Hälsofrämjande arbete är en gren inom folkhälsoarbete. Arbetsplatsen är en arena som kan agera som stödjande miljö och där hälsofrämjande arbete kan bedrivas. Hälsofrämjande arbete på arbetsplatserna inom socialförvaltningen kan bedrivas med hjälp av teorin KASAM. Detta genom att skapa förutsättningar för första linjens chefer att uppleva hanterbarhet, begriplighet och meningsfullhet i att bedriva hälsofrämjande arbete. Syftet med studien är att beskriva vilka arbetsrelaterade möjligheter första linjens chefer inom socialförvaltningen upplever att de har för att kunna arbeta hälsofrämjande för medarbetarna. Studien har en kvalitativ ansats och riktar sig till målgruppen första linjens chefer inom socialförvaltningen. Data samlades in med semistrukturerade intervjuer och sex intervjupersoner valdes ut med ett målstyrt urval. Materialet analyserades med en manifest innehållsanalys. Studiens resultat belyser att målgruppen saknar väsentliga resurser som budget, tid, kunskap och stöd för att kunna bedriva hälsofrämjande arbete gentemot sina medarbetare. Resultatet visar även att det finns en skillnad i hur hälsofrämjande arbete definieras och att det behövs en ökad acceptans av att bedriva hälsofrämjande arbete. Slutsatsen är att hälsofrämjande arbete bedrivs genom arbetsmiljöarbete, delaktighet, närvaro och att ha en helhetssyn på medarbetarna. Vitala resurser för hälsofrämjande arbete saknas och förutsättningar samt acceptans behövs. / Health promotion work is a branch of public health work. The workplace is a developed arena that can act as a supportive environment where health promoting work can be conducted. Health promotion at workplaces within the Swedish social services administration can be conducted with the help of the theory sense of coherence. This by creating conditions for first-line managers to experience manageability, comprehensibility and meaningfulness in acting health promoting towards their employees. The purpose of the study is to describe the work-related opportunities first-line managers of the Swedish social services administration experience when acting health promoting towards their employees' work-related health. The study has a qualitative approach and is aimed at first-line managers in social services administration with a goal-oriented selection. Data was collected from six semi-structured interviews and was analyzed using a manifest content analysis. The results highlight a lack of significant resources such as budget, time and support to be able to conduct health-promoting work towards their employees. The results also show that there is a difference in how health-promoting work is defined and that increased acceptance is needed. The study concludes that health promotion work can be conducted through work environment management, participation and a holistic view. Vital resources are missing and acceptance for conducting health promotion work is needed.

In modern European society, there is not the slightest doubt that all people, regardless of gender, age, race, and health status have the same rights as guaranteed, which are called human rights. According to the existing laws and agreements (referred to in the work) and according to the generally accepted rules, the human rights are inalienable, with the exception of serious and precisely specified reasons. This work deals with the problem of how to balance this elementary right with the fact that for people with cognitive impairment it is sometimes necessary to carefully consider some form of restriction of their rights. The aim of this work is to find a definition of the human rights for the elderly with cognitive impairment. Secondary objectives are to describe the social services standards in relation to human rights and the subjects who are involved in supervising the observance of the rights, and the current status. The selected issues were viewed through the implementation theory, the concept of street-level bureaucracy, and the quality of life. The thesis is based on analysis of available secondary data and expert interviews. The acquired data show that although in the Czech Republic there are a number of institutions dealing with human rights, only a few of them are concerned with the rights of...

Bakgrund: I Sverige beräknas det finnas närmare 54 000 vårdchefer, och behovet av nyrekryteringar förväntas öka markant. De flesta utav dessa är förstalinjechefer. Hur väl en förstalinjechef klarar av balansen mellan de olika kraven är avgörande för såväl organisationens verksamhetsutveckling, arbetsmiljön samt konkurrenskraften. Det är dock problematiskt att denna chef, som har ett så brett ansvar, med vanligtvis begränsade resurser, förväntas uppnå positiva resultat vid sidan av alla de krav som ställs på denne. Genom att undersöka förstalinjechefers egna upplevelser av sin arbetssituation så är vår önskan att få en ökad kunskap och medvetenhet om hur det förhåller sig i verkligheten. Syftet: Syftet med studien är att bland första linjens chefer inom vård och omsorg studera upplevelser av förutsättningarna för att utöva ett för dem hållbart chefskap. Metoden vi har använt oss av är empirisk studie baserad på en kvalitativ ansats. Totalt utfördes fyra semistrukturerade intervjuer med hjälp av en intervjuguide, formulerad utifrån Gulicks organisationsteori. Resultatet visade fem återkommande teman: tid, planering, tillgänglighet och kommunikation, styrning, samt ledighet och återhämtning. Slutsats: Tidspress och tidskonflikt mellan olika arbetsmoment var en gemensam nämnare i vardagen för förstalinjecheferna. Vidare fanns en känsla av att det fanns höga krav och förväntningar uppifrån. I planeringen av vardagen föredrog cheferna en grov, flexibel, men även långsiktig planering. Tillgänglighet framför allt gentemot medarbetarna eftersträvades kontinuerligt. Den hade högt värde, och förknippades som ett av de viktigaste uppdragen som en chef har. Kommunikation beskrevs ha betydelse genom tydliga budskap, i chefens synlighet, i dess delaktighet och i respekten till andra. Det var varierande uppfattningar av balansen mellan det privata och arbetet. Hur medvetna cheferna var kring att koppla av på sin fritid verkade ha samband med hur de fördelade sitt arbete, och i vilken grad de också tog jobbet med sig hem till det privata.

Poor decision making among clinicians to transferring human immune deficiency virus (HIV) patients into second-line antiretroviral therapy (ART) has led to an increase in morbidity and mortality to people living with HIV (PLHIV). No clear barriers are known for clinicians not switching their patients. This is a descriptive qualitative research aimed to discover obstacles that influence clinicians' decision making to transferring patients into second-line ART despite higher level resistance to first-line ART. The researcher applied a participatory action research framework to solve the identified barriers with clinicians. Using the research questions the researcher explored reasons, perceived barriers and enabling factors for clinicians delay in making decision to transferring HIV patients into second-line ART. In-depth semistructured interviews were conducted with 30 participants. Six thematic areas (a) clinicians' capacity to diagnose treatment failure, (b) laboratory investigations, (c) availability, access, and tolerability to second-line ART, (d) clinicians' perceptions on ARV medicines, (e) clients' readiness for ARV medicines, and (f) adherence and retention to ARV medicines were analysed using STATA. Readiness, adherence and retention to ART, knowledge, competence and experience on ART , lack of viral load testing, and shortage of second-line ART were the common major barriers for clinicians in determining transferring patients into second-line ART. The government of Tanzania should acknowledge and create participation, responsibility, and commitment strategies to reduce the observed barriers. Findings of this study generates knowledge and provide actionable plans to help clinicians easily identify HIV patients who are in need of second-line ART.

The refugee crisis in the world, specifically after 2015, which came as a result of the repercussions of the war in Syria and the absence of the right political vision in Iraq and Libya. This migration has led to increased pressures on many countries in the European Union, as a result of the influx of more immigrants from the Middle East and North Africa. The purpose of this research for the bachelor's degree in POLITICAL SCIENCE, is to reveal the impact of the political integration process on solving the refugee crisis that plagued Europe in 2015, with a close focus on the asylum policy adopted by the EU during the refugee crisis in 2015.   The method used in this research is a qualitative case study in order to get an in depth understanding of the selected case and with the help of the data material obtained from the sources used. Through the method, materials and theoretical and empirical analysis, the purpose and questions posed within the research were answered. In this thesis, two theories were used in the research topic, namely, the theory of integration and the constructivist theory in international relations.  The results were as follows. Europe was seeking for solidarity among their countries in solving the refugee crisis that occurred in 2015. Further that solidarity could provide solutions that contribute to the distribution of burdens among the countries of the European Union. Solidarity means establishing compatible solutions among the countries of the Union. The result also showed that the 2013 Dublin III Regulation and European Asylum Policy need to be reformed because they do not work effectively during times of crisis and exceptional events.

Contexte : La pression croissante sur les soins primaires nécessite de développer des approches adaptées pour apprécier la valeur des innovations dans ce domaine et identifier les conditions favorables à leur diffusion, ce qui peut s'avérer difficile, puisque ces innovations sont souvent complexes et de nature organisationnelle. Objectifs : Explorer les arguments de valeur de 10 innovations identifiées comme prometteuses lors des symposiums sur les innovations du Collège québécois des médecins de famille et proposer des pistes pour leur bonification et diffusion. Méthodes : Approche délibérative multidimensionnelle avec un panel diversifié de 12 cliniciens, gestionnaires, patients et citoyens. À partir de données synthétisées par dimension, chaque participant a apprécié le potentiel de valeur des innovations par un score et des arguments justificatifs pour chaque dimension individuellement et suite à une délibération. Le potentiel de valeur moyen a été calculé par innovation, les arguments ont fait l’objet d’une synthèse qualitative. Ces résultats ont informé une seconde délibération visant à identifier des pistes d’amélioration et diffusion qui ont été organisées par analyse thématique. Résultats : Les innovations d’adaptation de l'organisation des soins aux populations vulnérables ont été considérées comme ayant le plus grand potentiel de valeur dans l’ensemble. Les innovations visant l’optimisation des processus cliniques et d’amélioration continue ont reçu des appréciations plus variables. 460 pistes ont été classées en six catégories : objectifs, modalités d’accès, fonctionnement, impacts, gouvernance et contexte externe. Conclusions : L’exploration du potentiel de valeur d’innovations complexes avec une approche délibérative multidimensionnelle permet d’identifier, pour certaines catégories d’innovations en soins primaires, des arguments de valeur communs, et facilite l’identification de pistes d’amélioration et diffusion. / Context: The increasing pressure on primary care calls for the development of appropriate approaches to assess the value of innovations in this field and identify the conditions for their diffusion, which can be difficult, as these innovations are often complex and organizational in nature. Objectives: To explore the value arguments of 10 innovations identified as promising during the Quebec College of Family Physicians' Innovation Symposia and to propose avenues for their improvement and diffusion. Methods: Multidimensional deliberative approach with a diverse panel of 12 clinicians, managers, patients and citizens. Using data synthesized by dimension, each participant assessed the value potential of the innovations by providing a score and supporting arguments for each dimension individually, and following group deliberation. The average value potential was calculated per innovation, and the arguments were qualitatively synthesized. These results informed a second deliberation aimed at identifying avenues for improvement and deployment that were organized by thematic analysis. Results: Innovations aimed at adapting the organization of care for vulnerable populations were considered to have the greatest value potential overall, while interventions aimed at optimizing clinical processes and continuous improvement received more variable appraisals. 460 avenues were categorized into six areas: objectives, access modalities, operations, impacts, governance, and external context. Conclusions: Exploring the value potential of complex innovations with a multidimensional deliberative approach allowed the identification of common value arguments for certain categories of primary care innovations and facilitated the identification of pathways for their improvement and dissemination.

Background: The care for the older adults is facing major challenges with the growing proportion of older people. This entails a need to find new ways to cope with the tasks of elderly care, and digitalization is seen as part of the solution. In order to succeed with digitalizing, the first-line managers in elderly care needs knowledge of change management and digitalization. That knowledge needs to be obtained via educational efforts. Aim: The aim of the study was to examine the experiences of first-line managers within elderly care after they recieved training in change management and digitalization. The aim was further to examine their perspectives on the influencing factors when it comes to leading change management in digitalization. Method: The method was a qualitative interview study with an inductive research approach and the sample consisted of first-line managers within elderly care in a medium-sized Swedish municipality. Semi-structured interviews were conducted which were analyzed by qualitative inductive content analysis.  Results: Four main categories emerged; perspectives on implemented educational efforts; identified potential, barriers and needs in change management and digitalization; responsibilities and roles in change management and digitalization; and perspectives on care users when using health and welfare technology. Potential and barriers included assent from management, cooperation between colleagues, influence of the first-line managers' level of interest, resources, goals and strategies. It also included prioritization of daily operations, employee needs, resistance and information about purpose, implementation process and technology. In order for the first-line managers in elderly care to achieve the expected benefit with training on change management and digitalization, the expectations needs to be well defined. Conclusion: Educational efforts in change management and digitalization alone are not enough to achieve a successful implementation of health and welfare technology in municipal care for the elderly. Digitalization is an ongoing process of changes and the first-line managers can-not do it by themselves. The preferred practice is to be able to create the conditions for interested employees to drive the work of digitalization within their respective operation.

Införandet av New Public Management i den offentliga sektorn har för första linjens chefer,benämnda som enhetschefer i denna studie, inneburit en ökad byråkrati och minskad kunskap inom hantering av olika arbetsuppgifter. Detta bland annat inom arbetet kopplat till personalärenden. På så sätt ökar värdet av ett gott samarbete och en god relation med HR-avdelningen och dess HR-partners. Studiens syfte avser att skapa förståelse kring enhetschefers upplevelse av relationen till sin HR-partner och vilka faktorer som ligger till grund för en högkvalitativ arbetsrelation. Studien ämnar att ta reda på vilka kriterier enhetschefer anser bör finnas i en högkvalitativ arbetsrelation samt på vilket sätt relationen mellan enhetschefer och deras HR-partners kan definieras som en högkvalitativ arbetsrelation. Alternativt vad som behöver utvecklas för att relationen skall definieras som en högkvalitativ relation. Genom en kvalitativ metod intervjuades enhetschefer inom en offentlig verksamhet. Semi-struktureradeintervjuer användes för att undersöka deras upplevelser av relationen till deras HR-partners. Genom en tematisk analys kunde ett resultat presenteras. Resultat visade att relationen idag ärgod, men är inte av en högkvalitativ karaktär. Relationen innehåller ömsesidig respekt ochempati som ger psykologisk trygghet till medlemmarna i den men det finns hinder för utvecklingen av relationen. Det handlar om att fylla ett behov för ett individ- och verksamhetsanpassat arbete som i dag saknas i relationen. Då relationer är dynamiska och en uppfattning om vad god kvalité innebär är individuellt kan relationer lätt få fel förutsättningar för att fungera. Genom att arbeta mot en tydligare målbild för vad arbetet skall bidra till samt vad relationen betyder för de olika parterna kan en högkvalitativ relation lättare uppnås. / The introduction of New Public Management in the public sector has meant increased bureaucracy and reduced knowledge in handling various tasks for first-line managers referred to as unit managers in this study. This, among other things, in work linked to personnel matters. In this way, the value of good collaboration and a good relationship with the HR department and its HR partners increases. The purpose of the study is to create an understanding of unit managers' experience of the relationship with their HR partner and the factors that form the basis for a high-quality working relationship. The study aims to find out what criteria unit managers believe should exist in a high-quality working relationship and in what way the relationship between unit managers and their HR partners can be defined as a high-quality working relationship. Alternatively, what needs to be developed for the relationship to be defined as a high-quality relationship. Through a qualitative method, unit managers in thepublic sector were interviewed. Semi-structured interviews were used to examine their experiences of the relationship with their HR partners. Through a thematic analysis, a result could be presented. Results showed that the relationship today is good, but is not of high-quality nature. The relationship contains mutual respect and empathy that gives psychological security to its member. There are obstacles to the development of the relationship that is about filling a need for individual and business-adapted work that is currently lacking in the relationship. As relationships are dynamic and perception of what good quality means is individual, relationships can easily have the wrong conditions to function. By working towards a clearer goal picture for what the work is to contribute to and what the relationship means for the various parties, a high-quality relationship can be more easily achieved.

The objective was to evaluate differences in the severity and symptoms of borderline personality disorder (BPD) according to sex and service context among adolescents involved with youth protection services (YPS) and first-line mental health services (FLMHS) in Quebec. A total of 45 adolescents (14 to 17 years old) with BPD traits were recruited from YPS (n=35) and CLSCs (n=10). The Borderline Symptom List (BSL-23) measured the severity of symptomatology while the Life Problems Inventory (LPI) evaluated the intensity of BPD. Independent samples t-tests and Mann-Whitney U tests were used to analyze group differences. Analyses revealed that girls had significantly higher mean symptom severity scores (BSL-23) than boys and a significantly higher interpersonal chaos score (LPI). No other significant differences emerged from the primary analyses. Supplementary item-by-item analyses of the BSL-23 and LPI, indicated that girls endorsed several internalizing behaviours, while boys endorsed numerous externalizing behaviours. In terms of service context, the YPS group scored higher on several externalizing behaviours, while the FLMHS group scored higher on many internalizing behaviours. The results of this study provide initial insights into BPD symptomatology and severity in these understudied service contexts and can guide early detection and intervention. / L’objectif était d’évaluer les différences de sévérité et de symptômes du trouble de personnalité limite (TPL) selon le sexe et le contexte de service chez les adolescents suivis en protection de la jeunesse (PJ) et dans les services de santé mentale de première ligne au Québec. Un total de 45 adolescents (14 à 17 ans) présentant des traits du TPL ont été recrutés en PJ (n=35) et en CLSC (n=10). Le Borderline Symptom List (BSL-23) a mesuré la sévérité de la symptomatologie et le Life Problems Inventory (LPI) a évalué l'intensité du TPL. Des tests t d'échantillons indépendants et des tests Mann-Whitney U ont été utilisés pour analyser les différences entre les groupes. Les analyses ont révélé que les filles présentaient des scores moyens de sévérité (BSL-23) significativement plus élevés que les garçons et un score significativement plus élevé pour le chaos interpersonnel (LPI). Aucune autre différence significative n'est ressortie des analyses primaires. Des analyses complémentaires item par item du BSL-23 et du LPI, ont indiqué que les filles endossaient plusieurs comportements internalisés, et les garçons des comportements externalisés. Au niveau du contexte de service, le groupe PJ a obtenu des résultats plus élevés pour nombreux comportements externalisés, tandis que le groupe en première ligne a obtenu des résultats plus élevés pour plusieurs comportements internalisés. Les résultats de cette étude fournissent un premier aperçu des symptômes et de la sévérité du TPL dans ces contextes de service peu étudiés permettant de guider la détection et l'intervention précoces.

Problématique: Le partenariat de soins est un concept qui s’avère prometteur pour améliorer la qualité des soins de santé offerts à la population. Les gestionnaires de proximité détiennent un rôle-clé dans son intégration en raison de leurs fonctions d’organisation des soins et de gouvernance, ainsi que de leur proximité avec les patients. But: Le but de cette étude est d’explorer l’intégration du partenariat de soins en administration des services infirmiers auprès de gestionnaires de proximité, de coordonnateurs de programme et de patients partenaires de trois unités de soins d’un centre hospitalier de la région de Montréal. D’une part, l’étude vise à explorer les perceptions des parties prenantes quant au rôle du gestionnaire de proximité dans l’intégration du partenariat de soins et, d’autre part, identifier les barrières, les facilitateurs et les compétences y étant associées. Méthodologie: Pour réaliser cette étude exploratoire descriptive, une entrevue semi-dirigée a été conduite auprès de chacun des huit participants : trois coordonnateurs de programme, deux gestionnaires de proximité et trois patients partenaires. Une analyse de contenu a été effectuée et guidée par le référentiel de compétences de pratique collaborative et partenariat patient en santé et services sociaux. Résultats: Le rôle du gestionnaire de proximité dans l’intégration du partenariat de soins en administration des services infirmiers concerne plusieurs thématiques, dont la gestion de projets, la valorisation du patient partenaire et la représentativité de la clientèle. Les principales barrières à l’intégration du partenariat de soins en administration des services infirmiers identifiées sont l’organisation des soins et la disponibilité des ressources. À l’inverse, le principal facilitateur est la gestion de projets. Les habiletés des parties prenantes peuvent être tant une barrière qu’un facilitateur. La communication, la clarification des rôles et des responsabilités et le leadership collaboratif sont des compétences-clé à maîtriser par les gestionnaires de proximité, selon les participants. Discussion/Conclusion: La variabilité dans l’intégration du partenariat de soins et l’importance de l’exercice du leadership dans la gestion des projets réalisés en partenariat sont constatées par l’étudiante-chercheure. Le rôle et le positionnement hiérarchique des coordonnateurs de programme semblent faciliter davantage l’intégration du partenariat de soins en administration des services infirmiers que ceux des gestionnaires de proximité. Un besoin de soutien en ce qui a trait à la compréhension de l’approche, au développement des compétences requises et à l’accès aux ressources en facilitant l’intégration demeure à combler. / Background: The patient partnership is a concept that appears to be promising for the improvement of the quality of care delivered to the population. The first-line managers play a key role in its integration because of their functions in care organization and governance and their proximity with the patients. Objective: The aim of this study is to explore the integration of the patient partnership in nursing administration in three units of a hospital of the greater Montreal area. On the one hand, the study will allow to explore the perceptions of the stakeholders related to the role of the first-line manager in the integration of patient partnership in nursing administration and, on the other, to identify the associated facilitators, barriers and competencies. Methods: A semi-directed interview has been conducted with each of the eight participants: three program coordinators, two unit head nurses and five patient partners. This descriptive exploratory study then included a content analysis guided by the competency framework for collaborative practice and patient partnership in health and social services. Findings: The first-line manager’s role regarding patient partnership integration in nursing administration is related to several themes including project management, valuing the patient partner and users’ representativeness. The main barriers documented regarding patient partnership integration in nursing administration are the organization of care and the availability of resources. The main facilitator relates to project management. The skills of the stakeholders are a common theme of the barriers and facilitators. According to the participants, communication, responsibilities and roles’ clarification, as well as collaborative leadership are key competencies that first-line managers need to master. Discussion/Conclusion: Variability in the integration of the patient partnership and the importance of leadership in project management regarding patient partnership were noted by the student-researcher. The role and hierarchical positioning of program coordinators seem to facilitate the integration of the patient partnership in nursing administration more than those of the first-line managers. Furthermore, support regarding understanding of the approach, competencies development and access to resources facilitating the integration is still required.