This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

The overall aim of this thesis was to describe and evaluate interprofessional education on an interprofessional training ward in municipal care for older persons. Interprofessional education has for some years now been proposed as a means to meet the call for effective collaboration, co-ordination and quality in health and social care. On the interprofessional training ward considered in this thesis, stu-dents from nursing, occupational therapy and social work programmes worked together for three weeks to learn with, from and about each other. In the first study (I) students’ perceptions and attitudes concerning the training on the ward were studied. An attitude questionnaire and a retrospective goal-fulfilment questionnaire were distributed to all students. Non-parametric statistics were used for the quantitative analysis, and qualitative content analysis for the qualitative parts. The results showed that the students had positive attitudes to-wards the training ward and in most respects the learning goals set up for the course were considered to have been met. In Studies II and III the focus was on students’ knowledge and understanding of their own and the others’ professions. Sixteen students were interviewed before and after. In the analysis of the interviews a phenomenographic approach was used. The findings showed a variation from simplistic conceptions of the profes-sions in terms of tasks to more complex conceptions in terms of the profession’s knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were espe-cially accentuated. The comparison between before and after indicated that there were changes in the students’ views. In some areas, however, there remained dis-crepancies between students’ understanding of their own profession and the oth-ers’ understanding of this profession. To promote mutual agreement on each other’s role this needs to be given careful consideration. In the fourth study (IV) the focus was on the students’ participation in the community of practice on the ward, and the findings reveal an ambivalent picture of this participation (and thus of their learning). The students collaborated in the care of the patients. However, they sometimes experienced a gap between expec-tations and reality with regard to both the profession-specific and the interprofes-sional training on the ward: what they had to do was sometimes felt to be be-neath their qualifications and irrelevant to the programme of education they were pursuing. This applied to all three groups, but especially student social workers. Interprofessional training wards can promote interprofessional learning, but it is crucial that setting should be right: it needs to be realistic for all the students involved, offering relevant profession-specific and interprofessional tasks and situations where the students can develop skills in collaborative, patient-centred care.

This dissertation covers the subject of how abstract concepts and complex situations can be concretized through research together with practitioners. The dissertation is based on four empirical studies. The researcher role, the practitioner participation and the methods for data collection and analysis have varied. In study I the concept ‘Närsjukvård’ was explored to understand how practitioners, managers and politicians in hospitals, primary health care and municipalities interpreted the concept. The researcher acted as consultant who collected data by interviews and questionnaires. Practitioners’ participation was limited. ‘Närsjukvård’ was interpreted as accessibility to hospital beds, accessibility to primary health care, collaboration between care providers and continuity and developed home care. Study II aimed to explore how people experienced leg ulcer care. The researcher acted as a consultant who performed the interviews and  analysed the data. Although the informants experienced their encounters with the nurses as satisfying, the study illuminated low participation in the care and low practitioner involvement in issues about daily living with the leg ulcer. The findings were brought back to the informants and the practitioners. The project did not proceed towards development and change. In study III the aim was to explore the Swedish concept ‘trygghet’ by using stories from daily life. Four older women were interviewed and the Story Dialogue method was used together with assistant nurses and registered nurses who participated in data collection and analysis. Two themes emerged: Sense of Security and factors strengthening the Sense of Security. Together with the assistant nurses, areas for improvements were identified. Study IV aimed to explore the discharge planning situation in order to     generate ideas for development. Members from a discharge planning network participated in the whole research process. Conditions for a successful coordinated discharge planning situation were a system including: the participation of the patient, the competence of the staff and the support from the organisation. The group arranged a workshop about communication and interdisciplinary   collaboration. The findings resulted in a form with self-evaluation questions. In conclusion, this thesis illustrates that it is possible to clarify abstract concepts and complex situations together with practitioners. To do this successfully, sense making activities and to start from practitioners’ experiences and their own context are key factors. The studies illuminate that building trust, relationship and sense of participation are essential in health and social care in general and specifically in the participatory action research process.

Ett gott ledarskap är en nyckelfaktor för att bedriva en fungerande vård. Chefer inom vård- och omsorg är en av de yrkeskategorier som har flest antal underställda per chef, det vill säga bredast kontrollspann. Det hälsofrämjande ledarskapet bygger på att ledaren kan skapa förutsättningar för sina medarbetare att bevara det som fungerar väl i verksamheten och kunna stärka och främja en hälsosam arbetsplats med välmående medarbetare. Syftet med denna litteraturstudie är att undersöka hur ett brett kontrollspann kan påverka förutsättningarna för ett hälsofrämjande ledarskap inom vård och omsorg. Valt tillvägagångssätt är systematisk integrativ litteraturöversikt. Ur den inkluderade studierna framkommer att breda kontrollspann överlag påverkar ledare och dess medarbetare negativt. Ett stort antal anställda skapar minskade möjligheter för ledaren att kommunicera med och finnas till för medarbetare och därmed försvåras det hälsofrämjande ledarskapet. Ett brett kontrollspann minskar också effekten av ledarskapsstilar som annars generellt visar positiv inverkan på mindre arbetsgrupper, såsom ett transformativt och transaktionellt ledarskap. Resultaten öppnar upp för en diskussion kring huruvida breda kontrollspann bidrar till sämre förutsättningar för ledare inom vård och omsorg att skapa en hälsofrämjande arbetsplats. Det finns studier som visar att stödfunktioner kan hjälpa en ledare med ett brett kontrollspann genom att avlasta ledaren med administrativa uppgifter. Alternativet är att minska kontrollspannet, men svaret på vad som är det optimala kontrollspannet råder det delade meningar om. Snarare bör fokus istället läggas på att skapa en hälsofrämjande arbetsplats för personalen och dess ledare. / A good leadership is a key factor to provide for a functional health care. Leaders of health and social care hold among the widest spans of control, with other words number of employees per leader, than most other professions generally. Health promoting leadership is built around the leader’s ability to help create conditions for the employees to preserve the aspects that are well-functioning, whilst strengthening and promoting a healthy workplace with healthy employees. The purpose of this literature review is to investigate how a wide span of control can affect the conditions for a health-promoting leadership in health and social care. Method of choice is a systematic integrative literature review. The included literature reveals that a wide span of control negatively affects leaders and employees. A wide span of control reduces the leader’s opportunities to interact with the employees, which in return complicates a health promoting leadership. A wide span of control also diminishes the effects of leadership styles that has proven having positive effect in smaller work groups, for example a transformational and transactional leadership. The results make way for a discussion whether a wide span of control contributes to worsening the conditions for leaders in health and social care in the making of a healthy workplace. Studies show that support functions can help a leader with a wide span of control , by relieving the leader from administrative tasks. The alternative is to reduce the span of control, but there are different opinions to the answer to what is an optimal span of control. Focus should rather be put in creating a health promoting workplace for the employees and their leader.

Syftet med studien är att undersöka om och i så fall hur enhetschefer på vård- och omsorgsboenden beaktar äldre människors sociala välbefinnande samt redogöra för vad enhetschefer i deras chefsroll uppmärksammar som viktigt för de äldres sociala välbefinnande. Frågeställningarna berör hur enhetschefer på vård- och omsorgsboenden arbetar för att främja de äldres sociala välbefinnande och vilka utmaningar avseende de äldres sociala välbefinnande som enhetschefer på vård- och omsorgsboenden identifierar. Studien utgår från ett kvalitativt metodval och resultatet har samlats in genom semistrukturerade intervjuer med enhetschefer på vård- och omsorgsboenden i en mellanstor kommun i Sverige. Studiens resultat belyser hur enhetschefer på vård- och omsorgsboenden arbetar med att främja de äldres sociala välbefinnande genom att skapa förutsättningar för trygghet, gemenskap och självbestämmande. Enhetscheferna identifierar utmaningar förenade med de äldres sociala välbefinnande och lyfter att hitta arbetssätt för att bidra till minskad ofrivillig ensamhet hos de äldre och bistå med stöd för att tillgodose de äldres individuella behov och öka deltagandet på de sociala aktiviteterna. / The purpose of this study is to investigate whether, and if so how, unit managers at nursing homes take the social well-being of older people into account and describe what managers in their position recognize as important for the social well-being of the elderly. The research questions are based on how unit managers at nursing homes work to promote the social well-being of the elderly, and which challenges regarding the social well-being of the elderly that unit managers at nursing homes identify. The study is based on a qualitative choice of method and the results have been collected through semi-structured interviews with unit managers at nursing homes in a medium-sized municipality in Sweden. The study's results highlight how unit managers at nursing homes work to promote the social well-being of the elderly by creating conditions for security, community and self-determination. The unit managers identify challenges associated with the social well-being of the elderly and find ways of working to contribute to reducing involuntary loneliness among the elderly.  The unit managers also assist with support to meet the individual needs of the elderly and increase participation in social activities.

Bakgrund Den pågående pandemin har orsakat stora svårigheter för den svenska hälso- och sjukvården. I Sveriges kommuner och regioner har beredskapen för en pandemi visat sig vara bristfällig och då främst inom den kommunala hälso- och sjukvården. Under den pågående Covid-19 pandemin har många studier gjorts där slutenvårdens sjuksköterskor beskrivit upplevelser av sin arbetsmiljö. Studier med kommunalt anställda sjuksköterskor har däremot varit få. Syfte Syftet med studien var att beskriva kommunalt anställda sjuksköterskor upplevelser av sin arbetsmiljö under Covid-19 pandemin. Metod Som metod användes en kvalitativ semistrukturerad intervjustudie med beskrivande design. Rekryteringen av deltagare gjordes bland sjuksköterskor verksamma i kommunala vård- och omsorgsboenden, i en kommun i södra Norrland, Sverige och slutligen intervjuades åtta informanter. Analysen av materialet utgick från en induktiv ansats och analysprocessen skedde under inspiration av den kvalitativa innehållsanalysen. Huvudresultat I analysprocessen framkom tre huvudkategorier, Upplevelser av en förändrad arbetsmiljö, Upplevelser av en bristande beredskap och Upplevelser av ett bristande stöd i arbetet och slutligen framträdde det övergripande temat, Att vara ensam och utlämnad. Resultatet i intervjustudien med sjuksköterskorna visade att deltagarna upplevde påtagliga brister i sin arbetsmiljö. Bristerna upplevdes som så stora att de ledde till konsekvenser i form av sjukskrivningar och en upplevd hotad patientsäkerhet. Slutsats Resultatet i den här intervjustudien med sjuksköterskor anställda inom kommunal hälso- och sjukvård visar att deltagarna upplevde påtagliga brister i sin arbetsmiljö under pågående Covid-19 pandemi. Sammanfattningsvis lyfte deltagarna den förändrade arbetsmiljön, den bristande beredskapen och brister i arbetsmiljöstödet som de mest centrala delarna. Resultatet i studien har bidragit med kunskaper om vilka åtgärder som inför framtida pandemier kan bidra till en bättre arbetsmiljö för sjuksköterskor inom kommunal hälso- och sjukvård. / Background The ongoing pandemic has caused major difficulties for the Swedish healthcare system due to the municipalities and regions lack preparedness for a pandemic, which has been especially apparent for municipal healthcare. During the Covid-19 pandemic many studies have been written where inpatient care nurses describe their experiences of their working environment, but few studies have been written on the working environment experiences for municipal nurses. Aim The aim of the study was to describe municipal nurses’ experiences of their working environment during the Covid-19 pandemic. Method The method used is a qualitative semi-structured interview study using descriptive research design. Participants for the study were recruited from nurses working in municipal social- and healthcare units in a municipality located in southern Norrland, Sweden. Eight informants were also interviewed. The analysis of the material was conducted using an inductive approach and the process was inspired by qualitative content analysis. Result During the analyzing process three main categories appeared, Experiences of a changed work environment, Experiences of a lack of workplace preparedness and Experiences of a lack of workplace support which eventually culminated into the overarching theme of Being alone and abandoned. Results from the interviews showed that the participants experienced significant workplace environment faults which were so dire that the consequences were employees on sick leave and a perceived threat to patient safety. Conclusion The results for this study conducted with municipal nurses show that the participants experienced significant workplace environment faults during the Covid-19 pandemic. In summary, the participants expressed and identified the change in workplace environment and procedure, the lack of preparedness and the lack of workplace support as the central parts of the problem. The results of the study have contributed to better understanding what repercussions are necessarily taken to better the workplace environment for municipal nurses during future pandemics.

Bakgrund: Idag är kompetensförsörjning ett stort problem inom den kommunala vård- och omsorgssektorn. Många medarbetare väljer att avsluta sina anställningar och personalomsättningen är hög. Samtidigt ökar andelen äldre vilket gör att behovet av kompetent personal som kan utöva en säker vård ökar. Det blir därmed viktigt att arbetsgivare försöker förstå sig på vad det är som motiverar medarbetare till att stanna inom vård-och omsorgssektorn och det är det som denna studie ämnar undersöka. Syfte: Syftet med studien är att få ytterligare kunskap kring vad som motiverar medarbetare i den kommunala vård-och omsorgssektorn att stanna kvar hos sin nuvarande arbetsgivare. Metod: I studien har en kvalitativ metod använts i form av semistrukturerade intervjuer där nio olika medarbetare har intervjuats i Jönköping kommun. Resultat och slutsats: Studiens resultat visar att avancemang inte hade någon betydelse för medarbetares beslut om att stanna hos sin nuvarande arbetsgivare. Den individuella känslan av att prestera var inte heller av vikt, däremot var erkännande för prestationer och att få förutsättningarna för att prestera av vikt. De faktorer som visade sig ha stor betydelse förbeslutet om att stanna hos arbetsgivaren var möjligheten till att ta ansvar, att få erkännande och uppskattning för sina prestationer och att arbetsuppgifterna upplevdes som roliga och meningsfulla. Slutligen var lönen även en viktig faktor för att motiveras till att stanna hos arbetsgivaren och flera ansåg att den behövde höjas för att fler skulle vilja stanna kvar hos arbetsgivaren. / Background: Today, the supply of skills is a major problem within the municipal health and care sector. Many employees choose to terminate their employment and the staff turnover is high in the sector. At the same time, the proportion of elderly people is increasing, which means that the need for competent staff who can provide safe care is increasing. It therefore becomes important that employers try to understand what it is that motivates employees to stay in the health and care sector. Purpose: The aim of the study is to gain further knowledge about what motivates employees in the municipal health and care sector to stay with their current employer. Method: A qualitative method was used in the form of semi-structured interviews with nine different employees in Jönköping Kommun. Results and conclusion: The result of the study shows that advancement and promotion had no effect on employees' decisions to stay with their current employer. The individual feeling of achievement was also not important, but on the other hand recognition for achievements and getting the conditions to be able to achieve were important. The factors that proved to be important for the decision to stay with the employer were the opportunity to take responsibility for one's tasks, to receive recognition and appreciation for one's achievements and that the tasks are perceived as fun and meaningful. Finally, the salary was also an important factor in being motivated to stay with the employer, and several felt that it needed to be increased so that more people would want to stay with the employer.

This study aims to examine the health and care policies of the Moderates, the Christian Democrats, the Liberals and the Sweden Democrats, then compare each policy with the Tidö-agreement and analyze the parties' potential motives for cooperation. To help achieve the purpose of the study, following questions have been formulated: How did the care and care policies of the Moderates, Christian Democrats, Liberals and Sweden Democrats look before the elections in 2018 and 2022 respectively?, in what way, and to what extent, are care and care presented in the Tidö-agreement? and what political motives can explain the Moderates', Christian Democrats', Liberals' and Sweden Democrats' reasons for entering into cooperation with each other? The method is a motive analysis and to find out the possible motives of the parties, and the theory is Wolfgang C. Müller's and Kaare Strøm's theory regarding motives for the parties' actions where the parties are either most policy-seeking or office-seeking. The hypotheses are that the Moderates', Christian Democrats' and Liberals' mostly are office-seeking parties, while the Sweden Democrats' mostly is policy-seeking. However, the study results in only the hypothesis about the Liberals being strengthened, while the remaining hypotheses fall.

År 2016 tillsatte regeringen med stöd av riksdagen en tillitsdelegation med syfte att reformera styrning och ledning av den svenska välfärden. Detta som ett svar på att den svenska välfärden under en längre tid hade detaljstyrts vilket gav ett begränsat utrymme till professionernas expertis. Tillitsbaserad styrning och ledning förordas sedan dess av staten, att införas brett inom kommuner och regioner, trots att det finns lite forskning om dess effekter. Forskare har den senaste tiden ifrågasatt reformens begriplighet och om den tillför något nytt. Syftet med studien var att få kunskap om hur enhetschefer inom vård och omsorg tolkar tillitsbaserat ledarskap samt om och hur enhetscheferna har anpassat sitt ledarskap efter införandet. Den här kvalitativa studien har undersökt forskningsfrågan med hjälp av kvalitativa intervjuer. Totalt sju enhetschefer inom vård och omsorg har intervjuats, där tillitsbaserat ledarskap har införts. Intervjuerna har sedan analyserats utifrån en fenomenografisk ansats. Det resultat som framkommer är att enhetscheferna gör sina egna tolkningar av tillitsbaserat ledarskap utifrån tidigare erfarenheter. Få eller inga anpassningar har gjorts i ledarskapet sedan tillitsbaserat ledarskap har införts i organisationen. Det framkommer att enhetscheferna saknar tydliga ramar kring det tillitsbaserade ledarskapet och strukturer för uppföljning vilket skapar en otydlighet kring ansvaret. Det framkommer att  enhetscheferna ökar kontrollen när de har mindre tillit till sina medarbetare och för att skapa tillit krävs förutsättningar för att kunna bygga relationer. Slutsatsen är att lite har förändrats i enhetschefernas sätt att leda samtidigt som införandet av tillitsbaserat ledarskap har skapat en otydlighet kring ledningen och styrningen. / In 2016, with the support of the Swedish Parliament, the government appointed a trust delegation with the aim of reforming the governance and management of Swedish welfare. This was in response to the fact that the Swedish welfare system had been micromanaged for a long time, leaving limited room for the expertise of the professions. Since then, trust-based governance and management has been recommended by the government to be introduced widely in municipalities and regions, although there is littler esearch on its effects. Researchers have recently questioned the comprehensibility of the reform and whether it adds anything new. The purpose of the study was to gain knowledge about how unit managers in health and social care interpret trust-based leadership and whether and how the unit managers have adapted their leadership after the introduction. This qualitative study has investigated the research question using qualitative interviews. Seven unit managers in health and social care have been interviewed, where trust-based leadership has been introduced. The interviews have then been analyzed based on a phenomenographic approach. The result that emerges is that the unit managers make their own interpretations of trust-based leadership based on previous experience. Few or no adjustments have been made in leadership since trust-based leadership has been introduced in the organization. It emerges that the unit managers lack a clear framework for trust-based leadership and structures for follow-up, which creates a lack of clarity regarding responsibility. It appears that the unit managers increase control when they have less trust in their employees, and to create trust, conditions for building relationships are required. The conclusion is that little has changed in the unit managers' way of leading at the same time as the introduction of trust-based leadership has created a lack of clarity about management and governance.

No / In this article we share our experiences of a large-scale five-year innovative programme to introduce mobile learning into health and social care (HSC) practice placement learning and assessment that bridges the divide between the university classroom and the practice setting in which these students learn. The outputs are from the Assessment Learning in Practice Settings (ALPS) Centre for Excellence in Teaching Learning (CETL), which is working towards a framework of interprofessional assessment of Common Competences in the HSC professions. The mobile assessment process and tools that have been developed and implemented and the outcomes of the first-stage evaluation of the mobile assessment tools are discussed from the student perspective.