<p>There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations.</p><p>This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II).</p><p>Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II).</p><p>The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II).</p><p>The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner.</p><p>The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning.</p> / <p>Stora förväntningar ställs på att samarbete mellan yrkesgrupper och mellan sektorer ska utveckla hälso- och sjukvården och leda till en förbättrad folkhälsa. I Världshälsoorganisationens policydokument “Health21” anges exempelvis målsättningen att hälsoprofessionerna i de europeiska medlemsländerna till år 2010 ska ha utvecklat en hälsofrämjande kompetens som bland annat innefattar teamarbete och samarbete på basis av ömsesidig respekt för de olika professionernas expertis. Det interprofessionella teamets utmaningar är dock mångfacetterade och kräver uppmärksamhet från det samhälle som skapar villkoren för hälsoprofessionernas samarbete inom hälso- och sjukvårdens organisationer.</p><p>Denna licentiatavhandling innehåller diskurs- och innehållsanalytiska studier om interprofessionellt teamarbete i vården. Avhandlingens övergripandet syfte var att undersöka och beskriva hur teammedlemmar konstruerar och skapar innebörder av team och teamarbete mellan flera hälsoprofessioner. Det ena specifika syftet var att undersöka hur medlemmar i multiprofessionella vårdteam talar om sitt team, särskilt avseende de diskursiva mönster som framträdde och vilken funktion dessa mönster hade (studie I). Det andra specifika syftet var att identifiera och beskriva svårigheter som hälsoprofessioner har uppfattat vid interprofessionellt teamarbete, där avsikten även var att möjliggöra en diskussion om implikationer för interprofessionellt lärande (studie II).</p><p>Fokusgruppintervjuer med teammedlemmar (n=32) från sex team analyserades utifrån en diskursiv socialpsykologisk forskningsansats och fokuserade på användningen av pronomina ”jag”, ”vi” och ”de”. Fynden relaterades sedan till teorier om diskursivt medlemskap och diskursiva samhällen (studie I). Individuella semistrukturerade intervjuer med teammedlemmar (n=18) från fyra av de sex teamen genomfördes med critical incident-teknik. Intervjuerna analyserades via latent kvalitativ innehållsanalys och fynden tolkades utifrån teorier om professionssociologi och lärande i arbetet (studie II).</p><p>Resultaten visade att två diskursiva mönster framträdde i teammedlemmarnas konstruktioner av ”vi-som-team”. Dessa mönster benämndes kunskapssynergi och tillitsfullt stöd (studie I). Vid individuella intervjuer med teammedlemmar identifierades följande tre teman som rörde svårigheter vid interprofessionellt teamarbete; (i) svårigheter som gällde den teamdynamik som uppstod när teammedlemmarna agerade som företrädare för sina professioner i relation till teamet, (ii) svårigheter när medlemmarnas olika kunskapsbidrag interagerade i teamet och (iii) svårigheter som rörde den omgivande organisationens påverkan på teamet (studie II).</p><p>Konklusionen gjordes att de diskursiva mönstren utgjorde retoriska resurser för teammedlemmarna, både för att bekräfta medlemskapet i teamet, för att hävda sina åsikter i kontakter med andra vårdgivare (”de andra”) och även för att hantera uppfattade svårigheter beträffande exempelvis bristande samsyn. Vidare drogs slutsatsen att en konsekvens av de uppfattade svårigheterna var, förutom individuella konsekvenser, begränsningar i användandet av de gemensamma resurserna för att nå en helhetssyn på patientens problem och att patienterna inte kunde bemötas på det sätt som önskades.</p><p>Forskningsprojektets praktiska implikationer rörde teamutveckling där olika former av interprofessionellt lärande påverkar teamets fortsatta utveckling, samt ledning av hälso- och sjukvården avseende betydelsen av imple-menteringsprocesser och organisatoriskt lärande.</p>

<p>Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluation of the educational toolbox was based on nursing staff ratings of their competence and psychosocial work environment, as well as on care recipients’ and family relatives’ ratings of the quality of elderly care.</p><p>Paper I validated a questionnaire measuring care recipient relatives’ perceptions of quality of care. Paper II compared self-rated competence, work strain, stress, and work satisfaction between staff working in home-based care and nursing homes. Papers III and IV evaluated the impact of the educational intervention on staff perceptions of their competence and psychosocial work environment (Paper III) and on care recipients’ and relatives’ perceptions of the quality of care (Paper IV).</p><p>The results showed that staff ratings of their competence and psychosocial work environment, including work satisfaction and work stress, improved significantly over time in the intervention municipality, compared to the reference group. Neither care recipients’ nor relatives’ ratings of the quality of care changed significantly over time in the intervention organization. Furthermore, there were no significant interaction effects over time between the intervention and reference groups for quality ratings. These results indicate that an educational toolbox that can be used according to local workplace needs may be an effective and sustainable intervention for improving staff competence and the psychosocial work environment. However, further studies are needed to investigate whether, and under what conditions, improved staff competence and work environment have an impact on quality of care.</p>

Insufficient competence among nursing staff is a major concern in elderly care worldwide as the healthcare needs of the elderly become increasingly complex. In previous research, insufficient competence has been associated with work dissatisfaction and stress among elderly care nurses, and with lower quality of care. This thesis describes the development, implementation and evaluation of an educational intervention for nursing staff in elderly care. In a prospective, controlled study, evaluation of the educational toolbox was based on nursing staff ratings of their competence and psychosocial work environment, as well as on care recipients’ and family relatives’ ratings of the quality of elderly care. Paper I validated a questionnaire measuring care recipient relatives’ perceptions of quality of care. Paper II compared self-rated competence, work strain, stress, and work satisfaction between staff working in home-based care and nursing homes. Papers III and IV evaluated the impact of the educational intervention on staff perceptions of their competence and psychosocial work environment (Paper III) and on care recipients’ and relatives’ perceptions of the quality of care (Paper IV). The results showed that staff ratings of their competence and psychosocial work environment, including work satisfaction and work stress, improved significantly over time in the intervention municipality, compared to the reference group. Neither care recipients’ nor relatives’ ratings of the quality of care changed significantly over time in the intervention organization. Furthermore, there were no significant interaction effects over time between the intervention and reference groups for quality ratings. These results indicate that an educational toolbox that can be used according to local workplace needs may be an effective and sustainable intervention for improving staff competence and the psychosocial work environment. However, further studies are needed to investigate whether, and under what conditions, improved staff competence and work environment have an impact on quality of care.

Medical treatments with statins are prescribed to patients with increased risk of cardiovascular events. The benefits from statin treatment are well documented in clinical trials, but long-term adherence in patients is low, indicating that patients have an uncertainty about the necessity and benefits of treatment. The aims of this thesis were to investigate how patients and doctors view different aspects of statin treatment. Further aims were to investigate if the cardiovascular risk level in patients affects their views about different aspects of statin treatment. Yet further aims were to compare health behaviours and views about risk factors in patients using statins to a non-treated population. Data was obtained from patients (n = 829), doctors (n = 330) and a population sample (n = 720) using postal questionnaires. Views about the effect of statin treatment were assessed in different ways for patients and doctors. Patients based their assessments on their own situation, and doctors’ treatment decisions and assessments of anticipated effect of treatment were based on two hypothetical patient cases. The results indicate that patients greatly overestimate the general effect of statins, compared to efficacy results reported from clinical trials. Patients’ previous coronary heart disease or high overall risk were factors not associated with their views and expectations of treatment effect. Statin users with an internally perceived health control and patients satisfied with their doctor’s treatment explanation reported higher beliefs in treatment necessity and benefits. Statin users reported having better health behaviours and generally rated risk factors as more important than the non-treated population. Doctors had suboptimal understanding of the number of patients expected to benefit following five years of statin treatment and had a varying understanding of statins’ ability to prolong life. Overall the results illustrate that patients and doctors have different perspectives and views of the benefits from statin treatment which puts emphasis on how statin treatment is discussed in the clinical setting.

The aim of this study is to examine social workers' and social work students' attitudes towards people living with hiv in Sweden. I will also examine if there is a connection between knowledge and attitudes. The questions at issue are how social workers' and social work students' attitudes can assume to influence on their professional practice and what causes can affect their attitudes towards people living with hiv. The study is based on a qualitative method. The methods have been: conversational interviews with five social workers, who work with family issues and integration, and a focused group interview with four social work students. Both forms of interviews were combined with the vignette method. The theoretical framework of this study is symbolic interactionism. The result of the study indicates that both the social work students and the social workers lack adequate knowledge about hiv, however, the respondents are capable of reflecting and are able to put themselves into others' situations and therefore they will not discriminate their clients because of their disease. Results of the study also indicate that there is a great ambiguity among all of the respondents because of the lack of knowledge and adequate education.

The thesis examines the privatisation of China's health care since the 1980s, focusingon the privatisation of primary health care at the county level. The research choosesprivate clinics as research objects, includes a brief historical description of privatehealth care evolution and the existing health care system in China; based on theempirical data collected in the field work, it provides a current picture of private clinicand its privatisation process in a Chinese city, discusses the problems in privatemedical practice and challenges private clinic faces, and the influence of privatisationon health sector performance.The thesis notes the privatisation of primary health care by private clinics supplies analternative way for health care services. It plays a significant role in compensatingpublic system and promotes more equal health access, although the radicalprivatisation of all health sectors undermines the accessibility and quality of healthservices in general. Currently the private health sector in China is still small and yet toform a mature market, and there are multiple challenges for its further development,but it can be expected that the private sector in the health care area will expand rapidly,and China could hopefully find a suitable way of public/private mix under the newhealth reform.

Background: The recent increase in long-term sickness absence both in Sweden and many other countries has been met with various attempts to intensify the use of rehabilitation measures in order to prevent people from remaining long-term sickness absent. Several actors, among them professionals in healthcare, occupational health services, and social insurance are involved in handling issues related to the sick leave of an individual, and in providing measures to promote return to work (RTW). Identification of the factors that are related to RTW of the individual is a multifaceted task; therefore to meet the individual in this process is an essential challenge for many actors involved. Knowledge is needed about factors that might promote RTW in order to facilitate future research aimed at designing effective rehabilitation programs. Such information is of great importance to improve the work situations of the professionals, to decrease the cost for society, and to improve the situations for people on sick leave by facilitating RTW. Objectives: The overall aim of the work underlying this thesis was to ascertain whether contacts between professionals and sickness absentees might a factor that can promote RTW, and also to identify different aspects of how such positive encounters are experienced by those who are sick listed. Material and methods: Five investigations were conducted using different study designs, data, and methods of data analyses. The first two (papers I and II) concerned interviews with people on sick leave about positive experiences of their encounters with professionals. The third study (paper III) was based on four questions about encounters, which were included in a questionnaire that was administrated to people who were on sick leave. The fourth study (paper IV) used a broad questionnaire to examine experiences of positive encounters, and the final study (paper V) proposed a model of possible effects of the encounters on RTW. Results: In paper I and II different aspects of sick-listed person’s experiences of positive encounters were identified. For example, it seemed that important qualities included being treated with respect, feeling supported, establishing a personal relationship, and participating in decisions regarding RTW measures. Several of the interviewees stated that RTW might be promoted by positive encounters. Paper III showed that perceptions of interactions varied with the type of professionals, as well as with demographics. The respondents perceived their encounters with professionals within healthcare as most positive, followed by social insurance, and lastly occupational health services. In general, females, people born in Sweden, and those who were older, or had a higher education rated their encounters with professionals as more positive. The main finding reported in paper IV was that the majority of the participants had experienced being positive encountered by professionals. Three aspects of such encounters were stressed, namely being treated with ”competence”, ”personal attention”, and ”competence and trust”. The results related in paper V indicated that theories about empowerment and on social emotions could be successfully applied in this area, after they were specifically adapted to some unique features of the contacts between sickness absentees and rehabilitation professionals. Conclusions: This thesis emphasizes that being positively encountered by professionals can have a beneficial impact on RTW after a period of sickness absence. More research is required to elucidate the interaction between sick-listed persons and professionals who are involved in their cases. Further studies should focus on how methods for professionals can be provided to increase sick-listed persons’ own ability to mobilize and develop their resources. Moreover, additional knowledge is needed to extend professional treatment strategies that enhance self-confidence and empowerment of individuals during sickness absence.

There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations. This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II). Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II). The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II). The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner. The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning. / Stora förväntningar ställs på att samarbete mellan yrkesgrupper och mellan sektorer ska utveckla hälso- och sjukvården och leda till en förbättrad folkhälsa. I Världshälsoorganisationens policydokument “Health21” anges exempelvis målsättningen att hälsoprofessionerna i de europeiska medlemsländerna till år 2010 ska ha utvecklat en hälsofrämjande kompetens som bland annat innefattar teamarbete och samarbete på basis av ömsesidig respekt för de olika professionernas expertis. Det interprofessionella teamets utmaningar är dock mångfacetterade och kräver uppmärksamhet från det samhälle som skapar villkoren för hälsoprofessionernas samarbete inom hälso- och sjukvårdens organisationer. Denna licentiatavhandling innehåller diskurs- och innehållsanalytiska studier om interprofessionellt teamarbete i vården. Avhandlingens övergripandet syfte var att undersöka och beskriva hur teammedlemmar konstruerar och skapar innebörder av team och teamarbete mellan flera hälsoprofessioner. Det ena specifika syftet var att undersöka hur medlemmar i multiprofessionella vårdteam talar om sitt team, särskilt avseende de diskursiva mönster som framträdde och vilken funktion dessa mönster hade (studie I). Det andra specifika syftet var att identifiera och beskriva svårigheter som hälsoprofessioner har uppfattat vid interprofessionellt teamarbete, där avsikten även var att möjliggöra en diskussion om implikationer för interprofessionellt lärande (studie II). Fokusgruppintervjuer med teammedlemmar (n=32) från sex team analyserades utifrån en diskursiv socialpsykologisk forskningsansats och fokuserade på användningen av pronomina ”jag”, ”vi” och ”de”. Fynden relaterades sedan till teorier om diskursivt medlemskap och diskursiva samhällen (studie I). Individuella semistrukturerade intervjuer med teammedlemmar (n=18) från fyra av de sex teamen genomfördes med critical incident-teknik. Intervjuerna analyserades via latent kvalitativ innehållsanalys och fynden tolkades utifrån teorier om professionssociologi och lärande i arbetet (studie II). Resultaten visade att två diskursiva mönster framträdde i teammedlemmarnas konstruktioner av ”vi-som-team”. Dessa mönster benämndes kunskapssynergi och tillitsfullt stöd (studie I). Vid individuella intervjuer med teammedlemmar identifierades följande tre teman som rörde svårigheter vid interprofessionellt teamarbete; (i) svårigheter som gällde den teamdynamik som uppstod när teammedlemmarna agerade som företrädare för sina professioner i relation till teamet, (ii) svårigheter när medlemmarnas olika kunskapsbidrag interagerade i teamet och (iii) svårigheter som rörde den omgivande organisationens påverkan på teamet (studie II). Konklusionen gjordes att de diskursiva mönstren utgjorde retoriska resurser för teammedlemmarna, både för att bekräfta medlemskapet i teamet, för att hävda sina åsikter i kontakter med andra vårdgivare (”de andra”) och även för att hantera uppfattade svårigheter beträffande exempelvis bristande samsyn. Vidare drogs slutsatsen att en konsekvens av de uppfattade svårigheterna var, förutom individuella konsekvenser, begränsningar i användandet av de gemensamma resurserna för att nå en helhetssyn på patientens problem och att patienterna inte kunde bemötas på det sätt som önskades. Forskningsprojektets praktiska implikationer rörde teamutveckling där olika former av interprofessionellt lärande påverkar teamets fortsatta utveckling, samt ledning av hälso- och sjukvården avseende betydelsen av imple-menteringsprocesser och organisatoriskt lärande.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 6 uppsatser.

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