Denna rapport ger en översiktlig presentation av forskningen kring anhörigas insatser och behov av stöd. Dessutom presenteras de stödformer som erbjuds från kommuner och frivilligorganisationer. Därefter redovisas två studier av hur anhöriga upplever olika former av stöd. I den ena studien intervjuas några anhöriga i Vansbro kommun. I den andra studien intervjuas några anhöriga vars närstående deltar i verksamheten vid Gagnefs kommuns centrum för anhörigstöd. De anhöriga delar med sig av sina erfarenheter av olika stödformer och beskriver också vilket stöd de saknar.

Both effectiveness and good care is demanded of nurses in a complex environment. The aim of the study was to describe how nurse managers and nurses interpret and are guided by stated goals in their health-care organisation, their own influence over work and obstacles to carry out work in an operating department. A qualitative study, consisting of interviews with nurse managers and nurses, and a description of goal documents and the workplace, were conducted in an operating department in Sweden. The interviews were analysed with manifest content analysis. Work was guided by daily goals for the nurses: to meet the operating schedule and to ensure good-quality patient care. The organisational goals were little known and used. The nurse managers and nurses had limited influence over their work, changes in assignments and in the operating schedule, and unsuitable environmental premises created obstacles in their work. If organisational goals are to guide work there is a need for nurse managers to transform them into understandable, applicable goals and incorporate them into nurses’ daily work. Letting the nurses influence the operating schedule could be one way to overcome obstacles in work. The study also highlights the importance of a functional physical work environment.

Background

The health care system is an complex structure with many different actors and professions, who are subject to different management and different conditions. Within this organisation, many situations may arise that can cause dissatisfaction among care recipients.

Aim

To describe organisational factors in healthcare that cause dissatisfaction with carers, as well as to describe the selection processes for the selected articles' sample groups.

Design

Literature review based on twelve articles, both quantitative and qualitative, from 2007-2017.

Main results

The main problem area for patients was accessibility. Waiting times of various kinds were common: waiting to get an appointment, long time in the waiting room, waiting for treatment, and more. Specific to primary care were difficulties in getting appointments at all, and perceptions in patients that primary care could not help them with their problems. Dissatisfaction with the physical care environment was mentioned mainly in the form of understaffing and unavailability of hospital beds, but there were also other complaints related to the physical environment. Lack of coordination between different actors cause discontent in some patients, for instance due to poor continuity of care.

Conclusions

There are a number of reasons for care recipients’ dissatisfaction that have their foundation in the health care organization. Focusing on the patient's emotions, the nurse can help the patient in developing and improving the handling of the problematic situation and the feelings that arise. This is facilitated by the nurse having knowledge of how the organisation is structured, and understanding of its complexity. This knowledge and understanding is also a good prerequisite for organisational improvement.

Background: Workplace violence (WPV) is a phenomenon that affects all organizations within health care, with nurses being the most affected profession. Workplace violence is defined by the relationship between the perpetrator and the victim, but also according to the type of violence that is carried out: verbal, sexual or physical violence. Consequences of being exposed can include stress, burnout, anxiety and thoughts about ending one's career in the profession. Aim: The purpose of this literature study was to describe nurses’ experience of WPV in the healthcare system. Method: This review includes twelve qualitative articles collected through three databases: CINAHL, PubMed and PsycInfo. The inclusion criteria for included data were nurses' perspective, empiric qualitative studies, IMRAD structures and studies that subline with the authors aim. Exclusion criteria were studies with aim to describe terrorism, bullying and sexual violence as a lone issue. The remaining articles were analyzed through a descriptive data analysis method. Results: The three main themes in the results were identified as: Nurses experience of WPV where nurses identified the sequence of events, Nurses health and well-being in the presence of WPV where nurses identified and reflected upon health and well-being, including Nurses experience of organizational absence in the presence of WPV where nurses identified barriers in support and feedback when reporting WPV. Conclusion: With this study the authors aspire to illustrate the phenomenon of WPV and the importance of preventing, implementing interventions for strategies and knowledge and provide nurses with organizational support when WPV occurs.

OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

SETTING: An OR department at a county hospital in Sweden.

PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

TRIAL REGISTRATION NUMBER: 2016/264.

Bakgrund

Den svenska äldreomsorgen blir allt mer ansträngande att arbeta inom. Stora organisa-toriska förändringar har lett till att arbetet upplevs som oroligt och stressfullt. Den administrativa rollen har ökat och första-linjens chefers möjligheter att delta i det dagliga arbetet har minskat. För att klara av de allt högre krav som ställs är det viktigt att cheferna känner att de har goda strukturella förutsättningar (empowerment), handlingsutrymme och känner att de har kontroll över sitt arbete.

Syfte

Att beskriva manliga första-linjens chefers upplevelser av sin arbetssituation i äldreomsorgen.

Metod

Semi-strukturerade intervjuer gjordes med fjorton manliga första-linjens chefer i äldreomsorgen i Sverige från hösten 2010 till våren 2011. Intervjuguiden var inspirerad av teorier om empowerment. Tolv chefer arbetade inom kommunal äldreomsorg och två chefer inom privat äldreomsorg. Deltagarna valdes utifrån ett ändamålsenligt urval med förhoppningen om att ge en variation i sina skildringar. De hade arbetat som chefer mellan 0.5-35 år. Intervjuerna varade mellan 1-2.5 timmar och materialet analyserades med kvalitativ innehållsanalys. Två teman och fem subteman skapades.

Resultat

Det första temat handlade om när organisatoriska krav var i balans med chefernas upplevda chefsansvar och strukturella förutsättningar. Där beskrevs upplevelserna av att vara ensam men inte utelämnad, att ha frihet inom givna ramar samt en känsla av tillfredsställelse och stimulans i arbetet. Det andra temat handlade om när organisatoriska krav var i obalans med chefernas upplevda chefsansvar och strukturella förutsättningar. Detta tema beskrev chefernas känsla av frustration och en känsla av uppgivenhet. Sammantaget upplevde de manliga första-linjens cheferna att arbetssituationen var både utmanande, komplex och föränderlig. Cheferna behövde bättre tillgång till strukturella förutsättningar, speciellt i form av resurser, stöd och information. Utmaningarna sågs dock som en ständig drivkraft för cheferna. De beskrev att deras arbete var ”mödan värt” även om de ibland upplevde arbetssituationen som negativ. Slutsatsen i studien var att cheferna upplevde sitt arbete som en positiv utmaning även om de beskrev brister i sitt stöd.

AIM: To investigate relationships between first-line managers' ratings of structural and psychological empowerment, and the subordinates' ratings of structural empowerment, as well as their ratings of the managers' leadership-management performance.

BACKGROUND: Work situations in elderly care are complex. To date, few studies have used a longitudinal, correlational and multilevel design to study the working life of subordinates and managers.

METHOD: In five Swedish municipalities, questionnaires were answered twice during 2010-12 by 56 first-line managers and 769 subordinates working in nursing homes or home-help services.

RESULTS: First-line managers' empowerment at Time 1 partially predicted subordinate's structural empowerment and ratings of their managers' leadership-management performance at Time 2. Changes over time partially revealed that the more access managers had to structural empowerment, i.e. increase over time, the higher the ratings were for structural empowerment and managerial leadership-management performance among subordinates.

CONCLUSIONS: Findings strengthen research and theoretical suggestions linking first-line managers' structural empowerment to their subordinates' structural empowerment and ratings of their manager's leadership-management performance.

IMPLICATIONS FOR NURSING MANAGEMENT: Managers with high access to structural empowerment are more likely to provide subordinates access to structural empowerment.

Psykisk ohälsa är ett av de folkhälsoproblem som ökar mest i Sverige. En särskilt drabbad arbetsgrupp har visat sig vara vård- och omsorgspersonal. Stress kan leda till utmattningssyndrom som bidrar till långtidssjukskrivningar. Maslach Burnout Inventory är ett vedertaget mätinstrument som används för att skatta upplevelse av utmattning i tre dimensioner. Syftet med föreliggande litteraturstudie var att beskriva hur sjuksköterskor med symtom på psykisk utmattning upplever sin vardag på arbetsplatsen.

Föreliggande studie är en beskrivande litteraturstudie vars resultat vilar på tio vetenskapliga artiklar med kvantitativ ansats. Underlaget inhämtades via databassökningar i Pubmed och Cinahl.

Resultatet visade att sjuksköterskor upplever måttliga till höga nivåer av psykisk utmattning på arbetsplatsen. Viktiga faktorer visade sig vara ålder och erfarenhet samt arbetsplatsens omständigheter. Erfarenheten hade positiv inverkan på utmattningsnivåerna, där sjuksköterskor med högre utbildning skattade lägre enligt MBI. Stöd från ledningen och organisationen samt en funktionell arbetsmiljö påverkade upplevelserna positivt.

En slutsats är att flertal sjuksköterskor världen över upplever psykisk utmattning. Detta är anmärkningsvärt då vetskap om denna problematik funnits i över tre decennier. Sjuksköterskeprofessionens hälsa bör komma i första rummet ur ett samhällsperspektiv. Vidare  forskning bör förslagsvis bedrivas i Sverige, för att säkerställa att en god vårdkvalité upprätthålls.

Nyckelord: Utmattningssyndrom, Sjuksköterska, Upplevelse, MBI.

Obesity and overweight are growing public health problems in Sweden, which is why the authors find it interesting to investigate which methods of treatment that are used. This descriptive study opens with a review of previous studies and definitions of relevant concepts. Thereafter, the focus question is treated qualitatively through semi structured interviews with six persons: two patients suffering from obesity, a doctor, a dietician, a student nurse and a diabetics nurse. On the basis of the interviews it is concluded that methods of treatment used in Sweden to fight obesity and overweight include cognitive therapy, surgery and medication. It appears that cognitive therapy is the most common, that surgery – in both the short and the long run – is the most effective and that medication is used with caution due to the risk of severe side effects. However, a majority of the interviewed report that they in several cases combine the three methods of treatment; for example, surgery is often both preceeded and followed by cognitive therapy. The study at hand closes with suggestions on ways in which consecutive studies could investigate how the most commonly used method of treatment, cognitive therapy, could be optimized and/or supplemented. The authors propose the hypothesis that cognitive therapy should be executed closely linked to the patient’s behavioural pattern, and suggests a quantitative observational study to test this hypothesis.

BACKGROUND:

During the past decade, the concept of Lean has spread rapidly within the healthcare sector, but there is a lack of instruments that can measure staff's perceptions of Lean adoption. Thus, the aim of the present study was to develop a questionnaire measuring Lean in healthcare, based on Liker's description of Lean, by adapting an existing instrument developed for the service sector.

METHODS:

A mixed-method design was used. Initially, items from the service sector instrument were categorized according to Liker's 14 principles describing Lean within four domains: philosophy, processes, people and partners and problem-solving. Items were lacking for three of Liker's principles and were therefore developed de novo. Think-aloud interviews were conducted with 12 healthcare staff from different professions to contextualize and examine the face validity of the questionnaire prototype. Thereafter, the adjusted questionnaire's psychometric properties were assessed on the basis of a cross-sectional survey among 386 staff working in primary care.

RESULTS:

The think-aloud interviews led to adjustments in the questionnaire to better suit a healthcare context, and the number of items was reduced. Confirmatory factor analysis of the adjusted questionnaire showed a generally acceptable correspondence with Liker's description of Lean. Internal consistency, measured using Cronbach's alpha, for the factors in Liker's description of Lean was 0.60 for the factor people and partners, and over 0.70 for the three other factors. Test-retest reliability measured by the intra-class correlation coefficient ranged from 0.77 to 0.88 for the four factors.

CONCLUSIONS:

We designed a questionnaire capturing staff's perceptions of Lean adoption in healthcare on the basis of Liker's description. This Lean in Healthcare Questionnaire (LiHcQ) showed generally acceptable psychometric properties, which supports its usability for measuring Lean adoption in healthcare. We suggest that further research focus on verifying the usability of LiHcQ in other healthcare settings, and on adjusting the instrument if needed.

The rapid spread of Lean implementation within the health care sector has made it urgent to evaluate the effects of Lean on productivity, working conditions and health. Therefor an instrument is needed to measure Lean in primary care. The aim with this research is to find an instrument that captures the character of Lean. A literature search was conducted in Academic Search Elite, WileyOnlineLibrary, PubMed, Cinahl, PsycInfo, JSTOR, ScienceDirect, Emerald and Scopus. Keywords used were reflecting Lean and measurement and the search resulted in 7933 hits. Included were articles that presented an instrument that had the possibilities to distinguish between high or low Lean adoption. Malmbrandt and Åhlstöm´s (2014) instrument fulfilled criteria and was chosen. The original instrument was firstly translated to Swedish. A back translation was made by a bilingual authorized translator. The prototype will be tested among health care professions in Sweden using the think aloud method (TA) with the aim to explore how the participants perceive and interpret the Swedish version (Collins 2003). Immediately afterwards, they will be interviewed about how they interprets specific expressions in the questionnaire. After every round of 5-15 interviews the prototype will be adjusted and when saturation is reached the TA will terminate. After psychometric tests the finalized Swedish version of the instrument is to be used in a longitudinal study to describe status of Lean and how Lean correlate with the health of primary health care staff, there working conditions and productivity over time.

Background

Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect.

Method

A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation.

Results

First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect.

Conclusion

The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

BACKGROUND: Swedish Healthcare Direct (SHD) receives 6 million calls yearly and aims at increased public sense of security and healthcare efficiency. Little is known about what SHD managers perceive as the primary goals of telephone nursing (TN) work and how the organisation matches goals of health promotion and equitable healthcare, so important in Swedish healthcare legislation. The aim of the study was to explore and describe what the SHD managers perceive as the goals of TN work and how the managers view health promotion and implementation of equitable healthcare with gender as example at SHD.

METHODS: The study was qualitative using an exploratory and descriptive design. All 23 managers employed at SHD were interviewed and data analysis used deductive directed content analysis.

RESULTS: The findings reveal four themes describing the goals of TN work as recommended by the SHD managers. These are: 'create feelings of trust', 'achieve patient safety', 'assess, refer and give advice', and 'teach the caller'. Most of the managers stated that health promotion should not be included in the goals, whereas equitable healthcare was viewed as an important issue. Varying suggestions for implementing equitable healthcare were given.

CONCLUSIONS: The interviewed managers mainly echoed the organisational goals of TN work. The managers' expressed goal of teaching lacked the caller learning components highlighted by telenurses in previous research. The fact that health promotion was not seen as important indicates a need for SHD to clarify its goals as the organisation is part of the Swedish healthcare system, where health promotion should always permeate work. Time used for health promotion and dialogues in a gender equitable manner at SHD is well invested as it will save time elsewhere in the health care system, thereby facing one of the challenges of European health systems.

The USU-project which stands for development, cooperation and education is a cooperating project including the local medical care centre and the old age care centre in the city of Ovanåker. Great demand for medical and personal care as well as demands to effect economies require new methods of working with elderly and sick people in the future. The thrust is to make it possible for all fellow workers in the field of action to participate in a common process in purpose to analyse the needs of care as well as the needs of development in the future. The project mainly focus on quality, efficiency and pleasure in one's work. An external evaluator was connected to the project in purpose to describe how the staff as well as those in need of professional care experience the field of action today and to which extent they will experience any development connected to the project in the future. This report, which is the first of two, describes what have been done in the project workduring 1999 and how the staff and the patients experience the old age care today. The data have been collected during the period of January to June 1999. Observations and interviews have been done with bosses, other fellow-workers and people in need of professional care. The results show that the staff as well as the patients has a very positive opinion about both the medical and the social care in the city of Ovanåker. The results also shows that there are fields of development which are important to pay attention to in a vision of the future. The fields are for example development of the leadership in the field of social care, development of the competence and responsibility in the teams of social care and further development of the cooperation between the social and the medical care. For instance through meetings for individual care planning, common group meetings and further training.

This paper reviews the authors'€™ work on Integrated Planning (IP) as a construction site management tool. IP integrates the different planning skills used by site managers, construction workers and craftspersons into an interactive group which manages a production planning process from the earliest stages to the end of a building project. The studies reviewed in this paper, performed over the last three decades, tested, longitudinally evaluated and refined the IP model for use in modern sustainable building sites. The refined model, Integrated Planning for Sustainable Building Production (SBP), includes the factors: leadership, health and safety, quality management and environmental management.

Background: Socially marginalised groups tend to have higher rates of mental disorders than the general population and can be difficult to engage in health care. Providing mental health care for these groups represents a particular challenge, and evidence on good practice is required. This study explored the experiences and views of experts in 14 European countries regarding mental health care for six socially marginalised groups: long-term unemployed; street sex workers; homeless; refugees/asylum seekers; irregular migrants and members of the travelling communities.      

Methods: Two highly deprived areas were selected in the capital cities of 14 countries, and experts were interviewed for each of the six marginalised groups. Semi-structured interviews with case vignettes were conducted to explore experiences of good practice and analysed using thematic analysis.      

Results: In a total of 154 interviews, four components of good practice were identified across all six groups: a) establishing outreach programmes to identify and engage with individuals with mental disorders; b) facilitating access to services that provide different aspects of health care, including mental health care, and thus reducing the need for further referrals; c) strengthening the collaboration and co-ordination between different services; and d) disseminating information on services both to marginalised groups and to practitioners in the area.      

Conclusions: Experts across Europe hold similar views on what constitutes good practice in mental health care for marginalised groups. Care may be improved through better service organisation, coordination and information.      

Efficient resource allocation in the management of occupational health and safety (OHS) in the workplace requires access to information about the effects of different psychosocial and physical risk factors in the workplace on lost working hours and reduced productivity. The present article aims to help the OHS policy-makers in their decisions on allocating economic and human resources to deal with different environmental risk factors and their socio-economic consequences in the workplace. The socio-economic consequences refer substantially to missed and unproductive working hours due to sickness absences and sickness presenteeism respectively. The methodologies employed to fulfil the purpose of this study included methods to estimate marginal effects of different risk factors on lost working hours and labour productivity. The empirical results of the study showed that the psychosocial and physical dimensions of the work environment of the Swedish company Sandvik Materials Technology had different socio-economic impacts in terms of lost working hours and labour productivity. The psychosocial work environment had the greatest impacts, particularly on reducing work ability and work interest among workers and on work-related disorders among female workers. 

The workplace has a direct impact on the physical, psychological, economic and social well-being of the workers. A healthy workplace leads to increased health among the employees which also makes the employees more productive (Källestål, 2004). A poor working environment can have negative consequences for individuals, companies and society (SOU, 2009:47).This is a qualitative study that investigates companies’ view of health promotion and how they practice health promotion in working life. Five private and five public companies, with representatives from the management were interviewed. The result showed that the companies looked at health promotion as means to support and create opportunities for the health of the employees. Ergonomics and work environment were the main drivers linked to health promotion. All companies had efforts for health promotion and the foremost was health care contributions which were offered annually. However, it appeared that few workers took advantage of it. Leadership proved to be very important for a healthy workplace. The companies´ visions for health promotion were that they would be an attractive workplace and that they wanted the employees to feel good at work. This was important because the companies wanted to benefit the business as well as the workers. The result agrees well with the literature, but it was unexpected that the companies would have such a broad view of health and health promotion.

The workplace has a direct impact on the physical, psychological, economic and social well-being of the workers. A healthy workplace leads to increased health among the employees which also makes the employees more productive (Källestål, 2004). A poor working environment can have negative consequences for individuals, companies and society (SOU, 2009:47). This is a qualitative study that investigates companies’ view of health promotion and how they practice health promotion in working life. Five private and five public companies, with representatives from the management were interviewed. The result showed that the companies looked at health promotion as means to support and create opportunities for the health of the employees. Ergonomics and work environment were the main drivers linked to health promotion. All companies had efforts for health promotion and the foremost was health care contributions which were offered annually. However, it appeared that few workers took advantage of it. Leadership proved to be very important for a healthy workplace. The companies´ visions for health promotion were that they would be an attractive workplace and that they wanted the employees to feel good at work. This was important because the companies wanted to benefit the business as well as the workers. The result agrees well with the literature, but it was unexpected that the companies would have such a broad view of health and health promotion.

This qualitative study describes relationships problems highlighted by individuals with an autism diagnosis and professionals at Vuxenhabiliteringen (adult disability services). It also captures the individuals’ and professionals’ opinion of how to work with these particular problems. Nine people were interviewed for this study. The interviews were semi-structured and systems Theory in Social Work were used to understand the organisational tension between where support for relationship problems for people with an autism diagnosis should lie. An autism diagnosis is linked to problems in social-emotional reciprocity, for example difficulties to initiate or respond to social interactions, inflexible adherence to routines and difficulties with sensory input. Several themes emerged regarding relationship problems; structure and planning, communication, understanding, sex and intimacy and partners’ own difficulties. Professionals reported that a number of services are currently being offered, such as diagnose information, talking therapy, help with planning and structure, among others. Professionals expressed that including the partner more, working more jointly with other professionals and starting a relationship group to share experiences could improve services. The support that neurodiverse participants asked for were couple’s therapy, information and education about sex, relationships and men. Relationship support can be given by VUH through the services already offered and by expanding them further. More research is needed to understand relationship issues in relation to an autism diagnosis. 

Keywords: Relationship, autism, neurodiversity, Vuxenhabiliteringen, health care, organisation, couple’s therapy, relationship difficulties

Sökord: Relationer, autism, neurodiverse, Vuxenhabiliteringen, Hälso och sjukvård, organisation, parterapi, relationssvårigheter

Author: Jessica Vannoorenberghe

Word count: 16846