The purpose of this study is to examine how activities are looked upon, organized and put into practice at homes designed for the elderly. To achieve this we have done a survey study, based upon the caregiver´s point of view regarding the subject activity. The result of this study has been interpreted and analyzed with help from the engagement- and disengagement theories. The result shows us that the caregiver´s find the term activity slightly abstract, and rather difficult to define. All of the caregiver´s did agree on the matter that it’s good to activate elderly people and that the elderly people are activated at a large extent. The result also shows us that it’s not always the elderly people’s own wishes and desires of activity that gets organized and put into practice at homes designed for the elderly. In conclusion we find the engagement theory to be very dominant in the thoughts and actions of caregiver´s in Swedish geriatric care, rather than the disengagement theories.

Arbetets syfte var att studera enhetschefer inom äldreomsorgens kunskapsanvändning. För att besvara syftet användes tre frågeställningar. Dessa var vilka kunskaper som enhetscheferna använder sig av, vad de anser är nödvändig kunskap och hur de fått denna samt om det finns hinder som medför att enhetscheferna begränsas i att använda viss kunskap. Arbetet har en fenomenologisk ansats. För att söka förståelse för enhetchefernas kunskapanvändning har sex enhetchefer intervjuats med olika bakgrund till det sociala arbetet inom svensk äldreomsorg. Både på särskilda boenden och inom hemtjänsten i två olika kommuner. Intervjuerna har varit semi-strukturerade. Arbetets teoretiska referensram har varit Goffmans teori om inramning samt begreppen gräsrotsbyråkrat och handlingsutrymme. Resultaten har presenterats i förankring till dessa teorier och det framkom att enhetscheferna använder sig av tre ramar för att tolka olika situationer i sitt arbete. Ledarramen, den professionella ramen samt vänskapsramen. I dessa ramar framkom många olika former av kunskap. Det framkom också att enhetscheferna fått nödvändig kunskap på många olika sätt, av tidigare utbildning, arbetslivserfarenhet, livserfarenheter men även personliga egenskaper. Enhetscheferna uttryckte begränsning i sin kunskapsanvänding i det att man hade många uppgifter i sitt arbete som tog för mycket tid från mötet med personal och brukare. Mycket av detta berodde på administrativ tid. Arbetets slutsats är att enhetschefernas gemensamma kunskapsanvändning är bred. Att det finns olika ingångsportar till att bli chef inom äldreomsorgen är viktigt att belysa, samt det faktum att äldreomsorgen är en komplex verksamhet som ses ur olika definitioner. Här belyser forskningen ofta äldreomsorg som antingen hälso-och sjukvård eller social arbete. I mitt arbete har enhetscheferna tillsammans en stor bredd, på grund av sina tidigare erfarenheter. Arbetets slutsats är därför också att enhetschefer skulle behöva möjlighet att inte enbart diskutera sin ledarroll, utan också annan kunskap som de använder sig av i sitt arbete.

Det finns begränsat med forskning kring hur biståndshandläggare inom äldreomsorgen arbetar med ensamhet hos äldre personer. Med anledning av detta är studiens huvudsakliga syfte att undersöka hur biståndshandläggare i Dalarnas kommuner arbetar med att utreda sociala behov till följd av ensamhet hos äldre personer samt att ta reda på vilka kommunala sociala insatser som erbjuds för dessa individer och på vilka grunder. Studien är genomförd utifrån en kvantitativ ansats, där vi har använt oss av en enkät, som innehåller frågor som avser att besvara syftet. Tolkningsramen för analysen av det empiriska materialet utgörs av Lipskys teori om gräsrotsbyråkrati. Studiens resultat visar att det finns behov av att både utöka och utveckla kommunernas utbud av sociala insatser för äldre personer samt att utveckla rutiner för hur man ska arbeta med ensamhet hos äldre personer. Studien påvisar ett behov av mer forskning, både internationell och nationell, kring hur biståndshandläggare arbetar med att identifiera ensamhet hos äldre personer. / There is limited research on how care administrators in elderly care work with loneliness among older people. For this reason, the study's main purpose is to examine how care administrators in Dalecarlian counties are working to investigate the social needs as a result of loneliness among older people and to find out which municipal-based social interventions that are offered for these individuals and on what grounds. The study was conducted based on a quantitative approach, were we have used a questionnaire that includes questions designed to answer the study’s purpose. Interpretative framework for the analysis of the empirical material consists of Lipsky 's theory of street-level bureaucracy. The study’s results show that there is a need to both expand and develop the municipal-based social interventions for the elderly and to develop procedures on how to work with loneliness among older people. The study demonstrates a need for more research, both international and national, about how care administrators are working to identify loneliness among older people.

Certified nurse aides provide approximately 65% of care to more than 1.4 million older adults residing in nursing homes who have been diagnosed with 1 or more chronic illnesses or debilitating conditions. Licensed nurses rely on nurse aides to report potentially harmful status changes in geriatric residents. Nurse aides often receive limited education and do not have a structured care process to guide them in their practice in the geriatric population. The purpose of this educational quality improvement project was to develop a geriatric-specific nurse aide care process to increase the knowledge of student nurse aides regarding processes to identify and observe potentially harmful status changes in geriatric residents, and what changes to report immediately to a licensed nurse. The knowledge-to-action model was used to address the practice problem and to guide the translation of this evidence-based project into practice. The methodology used to guide data collection and analysis was a 1-group, quasi experimental, pretest/posttest design to compare participants' knowledge before the intervention with their learning outcomes after the educational intervention was implemented. The findings revealed an increase in the knowledge of student nurse aides after the educational intervention. The project may promote social change on an organizational level by demonstrating the need for a structured geriatric care process for nurse aides prior to their entry into the long-term care workforce to improve care outcomes for geriatric residents. The project may involve social change at the state level because incorporating this process may require additional hours in the nurse aide education program curriculum.

<p>The main aim of this thesis has been to compare psychosocial working conditions in workplaces with different forms of ownership, i.e. public, private and cooperative. A second aim has been to study how organisational characteristics of relevance for psychosocial working conditions (in terms of management control strategies and prerequisites for management) are manifested in these ownership forms. The empirical data is based on structured interviews with managers at 60 workplaces within the service sector and on a questionnaire to all employees working in the participating workplaces, resulting in a set of 1384 individuals. An additional seven interviews with first-line managers within geriatric care were also conducted for the last study. The results show that employees in cooperatives perceived that they had better opportunities to influence decisions concerning the workplace as a whole, although there were also results showing advantages for public and private employees. Regarding opportunities for employees to influence their own work situation, there were no differences between the ownership forms. Differences were found in the prerequisites for first-line geriatric care managers. As a result of an earlier organisational change, the public managers were now further away from the strategic level and had to focus on daily, operative work tasks, while simultaneously also being responsible for keeping within the budget. The private managers, on the other hand, having group leaders to deal with the daily work concerning personnel and operations, could focus more on strategic work related to financial results in terms of planning and follow-up of the budget. One conclusion is that there are certain differences in both psychosocial working conditions and organisational characteristics between the ownership forms, but when the comparisons were restricted to only one type of service, in this case the provision of care, it is rather the similarities within the care organisations, regardless of ownership form, that are most pronounced.</p>

<p><strong>Bakgrund:</strong> Runt omkring oss i samhället finns det organisationer av olika slag. De organisationer som påverkar oss mest i vårt dagliga liv är dock troligen de kommersiella. För sådana organisationer utgör ägarna en stark intressentgrupp då de tillför kapital till verksamheten och för detta kräver ersättning i form av avkastning. För många kommersiella organisationer finns det dock fler intressenter med andra krav på organisationen och dess verksamhet, till exempel måste industrier investera i reningsanläggningar för att inte släppa ut skadlig rök till omgivningen. För de flesta organisationer finns det följaktligen minst två olika måldimensioner. Å ena sidan har vi ägare och investerare som vill ha avkastning på sitt kapital. Å andra sidan finns det intressenter som kräver saker som hög kvalitet, hög säkerhet och tillförlitlighet. Dessa olika krav kan skapa en målkonflikt för verksamheten.</p><p><strong>Syfte: </strong>Syftet med denna uppsats är att studera och analysera hur målkonflikten mellan intressenters säkerhets- och lönsamhetskrav hanteras i verksamhetsstyrningen.</p><p><strong>Genomförande:</strong> Med hjälp av intervjuer har vi genomfört fallstudier vid organisationer inom äldreomsorg och kärnkraftsindustri.</p><p><strong>Resultat: </strong>Vår studie visar på en rad faktorer som bör tas i beaktning vid organisationer med målkonfliktsproblematiken. Ledningen måste vara tydlig i sin målprioritering och kommunikation, ha en tydlig hantering av sina intressenter och deras krav samt att det bör finnas tillfredställande system för felidentifiering och rapporteringsmöjligheter för de anställda.</p> / <p><strong>Background: </strong>In the society we live in, there are different kinds of organizations. The organizations that affect us the most however are probably the commercial ones. For these organizations, the owners form a strong a group of stakeholders since they invest capital and therefore require return on their investments. Nevertheless, some organizations also face demands of safety and quality from other stakeholders. With this in mind it becomes clear that organizations sometimes have to handle at least two dimensions of goals, owners that demand yield and the general public that demands a satisfying amount of safety. These different kinds of goals and demands can create a goal conflict situation within the organizations.</p><p><strong>Aim: </strong>The purpose of this study is to explore and analyze how the conflict between safety and economic goals is handled in the operating control.'</p><p><strong>Completion: </strong>A case study was carried out in the geriatric care and nuclear power industry by means of qualitative interviews.</p><p><strong>Results: </strong>The result of this study indicates that there are certain aspects to bear in mind for organizations facing the goal conflict situation. The management has to be clear about what to prioritize and then clearly communicate this priority to the employees. The organization should also have a clearly defined stakeholder strategy concerning their demands and requirements. Finally, it is also important for an organization that employees have proper communication channels and failure identification systems, so that problems can be emphasized.</p>

<p>Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.</p>

The main aim of this thesis has been to compare psychosocial working conditions in workplaces with different forms of ownership, i.e. public, private and cooperative. A second aim has been to study how organisational characteristics of relevance for psychosocial working conditions (in terms of management control strategies and prerequisites for management) are manifested in these ownership forms. The empirical data is based on structured interviews with managers at 60 workplaces within the service sector and on a questionnaire to all employees working in the participating workplaces, resulting in a set of 1384 individuals. An additional seven interviews with first-line managers within geriatric care were also conducted for the last study. The results show that employees in cooperatives perceived that they had better opportunities to influence decisions concerning the workplace as a whole, although there were also results showing advantages for public and private employees. Regarding opportunities for employees to influence their own work situation, there were no differences between the ownership forms. Differences were found in the prerequisites for first-line geriatric care managers. As a result of an earlier organisational change, the public managers were now further away from the strategic level and had to focus on daily, operative work tasks, while simultaneously also being responsible for keeping within the budget. The private managers, on the other hand, having group leaders to deal with the daily work concerning personnel and operations, could focus more on strategic work related to financial results in terms of planning and follow-up of the budget. One conclusion is that there are certain differences in both psychosocial working conditions and organisational characteristics between the ownership forms, but when the comparisons were restricted to only one type of service, in this case the provision of care, it is rather the similarities within the care organisations, regardless of ownership form, that are most pronounced.

Falls and their consequences are a major health problem in the older population, increasing their immobility, morbidity and mortality. This thesis focuses on older people living in geriatric care settings, frail older people who are most prone to suffer falls. The aim was to study predisposing and precipitating factors associated with falls in older people with or without cognitive impairment. In a cross-sectional study with a one-year prospective follow-up for falls 63% of the 83 residents suffered 163 falls and 65% of the fallers fell more than once. The antidepressants selective serotonine reuptake inhibitors (SSRIs), impaired vision and being unable to use stairs independently were the factors most strongly associated with sustaining falls. Acute diseases were judged to have precipitated 32 % of the falls and drug side effects 9%. In another cross-sectional study with a one-year follow-up for falls, including 199 residents, previous falls and treatment with antidepressants (mainly SSRIs) were found to be the most important predisposing factor for falls. Acute disease was judged to be the precipitating factor alone or in combination, in 39% of the falls, medical drugs in 8%, external factors such as obstacles in 8% and other conditions both related to the individual and the environment, such as misinterpretation, misuse of roller walkers or mistakes made by the staff were judged to have precipitated 17% of the falls. In a population-based cross-sectional study including 3604 residents in geriatric care settings more than 8% sustained a fall at least once during the preceding week. A history of falls, the ability to get up from a chair, the need for a helper when walking, pain, cognitive impairment, use of neuroleptics and use of antidepressants were all associated with falls in multivariate analyses. In the subgroup of people with cognitive impairment (2008 residents) more than 9% had sustained a fall at least once during the preceding week. As for the whole population, being able to get up from a chair, previous falls, needing a helper when walking with the addition of hyperactive symptoms were the factors independently associated with falls. In a study with a one-year prospective follow up for falls, including 439 residents in residential care facilities, 63% sustained 1354 falls, corresponding to an incidence rate of 3.5 falls / person year. Thirty-three percent of the falls and 37% of the injurious falls occurred during the night (9pm-6am). There were significantly higher fall rates in the evening and in January, April, May, November and December. There were no associations between fall rates and any of the weather parameters studied. In conclusion falls and fall-related injuries in older people in geriatric care settings are common. Both predisposing and precipitating factors contribute to the risk of falling. Addressing precipitating factors for falls seems to be important in an individualised preventive strategy among older people in geriatric care settings.

Old people's life situation when receiving municipal help and care in theirlast period of life is sparsely investigated from their own perspective. Thepurpose of this study was focused on the thoughts of the aged people andtheir personal experiences on what quality is within the geriatric care. Inthis qualitative study, 10 elderly people aged 75-90 years wereinterviewed from 3 different nursing homes within Solna Municipality.Qualitative interviews, with the emphasis on their present life situationespecially what brought about a good life, were performed. The interviewswere analysed using qualitative content analysis. The implication of theterm “meaningful existence” is individual and differs from person toperson. This study has identified six categories that could lead to ameaningful existence for the elderly living in nursing homes. These were:to feel secure, maintaining self determination, maintaining relations, to berespected, to feel comfort and to be active. In conclusion it was found thata meaningful existence, what ever it may be to the single individual, isimportant the quality of life for the elderly person residing in nursing homes.