<p>The aim of the study has been to gain an increased understanding of the sense of participation and influence that the enrolled nurses, working with home-help services within the purchaser – provider model, feel and how this participation and influence affect them. Five enrolled nurses in three of Stockholm's districts related their experiences of participation and influence at work in the qualitative interviews that were conducted. The result was then analyzed with the help of two theories, Karasek's and Theorell´s Demand- Control Model and Antonovsky's theory regarding ”a Sense of Coherence (SOC)”. The analyzes show that the enrolled nurses have a low sense of participation and influence regarding decisions relating to their work situation. Decisions that affect the enrolled nurses are made by politicians, directors, and care managers of the city districts (biståndshandläggare). On the other hand, the enrolled nurses felt strong support from their peers at work. They could socialize and discuss issues with them. The analyzes show that without their peer support, they would have a lower sense of participation and influence. Furthermore the analyzes show that the interview subjects possess knowledge and competence that they are unable to make use of in their work.</p>

The aim of the study has been to gain an increased understanding of the sense of participation and influence that the enrolled nurses, working with home-help services within the purchaser – provider model, feel and how this participation and influence affect them. Five enrolled nurses in three of Stockholm's districts related their experiences of participation and influence at work in the qualitative interviews that were conducted. The result was then analyzed with the help of two theories, Karasek's and Theorell´s Demand- Control Model and Antonovsky's theory regarding ”a Sense of Coherence (SOC)”. The analyzes show that the enrolled nurses have a low sense of participation and influence regarding decisions relating to their work situation. Decisions that affect the enrolled nurses are made by politicians, directors, and care managers of the city districts (biståndshandläggare). On the other hand, the enrolled nurses felt strong support from their peers at work. They could socialize and discuss issues with them. The analyzes show that without their peer support, they would have a lower sense of participation and influence. Furthermore the analyzes show that the interview subjects possess knowledge and competence that they are unable to make use of in their work.

Since the end of the 1980s, the introduction of market mechanisms in the public sector has been a dominant feature in Sweden. The same is true for the social services in several municipalities, where business style behaviour and organisation, and competition have become salient features of market-oriented social services. The aim of the study is to describe and analyse: the structural conditions for market oriented personal social services; how social workers pursue client centred work in market oriented personal social services; the consequences of this market orientation on the personal social services. The empirical study is a case study of the personal social services in the municipality of Linköping. The purchaser-provider model in Linköping is one of the most advanced and discussed in Sweden. The research comprises a quantitative pilot study and a qualitative main study. The main study is based on twenty semi-structured interviews with experienced social workers and their immediate superiors. The analysis of the interviews reveals that the personal social services are only achieving to a lesser extent the ends that a quasi-market, theoretically, should achieve. The conditions that have to be satisfied to achieve the ends of the quasi-market are only partly met. Bureaucratic control is one important reason why the personal social services are imperfect as a quasi- market. The re-organisation has resulted in a number of, to some extent, positive consequences. The re-organisation has, however, also resulted in some negative consequences. In the thesis these are categorised in terms of fragmentation, antagonism and obscurity. A linguistic change, in market oriented personal social services, appears to have influenced social workers to think and act differently in relation to their work. The most important conclusion drawn from the study is that the market oriented personal social services partly function as a responsive quasi-market for strong, rational and well- informed clients. However, in relation to the most vulnerable, it is failing in many respects. / digitalisering@umu