. Observou-se a importância do diálogo aberto com a sociedade civil para refinamento e adequação do projeto especificamente às políticas públicas, às competências e procedimentos, à formação profissional e ficaram evidentes as lutas pelo mercado de trabalho e as vozes de apoio à regulamentação da profissão. Concluiu-se que o processo de regulamentação da profissão de cuidador de idosos passa pela sua regulação no mercado de trabalho, pois se relaciona com disputas com profissões já instituídas que se sobrepõem aos interesses e necessidades da população idosa que necessita de cuidados especiais / Due to the growth of the elderly population in Brazil, there is the need for long term care aimed at part of this group and of support to their families, who can no longer assume the role of care alone. In this context, the figure of the elderly caregiver whose function is classified by the Brazilian Classification of Occupations is recent in our society. The Senate bill 284/2011 introduced a proposal for regulating the elderly caregiver profession that, among other initiatives, was discussed at two public hearings. The goals of this study were to analyze the regulatory process of the elderly caregiver profession in the Senate; to identify and discuss the possible consequences of the approval of the bill to the Brazilian society; to analyze the relationship of this occupation with regulated professions and to identify and analyze the actions that will need to be taken after the regulation. This research relied epistemologically on social constructionism assumptions and used conceptual analytical techniques of Discursive Practices and Production of Meaning to understand the communication processes. The research objects were the two public hearings held by the Federal Senate to discuss the bill, the first held in Brasilia (2011) and the second in São Paulo (2012), recorded by TV Senado and sent on DVD for the researcher, that transcribed them. The analysis of the hearings was quantitative and qualitative, and to organize the examination, statement categorization tables and thematic synthesis tables were created. The analyzed themes were Public Policy, Professional Formation, Skills and Procedures, Employment Rights and Criminal Responsibility. Subcategories were created in each theme, according to the subjects addressed by the people who made significant pronouncements in the hearings. In the analysis of each hearing, a description of the context in which they occurred was made, and the speakers and others who have spoken and who had the lines included in the analysis were presented. Based on this global analysis, the quantitatively most important themes were analyzed in each hearing: on the first hearing they were Professional Formation, Public Policy, Skills and Procedures and on the second hearing, Professional Formation, Skills and Procedures. The joint discussion of the two hearings was done according to the following guiding questions: What are the consequences of the adoption of the bill for the Brazilian society? What is the relationship of this occupation with regulated professions? What actions need to be taken after the regulation? The main results showed that one consequence of the adoption of the bill is an increase in the State\'s obligation in relation to the direct assistance to the elderly and the training of elderly caregivers, which has been happening timidly so far. As for the relation with regulated professions, areas of conflict were observed, given that the attributions of regulated professions include functions that caregivers may provide, creating a dispute for the same target audience. Regarding the necessary actions after regulation, two aspects related to the training of elderly caregivers are discussed. The importance of open dialogue with civil society to refine and adapt the bill specifically to public policies, skills and procedures and professional formation, in which the the struggles in competing for the same market and the voices of support for the regulation of the profession were made evident, was observed. It was concluded that the regulatory process of the elderly caregiver profession touches on its regulation on the labor market, as it relates to disputes with professions already in place, with overlapping interests and needs of the elderly population that needs special care

Bakgrund: Smärta är ett vanligt problem hos äldre, vilket hanteras olika av sjuksköterskor. Det finns vissa svårigheter kopplade till åldrandet och läkemedel, bland annat ändrad fysiologi. De äldre kan ha föreställningar om att smärta är naturligt förekommande med åldern. Sjuksköterskors uppgift är att ge adekvat omvårdnad och därmed smärtlindring. Syfte: Att belysa sjuksköterskors erfarenheter av smärta inom äldrevården. Metod: Allmän litteraturöversikt med innehållsanalys. Nio artiklar ingår i resultatet. Resultat: I litteraturöversikten framkom två teman och åtta subteman som visar att det finns olika anledningar till att smärtan underbehandlas, exempelvis en rädsla för att övermedicinera eller svårigheter att tolka smärtuttryck på grund av tvetydigt kroppsspråk. Sjuksköterskor anser själva att de inte besitter tillräcklig kunskap för att utföra adekvat smärtbedömning och smärtbehandling. Slutsats: Det behövs fler riktade utbildningsinsatser för sjuksköterskor, både på arbetsplats och inom grundutbildningen. För att ge en adekvat smärtbehandling behöver sjuksköterskan förhålla sig till personcentrerad och evidensbaserad omvårdnad. / Background: Pain is a common problem in the elderly population, which is handled differently by nurses. There are some difficulties related to aging and drugs, including altered physiology. The elderly may have beliefs that pain is naturally occurring withage. The nurse's role is to provide adequate care and thus pain treatment. Aim: To elucidate the nurses’ experience of pain in the elderly care. Method: General literature review using content analysis. Nine articles were included in the result. Results: The literature review revealed two main themes and eight sub themes which show that there are different reasons for why the pain treatment is lacking, such as a fear of over-medicating or difficulties interpreting the painful expressions because of ambiguous body language. The nurses considered that they did not possess sufficient knowledge to perform adequate pain assessment and pain management. Conclusion: There is need for more targeted training for nurses, both at work and during the nursing education. To provide an adequate pain management the nurses need to relate to the person-centered and evidence-based nursing.