Le syndrome vache à terre (SVT) est rencontré chez la vache laitière et est une condition d’urgence à évolution rapide où le pronostic est réservé à sombre. Les seuls tests complémentaires disponibles actuellement nécessitent l’utilisation des services d’un laboratoire commercial. La présence d’hypoperfusion locale et systémique ainsi que de lésions cardiaques à la nécropsie rend potentiellement intéressant le dosage de la lactatémie (LAC) et de la troponinémie (cTnI) sanguine. Ces deux biomarqueurs pouvant être analysés à l’aide d’appareils portatifs. L’objectif de la présente étude était d’évaluer la valeur pronostique de la LAC et de la cTnI dosées à la ferme, directement au chevet de la vache laitière atteinte de SVT. Le pourcentage d’issue négative (mort ou euthanasie) à sept jours suivant l’inclusion (d7) était de 63.1 %. La lactatémie n’était pas associée au pronostic vital de l’animal lors de SVT. Par contre, une valeur sanguine de cTnI >0.7 ng/mL était associée à une issue négative à d7 (sensibilité, spécificité, valeurs prédictives positive et négative respectivement de 54.1 %, 78.4 %, 82.0 % et 48.3 %). L’utilisation d’un modèle de régression logistique multivariable a montré que cette hypertroponinémie était associée à un risque d’issue négative à d7 5.5 fois (IC95%: 2.1-14.6) plus grand que le groupe présentant une cTnI ≤ 0.07 ng/mL. De plus, les animaux ayant une FC >100 BPM étaient 3.7 fois plus à risque (IC95%: 1.5-10.2) de subir une issue négative à d7 que ceux présentant une FC≤100 BPM. / Downer cow syndrome (DCS) is observed in dairy cattle and is an emergency condition that progresses rapidly and whose prognosis is reserved to poor. The only available complementary tests require the services of a commercial laboratory. The presence of local and/or systemic hypoperfusion, along with the presence of cardiac lesions at necropsy renders the dosage of lactatemia (LAC) and cardiac troponin I (cTnI) in the blood potentially interesting. These two biomarkers being measurable through the analysis of portable equipment, the present study objective was to evaluate the prognostic value of measuring LAC and cTnl directly at the side of the dairy cow affected by DCS. The percentage of negative outcome (death or euthanasia; NO) seven days following the study inclusion (d7) was 63.1%. LAC was not associated with the prognosis of the animal suffering from DCS. However, a blood cTnl value of ˃0.7ng/mL was associated with a NO before d7 (sensitivity, positive and negative predictive values of 54.1, 78.4, 82.0, and 48.3%, respectively). The use of a logistic multivariable model demonstrated that hypertroponinemia was associated with a NO risk 5.5 greater (95%CI: 2.1-14.6) by d7 than animals presented with a blood cTnl value of ≤ 0,07ng/mL. The animals presenting a HR > 100BPM were 3.7 times more at risk (95%CI: 1.5-10.2) of exiting the herd by d7 than the animals with a HR of ≤ 100BPM.

Första linjens chefers position mellan arbetstagare och högre chefer innebär att det ställs höga krav både uppifrån och nedifrån på dessa chefer då de befinner sig mitt i mellan det operativa och det strategiska arbetet. Emellertid kan dessa krav variera i förhållande till verksamhetens komplexitet och de resurser som tillhandahålls av organisationen. För att säkerställa en balans mellan krav och resurser för cheferna måste organisationen tillhandahålla det organisatoriska stöd som behövs för att de ska få förutsättningar till att utöva sitt ledarskap. Vidare ska chefernas utvecklingsprocess gynnas genom en hanterbar arbetsbelastning. I denna uppsats fokuseras på hur eventuella brister på organisatoriskt stöd hos första linjens chefer kan påverka denna utvecklingsprocess.   Studien syftar till att undersöka och skapa kunskap kring hur eventuella brister av upplevda behov av organisatoriskt stöd kan vara ett hinder för utveckling hos första linjens chefer inom en offentlig verksamhet. Detta undersöks genom en jämförelse av tre olika förvaltningar inom organisationen, där samtliga är hälso- omsorgs- och serviceverksamheter. I studien har kvalitativa intervjuer genomförts med tolv chefer på första linjens nivå.   Resultatet visade att utbildningar som organisationen tillhandahöll var användbara stöd i chefernas ledarskap. Dock prioriterades dessa tillfällen till lärande bort av en del chefer på grund av tidspress i arbetet, vilket skapar ett hinder för utveckling både hos individen och organisationen. Stödfunktionerna HR, IT och ekonomi framkom att upplevas bristfälliga av flera av de undersökta cheferna. En viss skillnad kunde ses avseende förvaltning, typ av verksamhet samt antal underställda medarbetare.    Slutsatsen är att organisationen gör insatser för lärande och utveckling vilka dock inte når samtliga chefer. De uttalade faktorerna var bland annat hög arbetsbelastning och brist på organisatoriskt stöd. / The position of the first line managers between employees and senior managers means that high demands are placed on these managers from the top and bottom, as they are in the middle of the operational and strategic work. However, these requirements may vary according to the complexity of the business and the resources provided by the organization. In order to ensure a balance between requirements and resources for the managers, the management must provide the support that is needed for them to have the conditions to exercise their leadership. Furthermore, the managers' development process must be promoted through a manageable workload. This paper focuses on how any deficiencies in support and resources at the first line managers can influence this development process.   The study aims to investigate and create knowledge about how any deficiencies of perceived need for support and resources can be an obstacle to the development of first-line managers within a public service. This is examined through a comparison of three different administrations within the organization, where all are health care and service activities. In the study, qualitative interviews were conducted with twelve managers at the first line level.   The result showed that training provided by the organization was useful support in the managers' leadership. However, these opportunities for learning were prioritized by some managers due to time pressure in the work, which creates an obstacle to development both at the individual and at the organization. The support functions HR, IT and finances emerged that many of the investigated managers found it to be deficient. A certain difference could be seen regarding management, type of business and number of subordinated employees.   The conclusion is that the organization makes efforts for learning and development which, however, do not reach all managers. The stated factors were, among other things, high workload and lack of organizational support and resources.

Philosophiae Doctor - PhD (Chemistry) / Tuberculosis (TB) is an airborne disease caused by Mycobacterium tuberculosis (MTB) that usually affects the lungs leading to severe coughing, fever and chest pains. It was estimated that over 9.6 million people worldwide developed TB and 1.5 million died from the infectious disease of which 12 % were co-infected with human immunodeficiency virus (HIV) in the year 2015. In 2016 the statistics increased to a total of 1.7 million people reportedly died from TB with an estimated 10.4 million new cases of TB diagnosed worldwide. The development of the efficient point-of-care systems that are ultra-sensitive, cheap and readily available is essential in order to address and control the spread of the tuberculosis (TB) disease and multidrugresistant tuberculosis.

Submitted by Aurelio Miranda (aurelio_luca@yahoo.com.br) on 2017-12-28T00:33:37Z No. of bitstreams: 1 Pessoas-Miranda_Protocolo Final.pdf: 365048 bytes, checksum: ff50eb92e666475f562195ee70cf1619 (MD5) / Approved for entry into archive by Vera Lúcia Mourão (vera.mourao@fgv.br) on 2017-12-28T13:48:22Z (GMT) No. of bitstreams: 1 Pessoas-Miranda_Protocolo Final.pdf: 365048 bytes, checksum: ff50eb92e666475f562195ee70cf1619 (MD5) / Made available in DSpace on 2017-12-29T11:16:04Z (GMT). No. of bitstreams: 1 Pessoas-Miranda_Protocolo Final.pdf: 365048 bytes, checksum: ff50eb92e666475f562195ee70cf1619 (MD5) Previous issue date: 2017-12-01 / Este estudo situa-se na linha de pesquisa de gestão de pessoas e práticas gerenciais com o propósito de analisar os requisitos de habilidades gerenciais para o cargo de primeira liderança dentro da área financeira nas organizações. Identifica-se como gestor de primeira liderança, o funcionário que não contribui sozinho para o resultado da organização e possui o gerenciamento de equipe como uma de suas atribuições, geralmente, aquele que detém o cargo de coordenador ou supervisor nas empresas. Neste sentido, esta pesquisa encontra-se fundamentada em referências bibliográficas e estudos já desenvolvidos sobre as competências gerenciais e liderança. Para atingir os objetivos desta investigação, foi realizada uma pesquisa qualitativa em três fases: (i) definição do modelo de habilidades gerenciais a partir da revisão bibliográfica e do mapeamento para coleta de dados; (ii) aplicação de entrevistas com apoio de roteiro semiestruturado aos gestores que exercem o cargo de primeira liderança na área financeira em organizações utilizando-se de amostragem por conveniência, a fim de aprofundar e capturar as percepções destes gestores de primeira liderança e; (iii) na última etapa, foi desenvolvido o mapa de requisitos de habilidades gerenciais para o cargo de primeira liderança. Como conclusão deste trabalho, espera-se agregar conhecimento para o desenvolvimento de líderes iniciantes, oferecer insights para treinamentos e identificar os gaps de habilidades gerenciais entre o esperado dos gestores que exercem o cargo de primeira liderança e o efetivamente observado por eles. Ademais, há potencial de aplicação prática com a introdução deste tema nas grades curriculares dos cursos de pós-graduação voltados aos gestores da área financeira. O acesso aos profissionais à realização das entrevistas e o tempo despendido na análise dos dados coletados destacaram-se como fatores críticos no sucesso desta pesquisa. / This study is in the research line of people management and managerial practices with the purpose of analyzing the managerial skills requirements for the position of first line manager within the financial area in organizations. It is identified as a first line manager, an employee who does not contribute to the organization's results alone and has team management as one of his duties, usually holds the position of coordinator or supervisor in companies. In this sense, this research is based on bibliographical references and already developed studies on management skills and leadership. To achieve the objectives of this research, a qualitative research was carried out in three phases: (i) definition of the managerial skills model from the bibliographic review and the mapping for data collection; (ii) application of interviews with semi-structured script support to managers who hold the position of first line manager in the financial area in organizations with use of convenience sampling, in order to deepen and capture the perceptions of these managers of first line manager and; (iii) in the last step, the map of managerial skills requirements for the position of first line manager was developed. As a conclusion of this work, it is hoped to aggregate knowledge for the development of beginning leaders, to offer training insights and to identify managerial skill gaps between what is expected of managers who hold the position of first line manager and what is effectively observed by them. In addition, there is potential of practical application with the introduction of this theme in the curricular grades of the postgraduate courses directed to the managers of the financial area. The access to the professionals to the interviews and the time spent in the analysis of the collected data stood out as critical factors in the success of this research.

La tuberculose (TB), provoquée par Mycobacterium tuberculosis, est une des trois maladies prioritaires dans le monde. Les TB multi-résistantes (MDR) et ultra-résistantes (XDR-TB) représentent des obstacles majeurs pour la lutte antituberculeuse. Dans les pays à MDR-TB élevée, comme le Vietnam, la détection insuffisante de la résistance aux antibiotiques est un des facteurs principaux qui favorisent la transmission des souches résistantes. De plus, dans ces pays, encore très peu de choses sont connues sur la résistance à la pyrazinamide et aux antibiotiques de seconde ligne et sur les déterminants génétiques liés à ces résistances. Dans ce contexte, ce travail vise donc à acquérir des connaissances sur la résistance aux antibiotiques au Vietnam et à étudier comment M. tuberculosis évolue de l’état sensible à l’état ultra-résistant.260 isolats cliniques collectés au Vietnam entre 2005 et 2009 ont été inclus. Diverses techniques et analyses ont été utilisées: tests de sensibilité aux médicaments (développement d'un test à temps réduit), spoligotypage et MIRU-VNTR (24 loci) et séquençage de gènes. Les données ont été analysées par des analyses statistiques et phylogénétiques. Ce travail s’est d’abord focalisé sur la caractérisation d’isolats hautement résistants et sur la résistance à la pyrazinamide. Une forte proportion d'isolats quadruple résistants aux antibiotiques de première ligne a été identifiée comme pré-XDR et XDR et en majorité appartenant à la famille Beijing. L'analyse moléculaire a également révélé une forte proportion d'isolats, en particulier MDR, quadruple résistants et de la famille Beijing, portant des mutations associées à la résistance à la pyrazinamide.L'analyse génétique et phylogénétique globale a ensuite montré une grande diversité de profils de mutations dans chaque famille et chaque cluster MIRU-VNTR. Ces données suggèrent que M. tuberculosis peut suivre des chemins évolutifs variés pour devenir ultra-résistant. La prédominance de mutations et de combinaisons de mutations associées à un haut niveau de résistance et à un faible coût en termes de fitness suggère un effet cumulatif des mutations et un rôle de l’épistasie dans l'acquisition de la résistance multiple. De plus, une fréquence élevée de mutations compensatoires associées à la résistance à la rifampicine a été détectée chez les isolats très résistants. Ces processus semblent donc influencer fortement l'évolution de la résistance dans notre échantillon. Il est à noter que les mutations liées à des niveaux de résistance élevée et à de faibles coûts en termes de fitness, ainsi que les mutations compensatoires étaient plus particulièrement associées à la famille Beijing.En conclusion, ce travail fournit des connaissances uniques sur la résistance aux antibiotiques chez M. tuberculosis au Vietnam. En particulier, ces données prédisent une évolution de la résistance vers une situation de plus en plus préoccupante. Premièrement, la famille Beijing, en cours d’invasion au Vietnam, apparaît associée à de hauts niveaux de résistance, de faible coût en termes de fitness et aux mutations compensatoires. Deuxièmement, le risque élevé de résistance à la pyrazinamide remet en question son efficacité et son utilisation dans les traitements contre la MDR et la XDR-TB. Troisièmement, les données suggèrent une évolution de M. tuberculosis vers un potentiel de résistance plus élevé par effet cumulatif des mutations associés à la résistance et l’existence de phénomènes d’épistasie. Comme les échantillons étudiés dans ce travail ont été collectés, l’étape suivante est de valider nos hypothèses sur des données actualisées.Enfin, ce travail avec les données déjà publiées a permis d’établir, pour la première fois, un inventaire des mutations associées à la résistance aux antibiotiques chez M. tuberculosis au Vietnam. Cette base de données sera utilisée pour le développement d'une puce à ADN pour la détection rapide de la résistance aux antibiotiques au Vietnam. / Tuberculosis (TB) is one of the deadliest infectious diseases worldwide, mainly caused by Mycobacterium tuberculosis. Multidrug resistant (MDR) and extensively drug resistant (XDR) TB are currently main challenges for TB control. In high MDR-TB burden countries like Vietnam, one of the main factors of drug resistant strain spread is the insufficient capacity of drug resistance detection. Besides, still little is known in these countries about the resistance to second line and pyrazinamide drugs (key drugs in the MDR-TB treatment) and the genetic determinants linked to these resistances. In this context, this work aimed to acquire knowledge on drug resistance in Vietnam and to understand how M. tuberculosis evolved from sensitive to highly drug resistance form by molecular analysis.260 clinical isolates collected in Vietnam between 2005 and 2009 were included. Various techniques and analyses were used: drug susceptibility testing (development of a test with a reduced turn-around time), spoligotyping and 24-MIRU-VNTR typing and gene sequencing. The data were analyzed by statistical and phylogenetic analyses.First, this work was focused on highly drug resistant M. tuberculosis clinical isolates and pyrazinamide resistance. A high proportion of quadruple first-line drug resistant isolates (resistant to isoniazid, rifampicin, streptomycin and ethambutol) have been characterized as pre-XDR and XDR isolates, belonging especially to Beijing family. The molecular analysis revealed also high proportion of drug resistant isolates carrying highly confident pyrazinamide resistance-associated mutations, particularly in MDR and quadruple resistant isolates and in Beijing family.Second, the genetic and phylogenetic analyses showed high diversity of mutation patterns within each family and each MIRU-VNTR cluster suggesting various evolutionary trajectories towards first and second-line drug resistance. The predominance of specific mutations and combinations of mutations associated with high level of resistance and low fitness cost suggests a cumulative effect of mutations and a role for epistasis in multiple-drug resistance acquisition. In addition, high frequency of fitness-compensatory mutations associated with rifampicin resistant mutations was detected in highly drug resistant isolates. These processes may drive the evolution of drug resistance in this sample and lead to a successful spread of highly drug resistant strains. It is worth noting that Beijing family was specifically linked to high-level drug resistance and low fitness cost mutations and to compensatory mutations.In conclusion, this work provides knowledge on the resistance to the first and second-line anti-TB drugs in clinical M. tuberculosis samples collected in Vietnam between 2005 and 2009. These data predict an evolution towards a more problematic situation in terms of drug resistance. First, because the Beijing family, which is currently invading Vietnam, is associated with highly drug resistance, mutations linked to high-level drug resistance and low fitness cost and compensatory mutations. Second, the high risk of pyrazinamide resistance in our sample challenges the efficacy and the use of this drug in MDR-TB treatment. Third, our data suggest an evolution of M. tuberculosis towards a higher potential of drug resistance because of a probable cumulative effect of drug resistant mutations and epistatic interactions. Since the samples under study were collected between 2005-2009, the next step is to test our hypotheses on a recent sampling. Finally, this study together with published data allowed making, for the first time, an inventory of the drug resistance associated mutations in M. tuberculosis isolates from Vietnam.

Rollen som förstalinjechef innefattar olika sociala sammanhang och det är viktigt att genom sin kommunikativa förmåga kunna inspirera och påverka olika medlemmar i organisationen. Situationer då förstalinjechefen behöver förmedla information och samtala med medarbetare sker kontinuerligt i denna yrkesroll. I det dagliga arbetet som förstalinjechef kan flera tillfällen uppstå där denne upplever känslomässig påfrestning vid samtal med medarbetare. Syftet med denna studie är att undersöka känslomässiga påfrestningar som förstalinjechefer kan uppleva av olika anledningar vid samtal med medarbetare. Syftet är vidare att undersöka om hur de förbereder sig inför dessa samtal. Denna studie bidrar med ökad kunskap om hur förstalinjechefer går tillväga vid förmedling av information de personligen upplever som obekväm att förmedla till medarbetare. Studien skapar även en förståelse för hur förstalinjechefer kan hantera sina upplevda känslomässiga påfrestningar vid samtal med medarbetare. Studien är en kvalitativ empirisk studie där åtta intervjuer genomförts med förstalinjechefer inom olika organisationer och branscher. Intervjuguiden formulerades efter den teoretiska referensramen som presenterar vad tidigare forskning visar på i form av vetenskapliga artiklar. Respondenternas främsta ansvarsområde i sin yrkesroll är att kontinuerligt leda, motivera och följa upp medarbetarnas arbetsprestationer på arbetsplatsen. Respondenterna beskriver en komplexitet i att yrkesrollen fungerar som en länk mellan det operativa och det strategiska arbetet inom organisationen. Att upprätthålla en fungerande kommunikation mellan sig och medarbetarna är betydelsefullt för att kunna främja goda relationer och samspel dem emellan. Känslomässig påfrestning inför samtal med medarbetare är vanligt förekommande i form av bland annat stress och nervositet. Utifrån den teoretiska referensramen och det insamlade empiriska materialet har vi nått ökad kunskap om att en fungerande kommunikation mellan förstalinjechefen och medarbetare behöver råda för att kunna främja ett gott samspel och goda relationer sinsemellan. Då detta råder minskar känslomässiga påfrestningar hos förstalinjechefen vid samtal med medarbetare. Chefers känslomässiga påfrestningar bör hanteras på ettsätt för att främja goda relationer med medarbetarna. Att hantera dessa känslomässiga påfrestningar kan bland annat innebära att reflektera kring en gällande situation och få stöttning i sitt ledarskap. / A first line manager's role involves to interact in different social contexts. It is therefore important that the manager has good communicative skills to be able to inspire and influence the organizations employees. Situations where a first line manager has to inform and converse with employees occurs continuously. In their everyday work as a first line manager there can rise occasions where they are experiencing as emotionally strenuous before or when conversing with employees.The purpose of this study is t oexamine emotional strains that first line managers experience for different reasons before or when conversing with employees. The purpose is further to gain knowledg eabout their preparations for these type of conversations. The study contributes with knowledge of how managers give information to employees that they personally finds uncomfortable to give. Further creates this study an understanding on how first line managers handles their experienced emotionally strains before or when conversing with employees. A qualitative empirical research study whereby eight interviews has been made with different first line managers from different organizations and industries. The interview guide was formed from the presented theoretical reference frame that shows what previous research has reached in the form of scientific articles. The main responsibility a first line manager's role contains is to lead, motivate and follow up the employees work performances at the work place. The respondents describe their role as complex and as a link between the operative and strategic work within the organization. To maintain a suitable communication with the employees is important to be able to foster good working relationships and team work. The experience of emotional strainsat conversing with employees is common among the respondents and take shape in for example stress and nervousness. The theoretical reference frame and the collected empirical material has made it possible to reach knowledge about the importance of good communication between the first line manager and the employees. From a suitable working communication good team work and working relationships can grow between the parties. A first line manager's experiences of emotional strains when conversing with employees reduces when these aspects are available in the organization. First line managers emotionally experienced strains has to be handled in a way that grow suitable work relationships with the employees. The ability to reflect about a situation and getsupport in ones emotionally strains is important.

Sexuella trakasserier inom vårdbranschen är vanligt förekommande, och kan ha allvarliga konsekvenser för både individen och arbetsplatsen. Enligt tidigare studier är patienter en vanlig förövare för sexuella trakasserier, men trots det har arbetsgivaren ingen åtgärdsskyldighet utifrån Diskrimineringslagen. Däremot kan sexuella trakasserier ifrån patienter röra sig om en allvarlig arbetsmiljöfråga, vilket arbetsgivaren har yttersta ansvaret för. Det saknas generellt kunskap om sexuella trakasserier ifrån patienter, och i synnerhet kunskap i hur chefer på sjukhus upplever sitt arbete med att förebygga samt hanterar sexuella trakasserier ifrån sjukhus, vilket motiverar genomförandet av föreliggande studie. Syftet med denna studie var att undersöka första linjen-chefers upplevelser av att arbeta emot sexuella trakasserier ifrån patienter mot vårdpersonal på sjukhus. Studien är en mixed-method studie med kvalitativ ansats, som består av två delstudier: policystudien och intervjustudien. Policystudien bestod av en kartläggning över policydokument om sexuella trakasserier ifrån patienter inom en specifik region. Endast en relevant policy fanns och denna analyserades med hjälp av en policyanalys av Carol Bacchi: WPR. Data till intervjustudien samlades in via intervjuer med tio första linjen-chefer på sjukhuset som hade den relevanta policyn. Intervjuerna analyserades med hjälp av en kvalitativ innehållsanalys. Resultatet av studien visar att den analyserade policyn i liten utsträckning handlar om sexuella trakasserier, och framställer patienter som inte har förtroende för en arbetsgrupp kännetecknad av mångfald som ett problem. Första linjen-chefer i föreliggande studie upplever en viss mättnad i hur mycket som fenomenet går att förebygga, och de tror att de flesta incidenter hanteras av vårdpersonalen själva. / The aim of this study was to examine first line managers experiences of working against sexual harassment from patients against clinicians in hospitals. The study was qualitative using mixed methods gathering data. The study was conducted in two substudies. The first by mapping out policys on sexual harassment from patients within a specific region, then analysed by using the policy analysis method What’s the problem represented to be? The second substudy was carried out by conducting interviews with ten first line managers in a hospital, and analysed by a qualitative content analysis. The results show that the analysed policy does not include sexual harassment to a great extent, and presents patients distrust to a workgroup characterized by diversity as a problem. First line managers experience some saturation in how much they can prevent sexual harassment from patients, and feel that most incidents are handled by the clinicians themselves. First line managers experience the policy as some what “black and white” but at the same time a good basic support tool, and therefore the managers experiences of preventing and handling sexual harassment from patients could give a more nuanced picture of the phenomenon.

Den mänskliga resursen är en organisations viktigaste tillgång då organisationen är beroende av mänsklig aktivitet för att existera. Chefer blir i avseendet viktiga då de kan ses som organisationens företrädare samt då de bidrar till och formar processer och arbetsförhållanden. Det blir därav av vikt att skapa förutsättningar för dem att hantera sin roll och vilja stanna i den. Tidigare forskning visar att organisatoriska förutsättningar påverkar chefsrollen, men inte specifikt hur den organisatoriska kontexten får betydelse för deras intention att stanna i rollen. Syftet med den här studien är att undersöka hur första linjens chefers intention att stanna i rollen kan förstås utifrån den organisatoriska kontexten. Vidare är syftet att skapa förståelse för hur cheferna upplever sina förutsättningar att hantera rollen. För att besvara syftet har en kvalitativ metod i form av semistrukturerade intervjuer med första linjens chefer inom vården i offentlig sektor legat till grund för empiri. Resultatet visar att chefsrollen är komplex med förväntningar från flera håll, vilket tydliggör varför den organisatoriska kontexten är betydelsefull för att förstå chefernas upplevelser och deras intention att stanna i rollen. Ur chefernas berättelser kan uttydas att arbetstillfredsställelse och organisatoriskt engagemang är betydelsefullt, vilket främst härleds till den kliniska verksamheten och medarbetarna. Vidare framgår att organisatoriska förutsättningar som samspel, kommunikation och stöd får betydelse för hur de hanterar krav och förväntningar. Sammantaget bidrar studien till en ökad förståelse för hur en organisation, genom den organisatoriska kontexten, kan verka för att behålla första linjens chefer. / The human resource is an organization's most important asset as the organization depends on human activity to exist. In this reference, managers become important as they can be seen as the organization's representatives as well as they contribute to and shape processes and working conditions. It therefore becomes important to create an environment for them to manage their role and a will to stay in it. Previous research shows that organizational conditions affect the managerial role, but not specifically how the organizational context will have an impact on their intention to stay in the role. The aim of this study is to investigate how the first-line managers' intention to stay in their position can be understood from the organizational context. Furthermore, the aim is to develop an understanding of how the managers experience their ability to handle the role. To answer the aim, a qualitative method in the form of semi-structured interviews with first-line managers in public healthcare sector has been the source for empirical data. The result shows that the managerial role is complex with expectations from several directions, which explains why the organizational context is important for understanding the managers' experiences and their intention to stay in their position. From the managers' stories it can be read that job satisfaction and organizational commitment are important, which is mainly attributed to the clinical activities and the employees. Furthermore, it appears that organizational conditions such as interaction, communication and support will have an impact on how they handle requirements and expectations. In summary, the study contributes to an increased understanding of how an organization, through the organizational context, can work to retain first-line managers.

With the Covid-19 pandemic, many of the already identified shortcomings in our welfare society came to be challenged and care for the eldery was particularly affected. Eldery care had to endure harsh criticism and managers in eldery care were questioned. Based on this, the purpose of this study is to gain an in-depth understanding of the eldery care first-line leaders experiences of leading during the Covid-19 pandemic an how they are emotionelly effected and challenged during this period. The study is based on a qualitative method whit semi-stuctured interviews as a data collection method. Eight first-line leaders in eldery care have been interviewed and based on their stories, their experiences of leading during the covid-19 pandemic have been analyzed from Erving Goffman's dramaturgical perspective and Arlie Russel Hoschschild's theory of emotional work. The study shows the importance of a transparent and present leadership and that the unit leaders have experienced loneliness and inadequacy in their role as leaders, wherw the collegial support has proven to be central to being able to stand firmly as a leader during the pandemic.

Att arbeta som första linjens chef innebär ett komplext uppdrag där arbetsuppgifterna består av ansvar för personal, budget och arbetsmiljö. I arbetet befinner sig första linjens chefer i en mellanposition där de behöver ta hänsyn till att politiska riktlinjer följs och finnas tillgängliga för medarbetare och kunder. Syftet med studien är att undersöka första linjens chefers psykosociala arbetsmiljö i äldreomsorgen. Studien bygger på kvalitativ metod. Metoden som vi använde oss av var nio semistrukturerade intervjuer. Studiens teoretiska utgångspunkter är Rubenowitz modell av psykosocial arbetsmiljö och Karasek och Theorell modell om krav, kontroll och stöd. Resultatets teman är första linjens chef, psykosocial arbetsmiljö, handlingsutrymme samt socialt stöd och meningsfullhet. Temat psykosocial arbetsmiljö har en underrubrik som heter covid-19. Vi har kommit fram till att studiens resultat visar på att respondenterna delar samma uppfattning om att det är viktigt med en god psykosocial arbetsmiljö. / Working as a first-line manager implicates a complex mission where the tasks consist of responsibility for staff, budget and working environment. In their work, first-line managers are in an intermediate position where they need to consider that political guidelines are followed and are available to employees and customers. The purpose of the study is to investigate the psychosocial work environment of first-line managers in elderly care. The study is based on a qualitative method. The method we used was nine semi-structured interviews. The study's theoretical starting points are Rubenowitz's model of psychosocial work environment and Karasek and Theorell's model of requirements, control and support. The themes of the result are first-line manager, psychosocial work environment, margin of action and social support and meaningfulness. The theme psyhosocial work enviroment has a subheading named covid-19. We have concluded the results of the study show that the respondents share the same view; that it is important to have a good psychosocial work environment.