| 1. |
- Lundin, Anette
(författare)
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Rättfärdigade prioriteringar : en kvalitativ analys av hur personal i äldreomsorgen hanterar motstridiga verksamhetslogiker
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation aims at contributing to social scientific knowledge about prevailing prioritizations in eldercarepractice by looking at an economic and a caring logic, and how these logics are overlapping, contradictory or comein conflict with each other. A more concrete aim is to understand how the personnel describe their work with orfor balance between the logics and their justifications prioritizations made in the care of older persons. The researchquestion is: How do personnel and care unit manager at a public nursing home understand and handle the twologics that govern care work for facilitating wellbeing of the residents. The aim and research question led to threesub-aims: 1) to analyze the personnel’s experiences of and meaning making about the care work they carry out, 2)to illuminate and problematize the two logics above, and 3)to analyze how the personnel justify their prioritizationsin prevailing context, and how their accountability have an effect on their professional identities.Empirical material was gathered through 13 individual interviews with care personnel and their care unitmanager at a public nursing home in Sweden. These interviews were complemented by a group interview. Thematerial was analyzed by the use of three methods: phenomenology (Paper I and II), reflexive analysis (Paper III),and a positioning analysis (Paper IV). Paper I found that the personnel understands the residents’ well-being asbeing characterized by feeling of being existentially touched. This essence is constituted by feeling freedom ofchoice, pleasure, and closeness to someone or something. In Paper II, the work for facilitating this kind of wellbeingwas characterized by three ambiguities: (i) freedom of choice for the older persons vs. institutionalconstraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need forroutine vs. the eldercarers' not being able to know what the residents need. Paper III showed that the care unitmanager created a hybrid of the two logics (economy is care and vice versa) and that the personnel oppose thishybrid. The opposition is shaped as the personnel divides their work in care and “those other things”. Thesefindings showed how interaction between the logics expresses itself in practice and that it is the personnel who hasto handle contradictions between the logics in their everyday care work. The positioning analysis in Paper IV hadthree levels. The first level showed how the carers align with their peers and that they find the organizationalframe, within which they have agency, changed due to increased workload. This change led to an order of priorities.The second level showed that the carers relate to three aspects when making accounts: the care itself, the olderpersons, and the media. The third level showed that the carers share a view of administration, cleaning, servingmeals, and filling up supplies, as not being parts of caring.The dissertation’s theoretical framework focused on theories on logics, accountability, and professionalidentity. The conclusion is that both logics are needed in order to facilitate the well-being of the older persons. Therelationships between the two logics are not always clear and if their contradictions are not illuminated, there is arisk for a care practice that does not facilitate the well-being of their residents. An important theoreticalcontribution is that logics of activities should be understood vertically (form political, through management, anddown to the level of practice) instead of horizontally. The practical implications emphasize the importance ofsupporting the personnel’s professional identity on the one hand, and discussing the logics on the other. Byunderstanding differences between definitions on management-level and practice level, a homogeneity can bereached.
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| 2. |
- Schön, Ulla-Karin, 1970-
(författare)
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Kvinnors och mäns återhämtning från psykisk ohälsa
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder. Four studies have been carried. Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness. The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.
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| 3. |
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| 4. |
- Bromark, Kristina, 1973-
(författare)
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The user as a key actor in user participation : Exploring knowledge production in personal social services with a participatory approach
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The concept of user participation in social work is frequently debated. In Sweden, users are supposed to be active and involved in matters concerning them, a stance which is regulated in policy and law. The involvement of users in practice can be considered a form of knowledge production that can strengthen and develop users as well as the organizations. In practice, however, research shows that actual engagement, education or activation of users is difficult to attain and can be understood as a devaluation of user knowledge. The aim of this dissertation is to increase knowledge of how to understand and enhance the conditions for user participation in personal social services. To study this question, the dissertation focuses especially on young people’s participation in the context of out-of-home care. To explore user participation in personal social services, a participatory approach was applied. Data was gathered with young people and staff using participatory techniques as well as qualitative interviews. To explore challenges and possibilities with user participation, a future workshop was held with staff in personal social services (study I). This was followed by a co-design process in which staff, young people, and researchers collaborated on a support tool (study II), later to be implemented in practice (study III). The implementation process was explored by interviewing both staff and managers as well as a user representative (from a youth council). The co-design and implementation processes are problematized and discussed in the dissertation from a researcher’s perspective (study IV). The theoretical framework for understanding how users can be devalued as knowers is epistemic injustice. The assumption is that the role of a knower can shift, depending on social power and the structures in a context. The findings in this dissertation show that user participation is contingent on the distribution of power and responsibility and on perceptions of knowers and knowledge in practice. Although the general attitude towards user participation is positive, a reluctance in practice is revealed. It appears to be a challenge for staff to acknowledge the expertise of users, despite the fact that the users’ have the capacity and are willing to contribute with their knowledge. Work with user participation is identified as a team effort that requires actions at all levels of the organization as well as increased resources, leadership and a coherent understanding and agreement of the concept. A participatory approach to knowledge production with users is identified as a possible way to enhance epistemic justice and the inclusion of all relevant actors in activities and processes. The dimensions important to user participation can be acknowledged. For the dynamics to be maintained in a wider sense, however, an organizational infrastructure, with routines and methods, is necessary. To sustain epistemic justice in the implementation of user participation, a participatory culture with a solid and coherent understanding of user participation in practice is encouraged. A realization of user participation in practice requires a critical exploration of power and positions, systematic changes to infrastructure and transparency about roles and responsibility.
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| 5. |
- Grim, Katarina, 1971-
(författare)
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Legitimizing the knowledge of mental health service users in shared decision making : Promoting participation through a web-based decision support tool
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overall aim of this thesis was to explore the manner in which user knowledge and user perspectives can be included and supported in shared decision making (SDM) in mental health services.The thesis consists of four studies. Study I explored what needs service users identify to participate in deliberative processes and decision making in their care. Study II examined how a decision support tool (DST) for SDM can be designed to enhance service users’ ability to have active and meaningful roles in SDM. Study III investigated barriers and facilitators associated with the implementation of a web-based DST designed to provide a concrete structure to support SDM. In study IV, a theoretical analysis was performed to elucidate the barriers associated with user knowledge being expressed and legitimized in decision-making processes.Methods: A key feature of the project involved a process of exploring decisional and informational needs and of developing, testing and implementing a DST for SDM. Qualitative data have been collected through focus group and individual interviews with service users and service providers, usability testing with service users and checklists.Findings: The findings show a number of characteristics specific to the mental health service context that need to be considered when developing support for SDM. Decisions were often complex and found to encompass a number of life domains. Issues related to social context and individual recovery highlighted the necessity to include the knowledge perspectives of service users throughout decision processes. In response, phases for preparation and follow-up was emphasized in the DST. The results indicate that supportive structures are required for service users to express their knowledge perspectives and for providers to include them in their decision-making. Moreover, existing barriers related to organizational structures and to power differentials need to be addressed. Conclusions and implications: A DST specifically designed for the mental health context, that methodically invites service users to participate in each phase of the decision-making process might function as a guiding structure to validate service users as knowledgeable agents.
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| 6. |
- Osman, Fatumo, 1973-, et al.
(författare)
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Ladnaan - att må bra : En utvärdering av ett riktat stöd till somaliska föräldrar i Borlänge Kommun
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Folkhälsomyndigheten har finansierat ett samarbetsprojekt mellan Borlänge kommun och Högskolan Dalarna för att anpassa och implementera ett föräldrastödsprogram till somaliska föräldrar, samt att mäta effekten av denna intervention avseende föräldrars och barns psykiska hälsa. Studien började med en explorativ delstudie med syfte att samla kunskap om vad somaliska föräldrar upplever som utmanande i sitt föräldraskap i Sverige, vilket behov av föräldrastöd de behöver samt hur ett sådant stöd ska vara utformat. Studien genomfördes med hjälp av fokusgruppsintervjuer med 23 föräldrar (15 mammor och 8 pappor) boende i Borlänge. Resultatet visade att föräldrarna upplevde en rad utmaningar i sin nya livssituation och i sitt föräldraskap i nya landet. De beskrev skillnader i synsätt på barnuppfostran och föräldraskap mellan hemlandet och Sverige och eftersträvade därför att kulturanpassa sitt föräldraskap.Resultaten från denna studie samt en genomgång av forskning kring föräldrastöd låg till grund för valet av föräldrastödsprogram samt ett samhällsorienterande tillägg till programmet. Målgrupp för studien var föräldrar med barn i åldrarna 11-16 år och som upplevde stress i sitt föräldraskap. Föräldrarna erbjöds sammanlagt 16 timmars utbildning fördelat på 12 träffar (10 timmar Connect föräldrastöd + 6 timmar samhällsorienterande tillägg). Effekten av föräldrastödet undersöktes genom en randomiserad kontrollerad studie där totalt 120 föräldrar ingick. De preliminära resultaten visar att deltagande föräldrars barn har förbättrats signifikant i subskalorna ”socialt” och ”skola”. Dessutom minskade barnens oro, somatiska problem, sociala problem och brytande av regler. Föräldrarna var nöjda med interventionen. De upplevde att de fått en ökad kunskap om hur socialtjänstens arbete fungerar och fått förtroende för deras arbete kring barn och unga. Över hälften av föräldrarna upplevde sig mer säkra i sin föräldraroll och att deras relation med barnen hade förbättrats. Genom en processutvärdering av implementeringen av föräldrastödet har framgångsfaktorer för genomförandet avföräldrastödsprogrammet studerats. Resultatet visade att de olika strategier som vidtagits vid rekrytering av föräldrar och implementering av interventionen har varit lyckade. Exempel på sådana strategier har varit att projektmedarbetarna som rekryterat till föräldrastödet har varit av Somaliskt ursprung, kursen har getts på somaliska men framförallt att föräldrastödet utgick ifrån föräldrarnas upplevda behov.
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| 7. |
- Rosenberg, David, 1957-, et al.
(författare)
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Ett återhämtningsorienterat arbetssätt i Jönköpings län : erfarenher från ett uppföljningsarbete
- 2014
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Under de senaste åren har forskning om återhämtning från psykisk ohälsa resulterat i ny kunskap som fått relevans för såväl socialtjänstens som psykiatrins verksamhetsfält. Allt fler verksamheter som ger stöd och vård till människor med psykisk ohälsa syftar att bli mer återhämtningsinriktade. Det innebär att verksamheter fokuserar mer på insatser som främjar individens önskemål och delaktighet, och mindre på omsorgsinriktade insatser som främst fokuserar på symtom eller funktionsnedsättning. De brukare som beskriver sin återhämtning lyfter fram delaktighet, hopp för framtiden, meningsfullhet och egenmakt som centrala i den individuella återhämtningsprocessen. Det utbildningsarbete som sedan 2010 har bedrivits i Jönköpings län kring ett återhämtningsinriktat arbetssätt, dialogutbildningar, resurspersoner och återhämtningsombud, ligger i linje med nationell och internationell forskning och utveckling. Syftet med dessa utbildningar har varit att utveckla värderingar och attityder i socialtjänst och psykiatri för att främja brukares återhämtning samt att omvandla återhämtningsperspektivet till konkreta arbetssätt. Under hösten 2013 kontaktades författarna till denna rapport av representanter från Regionförbundet i Jönköping för en diskussion om hur ett återhämtningsperspektiv kan omvandlas till konkreta arbetssätt. Återhämtningsombud hade utbildats och varit aktiva i de dialogutbildningar som genomförts. Man ville nu genomföra ett utvärderingsarbete av dialogutbildningarna för att undersöka vilken betydelse de hade på personalens förhållningssätt och bemötande, samt studera om det hade haft någon betydelse på brukarnas upplevelser av de insatser de får från psykiatri och socialtjänst. Föreliggande rapport är ett resultat av det utvärderingsarbetet.
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| 8. |
- Rosenberg, David, 1957-, et al.
(författare)
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Obstacles and possibilities for implementing SDM in Swedish mental health services : Supporting interactivity and participation
- 2017
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Despite Swedish health care policy, which emphasizes patient participation in the planning of health care services, few programs have concrete methods for achieving this goal. Previous studies have shown that staff attitudes and systems which maintain power differentials, create obstacles for achieving participation despite methods such as SDM.The purpose of the study was to explore implementing SDM with an interactive digital decision tool, designed for users in community mental health services in Sweden. The tool was specifically developed, in collaborative research with users, to overcome disempowering experiences as they attempt to participate in treatment decisions.Method: A process evaluation design (Moore et al. 2015) was utilized in order to investigate obstacles and possibilities for a structured intervention to facilitate participation in decision making. The design utilized in the study included collecting qualitative and quantitative data focused on three identified evaluation components; Context, Implementation and Mechanism of impact.Results: Staff considered that SDM was most appropriate for formal treatment planning and that the use of the digital decision tool, which enabled interactive communication between staff and users, did support the user to be prepared for decisions, as well as helping staff to stay focused on user wishes.SDM was most often used voluntarily by each staff member, based on their experience and attitude, rather than a common practice for the service. Another barrier concerned capacity, with staff sometimes feeling they did not have formal power regarding treatment planning decisions, and expressing doubt as to the patient's willingness and ability to participate in decisions.Discussion: The results suggest that contextual barriers to implementing shared decision making can be addressed by utilizing interactive decision tools which concretely structure the interaction between users and staff and are connected to formally required treatment planning processes that are essential for user participation.
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| 9. |
- Rosenberg, David, 1957-, et al.
(författare)
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Återhämtning : Från idé till praktik
- 2014. - 2
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Ingår i: Att leva med psykisk funktionsnedsättning. - Lund : Studentlitteratur. - 9789144083872
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 10. |
- Schön, Ulla-Karin
(författare)
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Kunskapsbaserad praktik och brukarmedverkan för att stödja människors återhämtning från psykisk ohälsa
- 2011
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Ingår i: Hälsa, Livskvalitet och Välfärd. Forskningskonferens. - Falun.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Bakgrund Behovet av en evidensbaserad praktik påtalas allt mer. Det handlar bland annat om ett behov av att implementera ny kunskap, att systematiserat följa upp de insatser som ges, och i högre utsträckning inkludera brukaren i insatsernas utformning. I dag är kunskapen fortfarande begränsad kring betydelsen av brukarmedverkan både för verksamhetsutveckling och för den enskildes livskvalitet och upplevelse av tjänsterna. När det gäller stöd och service till människor med psykisk ohälsa har faktorer som brukarmedverkan, kontinuitet, sociala relationer identifierats som grundläggande i återhämtningsforskningen. Men denna kunskap har i mycket begränsad omfattning fått implikationer på politik och praktik. Det saknas metoder och system för en evidensbaserad psykiatri och socialtjänst till stöd för människors återhämtning från psykisk ohälsa. Syfte Projektet ska studera former för brukarmedverkan i en kunskapsbaserad praktik. Den centrala forskningsfrågan handlar sålunda om brukarmedverkan kan bidra till verksamhetsutveckling och förbättra den enskildes livskvalitet och upplevelse av tjänsterna. Om systematiserade mätningar av brukarupplevelse påverkar de insatser som ges till människor med psykisk ohälsa, med speciellt fokus på samspelet mellan individens erfarenhetskunskap och personalens bemötande och verksamheters utbud. Projektets syfte och forskningsfråga rymmer även ett återhämtningsperspektiv i vilket ovanstående frågor studeras utifrån grundantagandet att en ökad brukarmedverkan bidrar till ökade möjligheter till återhämtning. I projektet planeras tre delstudier, var och en med sin speciella fokusering när det gäller kunskap, implikationer för praktiken och individers möjligheter till återhämtning. Metod Delstudie 1 är en kvalitativ litteraturstudie. Delstudie 2 har en explorativ ansats där en erfarenhetspanel planeras samt brukarerfarna forskningspartners. Fokusgruppsintervjuer samt individuella intervjuer kommer att genomföras. Delstudie 3 är en kvantitativ studie där en validerad skattningsskala, Inspire 3.0, kommer att användas.
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