Sjuksköterskors praktiska kunskaper är avgörande för säker vård. Inom sjuksköterskeutbildningen kontrolleras färdigheter genom färdighetsexaminationer. Utifrån kartlagda brister i rättssäkerhet och arbetsmiljö vid färdighetsexaminationer initierades ett förbättringsarbete. Syftet med förbättringsarbetet var att förbättra processen för klinisk träning inom sjuksköterskeprogrammet genom att utveckla färdighetsexaminationer. En studie av förbättringsarbetet genomfördes i syfte att: Undersöka samsyn mellan lärare kring färdighetsexamination som pedagogisk aktivitet. Analysera och utveckla initial programteori utifrån intervjudata. Förbättringsarbete har utformats efter förbättringsmodellen, förbättringsrampen och programteoretisk ansats. Studie genomfördes med kvalitativa intervjuer och innehållsanalys utifrån en interaktiv och abduktiv ansats. Förbättringsarbetet resulterade i minskad variation mellan lärare i bedömningen av färdighetsexaminationer. Nya arbetssätt har lett till ökad samsyn mellan lärare och bättre arbetsmiljö. Programteorin reviderades utifrån intervjudata. Minskad variation visar på en ökad rättssäkerhet. Reviderad programteori har ökat möjligheten att dra lärdom av förbättringsarbetet såväl lokalt som generellt. Arbetet har bidragit till en utveckling av sjuksköterskeutbildningen och dess bidrag till en god och säker hälso- och sjukvård. / Nurses' practical knowledge is crucial for safe care. Within the nursing program skills are checked through clinical examinations. Based on identified deficiencies in terms of legal validity and working environment related to clinical examinations improvement work was initiated. The purpose of the improvement work was to improve the process of clinical training within the nursing program by developing the clinical examination. A study of the improvement work was conducted with the purpose of: Exploring teachers shared interpretations with clinical examinations as an educational activity. Analysing and developing initial program theory based on interview data. Improvement work was designed according to the model for improvement, improvement ramp, and a program theory approach. The study includes qualitative interviews with content analysis based on an interactive and abductive approach. The improvement work led to improved consensus between teachers and a better work environment. A reduction in variation between teachers’ assessments of clinical examinations was reached. The program theory was revised based on interview data. Reduced variation shows increased legal validity. Revised program theory has increased the possibility of learning from the improvement work both locally and in general. The work has developed the nursing education and its contribution to good and safe healthcare.

Andelen barn och ungdomar som befinner sig ett socialt utanförskap halkar efter alltmer i samhället. Att befinna sig ett socialt utanförskap kan medföra en rad negativa konsekvenser för såväl den enskilde individen som för samhället. Det finns ett stort behov av att belysa framgångsrika exempel på sociala innovationer, inriktade på unga i socialt utsatta områden, som kan förbättra deras välfärd och framtidsutsikter. Syftet med examensarbetet var att beskriva verksamheten ”Nattfotboll” utifrån programteori och undersöka dess förutsättningar för att skalas upp utifrån teorier om spridning av interventioner. Studien genomfördes med en kvalitativ studiedesign bestående av en fokusgruppsintervju med initiativtagare och projektledare, semistrukturerade intervjuer med 10 ledare och 21 ungdomar samt tre strukturerade observationer i samband med idrottsaktiviteter i Sandviken och i Örebro. Resultatet visade att konceptet Nattfotboll kännetecknades av flera viktiga kärnkomponenter och nyckelidéer. De komponenter som tillskrevs mycket stor betydelse för utfallet var de unga, utvalda ledare som drev idrottsverksamheten, men även den lokala projektledaren. Verksamheten visade sig främja ett relationsbygge mellan ungdomarna och ledarna som var betydelsefullt: ungdomarna fick tillgång till unga förebilder, medan de unga ledarna kunde växa som individer. Verksamheten erbjuder en träffpunkt som bidrar till att ungdomar breddar sitt kontaktnät, blir mer fysiskt aktiva och erbjuds en väg in i föreningslivet, då många av ledarna själva är idrottsaktiva. Studien visar att Nattfotbollskonceptet innehåller de fem kategorier som är nödvändiga för en framgångsrik uppskalning; Kärnkomponenter & Nyckelidéer, Upplägg, Kommunikation, Resultatmätning & Feedback samt Ledarskap. Ytterligare forskning skulle kunna bidra till att fördjupa förståelsen för vad interventionen har för betydelse för ledarna som individer. / A great number of children and adolescents who are in a social exclusion is lagging behind in society. A social exclusion can lead to a number of negative consequences for both the individual and the community. There is a great need to highlight successful examples of social innovations aimed at young people in socially vulnerable areas that can improve their well-being and prospects. The aim of the thesis was to describe the innovation Night Football on the basis of program theory and also examine its conditions for scaling up on the basis of diffusion theory and a framework for spread. The study was conducted with a qualitative study design consisting of a focus group interview with initiators and project managers, semi-structured interviews with 10 leaders and 21 young participants, as well as three structured observations in connection with sports activities in Sandviken and Örebro. The result showed that the Night Football concept was characterized by several key core components and key ideas. The components attributed to the outcome were the young, chosen leaders who run the sport activities, but also the local project manager. The innovation turned out to promote important relationships between the young people and the leaders: young people gained access to young role models, while young leaders could grow as individuals. The innovation offers a meeting point that helps young people broaden their network of contacts, becomes more physically active and they are also offered a way into sports associations, as many of the leaders themselves are connected to sport clubs. The study shows that the Night Football concept contains the five categories necessary for a successful upscale; Core components & Key ideas, Structure, Communication, Performance Measurement & Feedback, and Leadership. Further research could help to deepen the understanding of the innovations impact on the leaders as individuals.

Inledning: Göteborgs kommun implementerade år 2013 en intervention i form av gratis utdelning av broddar till kommunens äldre befolkning (65+), i ett försök att reducera antalet fall/halkolyckor på is/snö. Syftet med detta papper var att se över om interventionen hade haft en effekt på incidensen av fotgängarolyckor gällande fall/halkskador bland kommunens äldre befolkning. Metod: Pappret applicerade en kontrollerad före– och efterstudie för att se på skillnader mellan en föreperiod (2009–2012), då halkskydd ännu inte var utdelade, mot en efterperiod (2013–2016) då interventionen hade implementerats. Resultat: När interventionsgruppen (65+) jämfördes mot kontrollgruppen (16–64) hade antalet incidenser på is/snö minskat med 34.36 fall/halkolyckor per 100 000 efter utdelningen av broddar. Liknande trender kunde inte utläsas när analyser gjordes mot närliggande kontrollkommuner. Placebotest visade heller inte på någon signifikant effekt för Göteborg då placebokontroller utfördes för tidigare observerade perioder (2003–2010). Slutsats: Resultaten tyder på att antalet fall/halkincidenser på is/snö bland äldre invånare i Göteborgs kommun har sjunkit med 36 procent efter kommunens åtgärd. / Introduction: In 2013, Gothenburg municipality implemented an intervention in the form of free distribution of anti-slip devices to the municipality’s elderly population (65+) to reduce the amount of falls/slips on ice/snow. The aim of this paper was to evaluate if the intervention had an effect on the incidence of pedestrian accidents involving falls/slips among the municipality’s elderly. Methods: This paper applied a controlled before-and-after study to test for differences between a before period (2009-2012), when anti-slip devices were not yet distributed, to an after period (2013-2016) when the intervention had been implemented. Results: When the intervention group (age 65+ years) was compared to the control group (age 16–64 years), the number of incidences had significantly decreased by 34.36 falls/slips on ice/snow per 100 000 person-years after the distribution of anti-slip devices had been made. Similar trends were not seen when analysis were done to nearby control municipalities. A placebo test did not show any significant effect of Gothenburg as placebo controls were made on earlier observed periods (2003-2010). Conclusion: The results suggest that the number of fall/slip incidences on ice/snow among the municipality’s elderly residents has been reduced by 36 percent after the municipal intervention.

The aim of this essay is to analyze the implementation process of the International Baccalaureate’s Diploma Programme in four of the approximately 30 schools currently offering the IB at upper secondary level in Sweden. The starting point is a comparison between definitions in fundamental documents in the national programmes for Natural Science (NV) and Social Science (SP) on the one hand, and the IBDP on the other. The evaluation, based on Program theory, focuses in particular on the consistencies in the Organizational plans of each system.  The basic assumption is that the IB due to a deviating organizational system, different structures, aims and objectives makes a challenge for the dominating educational discourse, to use a concept by Michel Foucault, and that resistance against the IB therefore is to be expected. As a second part of the evaluation five people who either play, or have played the role of coordinators of the IB, and who thereby are responsible for the implementation, have been interviewed. The questions have been focused around in what sense the informants can confirm resistance in their implementation work due to the differences found in the first part of the evaluation, and in what ways it manifests itself. Finally, Michel Foucault’s power structures in connection to discourse analysis have been applied on the results of the two previous parts of the essay. Foucault claims a school to be one of the state institutions acting on its behalf in conserving and defending its discourse against outside enemies. Two configurations of power are according to Foucault used in the defence; ‘marginalization’ and ‘normalization’. The result of the study confirms evidence of both power structures being found in the implementation of the IB in the four schools included in the analysis and that the resistance against the IB in these schools can be interpreted accordingly. / Syftet med den här uppsatsen är att analysera implementeringen av International Baccalaureate Diploma Programme (IBDP) i fyra av det 30-talet gymnasieskolor som för närvarande erbjuder utbildingen i Sverige. Utvärderingen är indelad i två delar baserad på ’programteori’, och fokuserar på delar i respektive utbildnings organisationsplan.  Den första delen har sin utgångspunkt i styrdokument i respektive utbildning och utgör en jämförelse av olika grundläggande definitioner för, å ena sidan de nationella Naturvetenskapsprogrammet (NV) och Samhällsprogrammet (SP), och å andra sidan IBDP. Detta är av relevans för att IB-utbildningen skiljer sig tillräckligt mycket från de nationella programmen för att utgöra en utmaning av det nationella systemet, det som Michel Foucault skulle kalla den dominerande diskursen. Den andra delen består av fem intervjuer med nuvarande eller före detta coordinatorer, de personer som ansvarar för implementeringsarbetet på de enskilda skolorna. Här är frågorna fokuserade runt de områden där implementeringsarbetet antas vara svårast utifrån de skillnader som framkommer i den första delen av utvärderingen. Slutligen används de maktbegrepp som Foucault anger i sin diskursanalys på de två första delarna av arbetet. Foucault hävdar att skolan är en av de institutioner som agerar för att bevara och försvara en stats diskurs mot utomstående makter. Enlig Foucault uttrycks detta i två maktkonfigurationer; ‘marginalisering’ och ‘normalisering’. Resultatet av studien visar att det finns tecken på att båda maktmedel i implementering av IB på de fyra aktuella skolorna och att motståndet mot IB går att förstå enligt denna modell.

As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained? The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project. The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain. The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.

As an innovation Evidence-Based Practice (EBP) is designed as a tool for clinical problem solving. According to its theory of use EBP will bring a difference for policy makers, for professionals, for researchers and for service users. One question to be asked is whether EBP actually leads to the radical social change it is designed to accomplish. The aim of the study is to describe and analyse the outcome of the effort to establish EBP, with a focus on the case of social work in Sweden. The research questions are: What is EBP? Why are efforts made to establish EBP? What is the outcome of the EBP project? How can the outcome of the EBP project be explained? The case study was conducted on a critical realistic meta-theoretical ground with a focus on explanation of social change with an explicit actor-structure perspective. Methodologically, a narrative synthesis of studies was made. As a complement primary data were collected to fill empirical gaps. The state of things was described before and after the EBP-initiatives. Several helping theories – Kuhn’s theory of paradigm, program theory, neo-institutional theory and theory of diffusion – were used to analyse the empirically mapped outcome of the EBP project. The results show that the import of the original model of Evidence-Based Medicine (EBM) to social work is a part of a wider social movement in the helping and educational professions. The new model has influenced social work as a discipline, as a field of practice and as a field of policy. There are examples of full-scale implementations of EBP, although EBP has not reached a general status as daily practice. Some obstacles remain. The gradual adaption of EBP corresponds to criteria hold by Kuhn for a paradigm shift. Acceptance of the model has contributed to change the structure and function of social systems. At an organizational level, this change means on-going institutionalization. The innovation is influencing the way institutional actors conduct their work. Although the structural conditions have been optimal, the EBP-model has been debated with heat. The EBP-debate and policy-driven infrastructural efforts have brought a more in-depth examination of the model. So-called coercive, normative, and regulative isomorphisms were used to change organizations. The degree of institutionalization depended on the individuals and the organizations willingness and preparedness to change, to understand, and to put the model into practice. When actors used a less strict version of the original EBP model, the pace of cultural and institutional change slowed down.