The objective of this study is to test if the hypothesis of the environmental gerontology theory can be applied to a cross-cultural environment. This study examined the applicability and functionality of the Multiphasic Environmental Assessment Procedure (MEAP), a tool based on the environmental gerontology theory, and assessed the quality of elderly care facilities in Taiwan. Special emphasis was placed in examining the functionality of the MEAP from the cross-cultural standpoint and also in identifying the associations or potential impacting factors of care quality. This is the first study with the application of the MEAP to examine the quality of the two major care facilities in Taiwan. Results of this study provide not only an insight into the characteristics of the elderly care facilities ,and a reference for policy making and regulation, but also valuable data for cross-cultural comparisons. The study employed the MEAP to achieve the stated objectives and further evaluated the differences in the characteristics of the two major elderly care facilities, namely the nursing homes and assisted-living facilities in Kaohsiung city in Taiwan. This cross-sectional research was conducted with questionnaires by 687 employees (excluding foreign workers) and 429 residents in 35 nursing homes and 41 assisted living facilities in Kaohsiung city were interviewed. Participants were selected from residents who were conscious and without cognitive disorder for face-to-face questionnaire interviews. For facilities with ten or more residents, 50% of the eligible residents were selected for this interview. For facilities having less than ten residents, all those qualified residents were interviewed. Results were analyzed on the basis of institutional units rather than the individual basis. Results showed that the MEAP effectively evaluated the associations of the multiple environmental factors with the quality of life of the two major elderly care facilities in Kaohsiung city. Standardized multiple quality indexes mode showed that the assisted-living facilities have better overall quality than nursing homes do. The major findings are: 1.The major residents of elderly care facilities in Kaohsiung city were the socioeconomically less privileged residents, including house wifes, the disabled, and widowed. The service most needed was personal care such as bathing. 2.Based on the MEAP, a total of eight significant variables were compared between nursing homes and assisted living facilities. Among these variables, nursing homes were better in staff resource than that of the assisted living facilities. Assisted-living facilities were better in all other seven variables including functional abilities, activities in community, acceptance of problem behavior, physical amenities, social-recreational aids, and orientational aids and staff facilities. 3.The staff members of both nursing homes and assisted living facilities have better SCES than that of their residents. 4.Compared to assisted living facilities, the nursing homes were superior in staff level and staff resources but inferior in comfort, security, and control. No differences were observed in services, autonomy, rapport and morale. 5.The characteristics of organizational management, such as ownership, type and size, were important impacting factors of care quality. The nonprofit-nursing homes were better scored in six of the eight quality indexes than the ones owned by privately-for-profit. 6.Factors that influenced the quality of the nursing homes include number of workers, number of beds, number of residents, ownership, functional abilities, actively level, activities in community, occupancy rate and type of elderly care facility. 7.Factors that influenced the quality of assisted living facilities include occupancy rate, number of residents, number of workers, activity level and type of elderly care facility. 8.The regression model for the outcome of multiple environmental quality indexes with the structure and process indexes is related in nursing homes. The regression model indicates that the model significantly predicted outcome quality index (morale) (R2 = 49.4%). Both structure quality index (comfort and safety) and process quality index (autonomy and rapport) were significant predicting factors of outcome quality index (morale). Autonomy was a negative predicting factor. 9.Standardized multiple environmental quality index indicated that based on the MEAP, assisted living facilities had a little bit higher quality than that of nursing homes in Kaohsiung city. In conclusion, this study confirmed the hypothesis that the MEAP can be applied effectively to evaluate the quality of elderly care facilities in a cross-cultural environment. However, cultural differences do have an impact on the functionality of the tool. Results of this study indicate that the two major elderly care facilities in Kaohsiung city have relatively similar characteristics, but the assisted living facilities are slightly better in overall quality than that of nursing homes. The major factors that impact the quality of elderly care facilities are the operational characteristics and efficience. Results of this study indicate that the MEAP provides very useful indicators for assessing the quality of elderly care facilities in Taiwan, especially for nursing homes. The MEAP identified more structure and process-related impacting factors than outcome-related impacting factors in this study. Concerning cultural difference, the MEAP could be benefited from some modification in certain measurements, especially in facility atmosphere(SCES), when applied in Taiwan.

No description available.

published_or_final_version / Gerontology / Master / Master of Social Sciences

Denna studie har undersökt professioners lärande inom äldreomsorg, förskola och musikskola i det tillfälliga nätverket "sång- och musikstunden" som är en del av projektet "Barn och äldre sjunger tillsamman". Studien är inspirerad av Aktör-nätverksteorin. Studiens är kvalitativ och data har insamlats med hjälp av intervjuer och observationer. Studien har studerat samspelet mellan mänskliga och icke-mänskliga aktanter och hur dessa påverkat det tillfälliga nätverket. Resultatet visar på att aktanterna har betydelse för hur kommunikationen uppstår i det tillfälliga nätverket. Studien har också visat att det tillfälliga nätverket bidragit till lärande hos professionerna som deltagit. / This study examined professions learning in elderly care, kindergarten and music school in the temporary network "song- and music time" as part of the project "Children and the elderly are singing together" The study is inspired by actor-network theory. The study is qualitative and the data was collected through interviews and observations. The study has studied the interaction between human and non-human actants and how these affected the temporary network. The results show that the actants are important for how communication occurs in the temporary network. The study has also shown the temporary network contributed to the learning needs of the profession who participated.

The overall aim of this thesis is to describe perception of conscience, stress of conscience (stress related to troubled conscience) and burnout, to explore their relationships and to illuminate meanings of the lived experience of troubled conscience in one’s work among registered nurses (RNs) and nurse assistants (NAs) in municipal residential care for the elderly. The thesis comprises four studies; studies I-III are based on questionnaire data from 50 RNs and 96 NAs and study IV is based on interview data from 6 RNs and 6 NAs selected from the participants in the questionnaire study. Questionnaire data was analysed with multivariate statistics (I-III). Narrative interviews were interpreted with a phenomenological hermeneutic method (IV). Study I showed two relationships explaining a noteworthy amount of the shared variance by themselves (25.6% and 17.8%). One relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to external demands which was interpreted as having to deaden one’s conscience in order to be able to collaborate with co-workers. The other relationship was shown between having to deaden one’s conscience in order to keep working in healthcare and stress of conscience related to internal demands which was interpreted as having to deaden one’s conscience in order to be able to feel like a good healthcare professional. Study II showed a relationship between stress of conscience and burnout (43.6% explained variance) indicating that experiences of shortcomings and of being exposed to contradictory demands are strongly related to burnout. The relationship between perceptions of conscience and burnout (33.9% explained variance) indicated that having to deaden one’s conscience in order to keep working in healthcare is strongly related to burnout. Study III showed that both RNs and NAs perceived conscience mainly as an asset and a guide and not as a burden in their work. Lack of time and high demands of work influencing home life were the situations related to the highest stress of conscience for both RNs and NAs. The predictive pattern for RNs was interpreted as RNs showing sensitivity to expectations and demands and NAs using their conscience as a guide in their work. Study IV showed that meanings of the RNs’ lived experience of troubled conscience in their work are of being trapped in feelings of powerlessness and a sense of being inadequate. They feel they are failing to live up to expectations from residents and their families, colleagues and themselves because of feelings of powerlessness, cowardice and incompetence. Meanings of NAs’ lived experience of troubled conscience in their work are a sense of being hindered in providing the level of care they would like to provide because of pre-determined conditions and by feelings of being inadequate. They are betraying the residents and themselves by accepting perceived inadequate working conditions and through their own perceived sense of cowardice and negligence. The conclusion of these studies is that stress of conscience is related to burnout among RNs and NAs in municipal residential care for the elderly. Experiences of inadequacy, powerlessness and feelings of being hindered are shown in situations where they have troubled conscience. When the norms of others and/or the pre-determined conditions do not correspond to their own values and norms it may result in the feeling that they cannot perceive themselves as good healthcare professionals.

Andelen äldre personer i Sveriges befolkning ökar, vilket leder till större behov av väl fungerande äldreomsorg. Kommunerna har ansvar för äldreomsorgen oberoende om den utförs i offentlig eller privat regi. Den 1 januari 2009 trädde lagen om valfrihet i kraft som bland annat syftar till att öka individens möjlighet att välja hemtjänstutförare. Idag har privata aktörer större möjligheter att etablera sig inom hemtjänsten. Kontrakten som tecknas mellan kommunen och en privat utförare är den enda direkta legala möjligheten för den ansvariga kommunen att påverka kvaliteten i verksamheterna. Därför är det viktigt att kraven som ställs i kontrakten tydligt beskriver vad kommunen vill att de privata aktörerna ska utföra och vilken kvalitet dessa tjänster ska ha. Syftet med studien var därför att undersöka om och hur kommunernas kontrakt med de privata utförarna fångar upp centrala aspekter av omsorgskvalitet inom hemtjänsten. En kvalitativ deduktiv ansats användes och en innehållsanalys genomfördes för att besvara frågeställningarna. Med hjälp av en utformad analysmodell besvarades vilken typ av kvalitetskrav som ställs i kontrakten. Resultaten visade att majoriteten av de identifierade kvalitetskraven i kontrakten beskrev hur omsorgstjänsterna ska utföras. Kraven utifrån de sex kategorierna, som ingick i analysmodellen, diskuterades i kontrakten. De flesta av kraven som ställdes i kontrakten var specificerade och uppföljningsbara. Dock visade det sig att det inte gick att mäta i vilken grad kraven var uppnådda. Utifrån studiens resultat verkar svårigheterna för kommunerna vara att formulera tillräckligt omfattande och mätbara krav, vilket kan försvåra styrningen av kvaliteten inom äldreomsorgen. / The elderly population in Sweden is growing, which means that more efforts by the home care services are needed. The municipality is responsible to ensure that their population gets the services they need by public or private home care agencies. In January 2009 the law of system of choice was introduced. One aim of the law was to give the individual more freedom to choose home care provider. The only legal way for the municipality to control the quality in private services is to establish a contract between them. Therefore it is important that the contract is well written, and that the municipality clearly expresses what quality they expect the home care provider to perform. The aim of this study was to examine how the contracts are written and what kind of quality the text expresses. A qualitative deductive approach was used and a content analysis was made to examine the contracts. A model for analysis was developed with the purpose to examine the contracts. The results showed that the majority of the text about the quality in the contracts described specific how the services should be performed. The six categories, included in the model of analysis, were represented in the contracts. However, the requirements described in the text were not designed to be measurable. The results showed that it seems difficult for the municipality to formulate requirements that are measurable. This can be a reason for the difficulties for the municipality to control the quality in the elderly care.

The aim of this study is to understand first line managers experiences of the impact leadership have on the health of employees. The study focuses on leadership behaviours and actions, experienced by first line managers working in elderly care, with either positive or negative outcomes on the employees health. To answer the purpose of the study a qualitative method was used and the data was collected through seven individual interviews. The analyse was conducted using theories of transformational, transactional and laissez-faire leadership. To enable a broader dimension to the study the concept of health-promotion leadership was also used in the analysis. The first line managers experiences showed that communication, motivation and relationships were important parts of a leadership that could affect the employees health both positive and negative. Overall a leaders communication should be clear and meaningful, a leader should motivate the employees by showing interest in their work and a leader should build a relationship with the employees that are based on equality.

Visioner om IT lovar många och positiva förändringar i samhället. Detta gäller inte minst inom svensk äldreomsorg där IT ses som ett verktyg för att utveckla och förbättra äldreomsorgen. Genom att datorisera äldreomsorgen finns förhoppningar om goda effekter som bättre tillgång till information i samband med möte med den äldre, förbättrad samverkan över organisationsgränser samt bättre uppföljning. Den här avhandlingen handlar om datorisering av äldreomsorg, de aktörer genom vars intressen och värden IT-system utvecklas, och de värden som IT-systemen skapar. Då värden styr handlande, prioriteringar, beslut samt hur vi värderar det vi upplever påverkar värden utveckling och utvärdering av IT-system. Därmed studeras effekter som spår av värden. Detta är en kvalitativ studie som illustrerar hur fyra administrativa och äldreomsorgsstödjande IT-system i tre svenska kommuner har utvecklats genom olika aktörsgruppers värden och vilka värden dessa IT-system uppfattas stödja. Avhandlingsarbetet har en stark empirisk bas som har utvecklats genom att jag har deltagit i upphandling samt utveckling av IT-system för äldreomsorg i Örebro samt Linköpings kommun. Dessutom har jag studerat upplevda effekter av att använda IT-system som stöd för arbete inom äldreomsorg i Göteborg stad och Linköpings kommun. Avhandlingens resultat visar att datorisering av äldreomsorg drivs av och värderas utifrån fyra värdeområden: förvaltningsvärden, integrationsvärden, omsorgsvärden och professionsvärden. Förutom ovanstående resultat presenteras datoriseringsprocessernas aktörs-grupper och deras värden samt en jämförelse av värden som drivkrafter eller konsekvenser. Sju sammanfattande resultat avslutar beskrivningen av avhandlingens kunskapsbidrag.

Sweden has one of the best elderly cares in Europe and the Swedish care work is also one of the best in terms of quality, compared to other European countries. In recent years, higher demands have been set on the care work and the number of privatizations of public services has increased. In 2009 a new law came into force, the Act on System of Choice (LOV) which increased individual’s right to a greater participation and a free choice in the selection of health and social care providers. This paper aims to highlight the impact of the law, system of choice. By using the method of qualitative surveys and interviews with care managers, and an exploration of relevant studies and reports, I was able to complete this study. With institutional theory and other sociological concepts such as isomorphism and street-level bureaucracy, I made an analysis of both the care managers and also at an organizational level. In the conclusions I argue that the system of choice has had a greater impact at an organizational level rather than on the care managers. The paper also highlights the fact that the knowledge of processes of implementation and political governance has had a significant role. The three main issues are how the law has influenced care managers work, how organizations have changed, how and if the active choices work in practice.

Diss. Stockholm : Stockholms universitet, 2004.