M.A. (Health Studies) / The purpose of this study was to explore and describe communication effectiveness and communication satisfaction experienced by professional nurses in selected public health care services. Quantitative, explorative and descriptive research was conducted to determine the communication effectiveness and levels of communication satisfaction. The Downs and Adrian (2004) structured questionnaire was adapted and used to collect the data. The study population consisted of three groups of professional nurses, namely nurse managers (n=18), operational managers (n=22) and professional nurses (n=90). The study highlighted areas of effective and ineffective communication, as well as areas of communication satisfaction and dissatisfaction, among professional nurses. The findings revealed that although professional nurses are satisfied with their supervisor-subordinate communication, they are dissatisfied with personal feedback between all categories of professional nurses. Recommendations for the improvement of the communication effectiveness and communication satisfaction of professional nurses are aimed at creating an organisational atmosphere conducive to two-way communication. / Health Studies

Introduction: As medical treatment has improved, patients with heart failure (HF) now live longer and care mostly takes place at home with partners providing the main assistance. Taking care of an ill or disabled individual imposes a well-documented burden on the partner’s healthrelated quality of life. The awareness of partners’ burdensome situation is increasing, but few interventions have targeted the needs of patientpartner dyads with HF. The results have been inconclusive and give no clear guidance on how interventional programmes should be designed to improve both patient and partner outcomes. Aim: The overall aim of this thesis was to evaluate the effects of a psychoeducational intervention delivered to patient-partner dyads with HF during long-term follow-up, and to explore the dyads’ perceived caring needs. Methods: The thesis is based on four papers that used both quantitative and qualitative data. Study I and II used a randomized controlled design with a follow-up assessment after 24 months including 155 patientpartner dyads. The control group received care as usual. The intervention group received care as usual, and in addition they participated in the nurse-led psycho-educational intervention. Data was collected using questionnaires before and 24 months after the intervention, in order to determine the long-term effects on patients and partners regarding health related quality of life, perceived control, symptoms of depression and partners’ caregiver burden (I, II). A conceptual health promotion model inspired the intervention. To describe how the model was applied, a qualitative approach analysing nurses’ documentation of the sessions with 71 dyads in the intervention group (III) was used. Study IV has an explorative design. To further explore the dyads’ perceived caring needs, focus groups interviews with 19 patient-partner dyads with heart failure (IV) were performed. Results: The intervention did not have any significant effect on physical or mental health- related quality of life, depressive symptoms, or perceived control over the heart failure among the dyads (I) or caregiver burden in the partners (II) after 24 months. Furthermore, time to first event did not differ significantly between the dyads in the intervention group and the control group (I, II). As for the partners, both the intervention and control group reported decreased physical health between the baseline assessment and the 24-month follow-up (I). The intervention was composed of three components; 1) cognitive 2) supportive, and 3) behavioural component. The analysis of the nurses’ documentation confirmed the coverage of all the components and the analysis revealed a vide range of caring needs among the dyads (III). The dyads described a need to learn about HF to be able to manage everyday life. Regular outpatient clinic visits and access to telephone support were vital and both the patient and the partner need to be present at the clinic visits. Meeting others who are in the same situation and sharing the burden in nurse-led group sessions was proposed as an opportunity to support each other and others (IV). Conclusions: Over the 24-month follow-up period, the intervention had a neutral effect on health- related quality of life, depressive symptoms and perceived control over the HF among the dyads, and on partners’ caregiver burden. Considering the fact that partners serve as a critical extension of the formal healthcare system, and that both patients and partners ask for more support, it will become crucial to find new ways to support dyads affected by heart failure. This thesis may be viewed as a first step in trying to understand dyads’ perceived caring needs, and it can serve as a guide in clinical work and when designing new dyadic interventions.

Arbetet till sjöss är förenat med risker som kan medföra att olyckor sker. Det ska finnas en plan för krishantering redan innan en olycka har inträffat. Det grundläggande förutsättningarna för att hantera följderna av en händelse finns reglerade i svensk lagstifting men hur följs den drabbade sjömannens hälsa upp av rederiet som arbetsgivare? Med denna frågeställning som bakgrund är syftet med det här arbetet att undersöka hur svenska rederier använder sin krishanteringsplan med fokus på förberedande arbete och omhändertagande av personal efter en kris. För att få svar på frågeställningen har en kvalitativ intervjuundersökning används som metod för datainsamling. Undersökningen omfatter en delvis strukturerad intervju med sju respondenter från sex olika svenska rederier. Resultatet av undersökningen visar att rederierna förhåller sig till gällande krav och regelverk och för att uppfylla en del av kraven tar de hjälp av externa aktörer såsom företagshälsovård och psykologer. Rederierna poängterar att det är svårt att utforma en krisplan för något som inte har hänt, att förutse alla scenarion som kan inträffa betraktas inte som möjligt oavsett hur mycket de övar. Besättningen anses dock som det absolut viktigaste för verksamheten och det sätts inga gränser för att främja deras välbefinnande i kriser. / Shipping is often associated with risks which can lead to accidents. There should be a plan for crisis management even before an accident has occurred. Basic prerequisites to deal with the consequences of an accident are regulated in national legislation but how well monitored is the affected sailor’s health by the shipping company as an employer? With that question as a background, the purpose of this thesis is to research how swedish shipping companies use their crisis management plan to support and care for their crew after a crisis. In order to answer the question, qualitative interviews were used as a method for collecting data. The research survey includes a semi-structured interview with seven respondents from six different shipping companies. The research shows that the shipping companies adhere to the requirements and regulations and in order to meet parts of the requirements, they use services of external actors such as occupational health providers and psychologists. The shipping companies explain that it is difficult to create a plan of action for something that has not occurred. To predict a complete scope of crisis scenarios is not deemed as possible, regardless of the amount of drills conducted. The crew is considered the most important element of the business and no restrictions is put on their well being during a time of crisis.

The purpose of this study was to explore and describe communication effectiveness and communication satisfaction experienced by professional nurses in selected public health care services. Quantitative, explorative and descriptive research was conducted to determine the communication effectiveness and levels of communication satisfaction. The Downs and Adrian (2004) structured questionnaire was adapted and used to collect the data. The study population consisted of three groups of professional nurses, namely nurse managers (n=18), operational managers (n=22) and professional nurses (n=90). The study highlighted areas of effective and ineffective communication, as well as areas of communication satisfaction and dissatisfaction, among professional nurses. The findings revealed that although professional nurses are satisfied with their supervisor-subordinate communication, they are dissatisfied with personal feedback between all categories of professional nurses. Recommendations for the improvement of the communication effectiveness and communication satisfaction of professional nurses are aimed at creating an organisational atmosphere conducive to two-way communication. / Health Studies / M.A. (Health Studies)

Object of study: The innovation “Digital health care center” from a multi-level stakeholder’s perspective. Problem: A new technology era has opened up for new kind of innovations. Digital health care centers are a service that recently has been introduced on the Swedish market, which needs further investigation. To be able to better understand, explain and predict future behavior of an innovation the innovation could be theoretical conceptualized and classified. In the specific area of health care, new innovation should preferable be investigated in from a multilevel perspective, including different stakeholders opinions. One if the stakeholders are the customers. If new innovative products and services want to be successful, it required consumers to adopt the product or service, but relatively few studies have focused on the adoption of technology services among customers. Purpose: The purpose of this thesis is to gain a better understanding of the innovation “digital health care center” in Sweden. Research question: How can the innovation “digital health care center” be described through a stakeholder perspective? Method: The empirical data were collected through qualitative semi-structured interviews and a structured quantitative questionnaire. Conclusions: The innovation digital health care center can from a multi-level perspective be described as an innovation that contributes and have an impact on the market and the healthcare industry in many ways. The innovation could be described as a complement to traditional health care. The innovation has influences from different theoretical classes of innovation which means that the innovation cannot be categorized in a specific class. The innovation can be considered successful because it facilitates for the patient.. According to the stakeholder group potential patients, a majority of the respondents thinks that increased availability and time-efficiency would be facilitating factors and reasons for using the service. The innovation is described by the various stakeholders as contributing to a better society. The care becomes more productive, cost effective, more available, and in the broader perspective, the innovation contributes to increased digitalization of the healthcare sector as a whole. There are many new possible fields of application which in the healthcare industry which could develop the innovation further. Strengths and opportunities with the innovation can be considering outweighing weaknesses with the innovation and potential threats of the innovation.

Det drivs många utvecklingsprojekt inom offentlig sektor, men det saknas kunskap om hur dessa projekt kan bidra till ett hållbart utvecklingsarbete. Syftet med avhandlingen är att förstå och förklara hur resultat och kunskap från utvecklingsprojekt kan integreras i den ordinarie verksamheten i offentliga organisationer och bidra till långsiktiga effekter, som har ett värde för brukarna, organisationen och de anställda. I forskningen saknas en etablerad begreppsapparat för att studera hållbar utveckling i organisationer. En utmaning har därför varit att identifiera och analysera tidigare forskning, för att därigenom definiera begreppet hållbart utvecklingsarbete och viktiga förutsättningar för ett sådant arbete. Den teoretiska referensramen baseras på ett institutionellt perspektiv: nyinstitutionell organisationsteori kombineras med Giddens struktureringsteori och sociologisk professionsteori, som synliggör spänningar mellan konkurrerande styrformer som byråkrati, marknad och professionalism. Avhandlingen utgår från en interaktiv forskningsansats och består av två empiriska delar: en  kvantitativ enkätstudie som inkluderar 348 utvecklingsprojekt inom vård och omsorg samt en kvalitativ flerfallstudie av fyra utvecklingsprojekt. Studierna visar att olika faktorer främjade projekten på kort och lång sikt. Tydliga projektmål, styrning och kompetent projektledning hade betydelse för de kortsiktiga projektresultaten, men mycket begränsat påverkan på den långsiktiga hållbarheten. Istället var det ett aktivt ägarskap, och andra faktorer kopplade till ledningen i mottagarorganisationerna, som tydligast främjade ett hållbart utvecklingsarbete. Studierna visar även hur konflikter och motstånd i projekten påverkade förutsättningarna för långsiktig hållbarhet. Det gällde konflikter mellan olika yrkesgrupper, mellan ledning och professionella samt mellan byråkratiska och professionella styrformer. En slutsats är att en analysmodell för hållbart utvecklingsarbete behöver komplettera ett organisatoriskt och institutionellt perspektiv med ett professionsperspektiv. / There are many development projects in the public sector, but there is a lack of knowledge about how these projects can be made sustainable. The aim of the thesis is to explain how project results and knowledge can be integrated into public organizations and contribute to long-term effects and value for clients, organizations and employees. The scientific literature lacks an established conceptual framework for studying sustainability in organizations. Therefore, it has been a challenge to identify and analyze previous research in order to delineate and define the concept of sustainable change in organizations. The research is based on an institutional perspective: neo-institutional theory in combination with Giddens' structuration theory and sociological profession theory, which reveal tensions between three competing logics of control, i.e., bureaucracy, market and professionalism. The method is inspired by an interactive research approach and comprises two empirical parts: a quantitative survey study, including 348 development projects in health and social care, and a qualitative multi-case study of four development projects. The studies showed that different sets of factors supported short-term project success and long-term sustainability. Project-related factors, such as goal setting and project management, had little impact on sustainability. Instead, it was primarily active ownership, and other factors related to management of the recipient organization, that influenced the routinization of project results. The studies also exposed several conflicts and tensions that affected project sustainability. There were conflicts between occupational groups, between management and professionals, and between the logic of rational, bureaucratic management and the logic of occupational professionalism. Thus, understanding sustainable change in organizations requires a professional perspective to complement the organizational and institutional perspectives.

The study concerns the needs assessment processes that older persons undergo to gain access to home care. The participation of older persons, their relatives and municipal care managers was studied from a communicative perspective. The assessment meetings functions as formal problem-solving events. The older persons´ accounts are negotiated discursively in interaction. Various storylines are used by the older persons and their relatives whether they view home care as an intrusion, as a complement or as a right. In case of divergent opinions the older person has the final say as prescribed by the Swedish social service act. One conclusion is that the role of relatives is not defined and a family perspective is not present. In the study the institutional structure of the assessment process was also analyzed. Older persons are processed into clients; their needs are fitted within the framework of documentation and institutional categories. In the transfer of talk to text all the particulars are not reflected and two types of documentation was identified; a fact-oriented objective language or an event-oriented personal language. Care management models and a managerialist thinking has influenced the assessment process by bureaucratisation of older people trough people processing, which is in contradiction to the individual-centric perspective prescribed by the law. The introduction of care management models in gerontological social work has lead to an embedded contradiction and constitutes a welfare political dilemma. Improved communicative methods are needed in order to achieve a holistic assessment situation. / Studien tar sin utgångspunkt i de bedömningsprocesser äldre personer genomgår för att få tillgång till hjälp i hemmet. Bedömningsprocessen där äldre, deras anhö-riga och kommunala behovsbedömare deltog studerades ur ett kommunikativt perspektiv. Interaktionen vid behovsbedömningssamtalet fungerar som en pro-blemlösningsprocess. Den äldre personens redogörelse för behov förhandlas diskursivt i interaktionen och tre olika berättelselinjer identifierades, baserade på om de sökande betraktar hemtjänsten som ett intrång, som ett komplement och stöd eller som en rättighet. När olika åsikter uttrycks har de äldre sista ordet i enlighet med Socialtjänstlagens föreskrifter. En slutsats är att de anhörigas roll i behovsbedömningsprocessen inte är definierad och att ett familjeperspektiv sak-nas. I studien analyserades också bedömningsprocessens institutionella struktur. De äldre behovssökande processas till att bli klienter, deras behov anpassas till dokumentationens ramverk och kategoriseras i enlighet med institutionella kate-gorier. I transfereringen av tal till text redovisas inte samtliga element i samtalet. Två typer av utredningstext identifierades, den faktaorienterade och den händelse-orienterade. I studien diskuteras det marknadsekonomiska tänkande som kommit att påverka bedömningsprocessen genom byråkratisering vilket står i motsatsställ-ning till det individcentrerade perspektiv som lagen förespråkar. Introduktionen av marknadsmodeller i det gerontologiska sociala arbetet har medfört en inbyggd motsättning och utgör ett välfärdspolitiskt dilemma. Förbättrade kommunikativa metoder behövs för att uppnå en holistisk bedömningsprocess.

Bakgrund: Att utföra fysisk aktivitet under graviditeten kan hjälpa kvinnan att bibehålla en god hälsa samt förebygga mot graviditetskomplikationer. Att drabbas av graviditetskomplikationer kan medföra allvarliga sjukdomar för kvinnan och fostret. Hypertoni, preeklampsi, graviditetsdiabetes, problematik med bäckenbotten är endast några exempel på graviditetskomplikationer som kan påverka hälsan. Genom att arbeta hälsofrämjande och sjukdomsförebyggande för att inte drabbas av graviditetskomplikationer, rekommenderas att fysisk aktivitet utförs minst 150 minuter i veckan med en medelmåttig intensitetsnivå. Syfte: Syftet med studien är att beskriva kvinnors upplevelse av fysisk aktivitet under graviditeten. Metod: För att genomföra studien användes en kvalitativ metod med semistrukturerad intervjuguide. Vid framtagandet av deltagare användes bekvämlighetsurval där fem deltagare som var fysiskt aktiva under graviditeten godkände en medverkan. Resultat: Utifrån deltagarnas upplevelse hävdas fysisk aktivitet under graviditeten påverka både kvinnans och fostrets hälsa positivt. Fysisk aktivitet påvisade främja den mentala och fysiska hälsan positivt genom att minska smärta och mentala påfrestningar. Slutsats: Utifrån resultatet ansågs fysisk aktivitet under graviditeten vara en hälsofrämjande och sjukdomsförebyggande åtgärd för att bibehålla en god hälsa, för både under och efter graviditeten.

Background: There are personal factors and environmental factors playing impacts on the participation of children with developmental disabilities in China. Aim: The aim of this study is to investigate the participation of children with developmental disabilities in outside home activities compared to typically developing children. Method: A quantitative cross-sectional method was used in this study. Participants were children with developmental disabilities (autism spectrum disorder and intellectual disabilities) and typically developing children between the age of 5 to 13. An instrument called ‘Picture My Participation’ (Simplified Chinese version) was used for data collection. Results: In general, typically developing children attended more frequently and felt more involved than children with developmental disabilities in outside home activities. There were many similarities in attendance between the two groups of children. They both attended more frequently in formal learning at school, shopping and playing with others, and less frequently in spiritual activities, social activities, and trips. Some differences were found in the activities with lower levels of involvement. Apart from the spiritual activity with the lowest mean score of involvement in both groups, typically developing children felt less involved in organized leisure and trips. However, children with developmental disabilities had lower levels of involvement in health center visits and social activities. There was no significant association between age, gender, place of residence, and participation in neither the attendance nor involvement aspect. Conclusion: Both intrinsic and extrinsic factors play essential parts in the participation of children with developmental disabilities. More support should be provided to children with DD.

Syftet med denna C-uppsats var att belysa hur anhöriga upplever sin roll i kontakten med psykiatrin till en närstående med diagnosen schizofreni eller schizoaffektivt syndrom. Det undersöks vilka erfarenheter anhöriga har angående att delta i processen kring vårdinsatser för en närstående. Vi hoppas att studien kan bidra till ytterligare sociologisk kunskap inom ämnesområdet för att lyfta anhörigas situation och känsla av utanförskap i relation till vården. Uppsatsen bygger på en kvalitativ intervjustudie där åtta personer har intervjuats över telefon och över Zoom. Genom fem artiklar och en historisk tillbakablick över hur psykiatrin i Sverige har utvecklats så får läsaren en djupare förståelse för hur anhörigas roll relaterat till psykiatrin har utvecklats och ser ut idag. Resultatet redovisas genom att presentera tre teman: Anhörigas kontakt med vårdpersonal, Nutid och Framtid samt Förbättringar gällande anhörigas delaktighet. Vid varje tema sammanfattas intervjusvaren där skillnader och likheter framställs och jämförs med varandra. Det teoretiska ramverket grundar sig på Melvin Seemans alienationsteori samt Birgitta Andersheds teori om delaktighet och används i analysen för att besvara frågeställningarna. Resultatet av den sociologiska analysen visar att anhörigas delaktighet i den närståendes vård förebygger anhörigas upplevelser av maktlöshet, meningslöshet och social isolering i sin vardag och i sin relation till vården. Delaktigheten bidrar även till att anhöriga mår bättre psykiskt och att närstående kan få vård i ett tidigare skede. / The purpose of this bachelor’s thesis was to shed light on how relatives experience their role in contact with psychiatry to a relative with a diagnosis of schizophrenia or schizoaffective syndrome. It also examines what experiences relatives have regarding being included in the process around care interventions. We hope that with this study we can contribute to further sociological knowledge in this subject area to raise the situation of relatives. The thesis is based on a qualitative interview study where eight people were interviewed over the phone and over Zoom. Through a number of articles and a historical review of how psychiatric healthcare in Sweden has developed, the reader gets a deeper understanding of how the role of relatives related to psychiatry has developed and how it looks today. The result is presented by three themes: Relatives' contact with care staff, Present and Future and Improvements regarding relatives' participation. For each theme, the interview results are summarized where differences and similarities are presented and compared with each other. The theoretical framework is based on Melvin Seeman's theory of alienation and Birgitta Andershed’s theory on participation and is used in the analysis to answer the questions. The results of the sociological analysis show that the relatives’ participation in the care of the close relative prevents the relatives' experiences of powerlessness, meaninglessness and social isolation in their everyday life and in their relationship to the care. Participation also contributes to relatives feeling better mentally and that relatives can receive care at an earlier stage.