| 1. |
- Carnesten, Hillewi, 1969-
(författare)
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Nurses' caring struggle : Stress in caring within hospital emergency care during the COVID-19 pandemic
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Nurses took a frontline caregiving role during the COVID-19 pandemic in pervasively altered conditions in Swedish hospital emergency healthcare. Little is known about nurses’ experiences of the stress they were subjected to. In this thesis, findings from individual in-depth interviews with both newly graduated registered nurses (NGRNs) and experienced nurses (ERNs), as well as a web-based questionnaire, illuminate nurses’ lived experiences of stress in caring during the COVID-19 pandemic. Three studies employed qualitative methods (I, II, IV), and one a mixed methods approach (III). Study I aimed to describe NGRNs’ experiences of encountering stress in EDs during the COVID-19 pandemic. Findings illuminate how dedicated NGRNs struggle to develop into the nurse they want to be whilst battling extraordinary situations and conflicting emotions. Loss of control and experiences of shortcomings caused by work overload in combination with understaffing force NGRNs into an independent role at an early point in their career. Study II aimed to illuminate the meaning of NGRNs' experiences of caring for patients in EDs during the COVID-19 pandemic. Findings comprise caring being bestowed through spatial, emotional, and temporal barriers. NGRNs want to be present, relieve suffering yet describe caring during the pandemic as being a hidden activity, less acknowledged and left to the recognition of each nurse. Study III aimed to explore healthcare workers’ (HCWs’) experiences of the changed caring reality of the COVID-19 pandemic. Findings disclose traumatic experiences and having to sacrifice moral values and harbour dilemmas in isolation. Experiencing stress was significantly correlated to lower sense of coherence (SOC). Study IV aimed to explore nurses’ lived experiences of stress in the transformed caring reality during the COVID-19 pandemic. The interpreted meaning comprises the dilemma of enduring the unbearable, meaning having to silence one’s inner ethical, caring compass. In conclusion, stress in caring during the COVID-19 pandemic from a nurse perspective, can be understood as a caring struggle entailing bodily, knowledge, and ethical stress in a search for meaning that might be found in togetherness with patients, with colleagues, with dear ones and in nature.
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| 2. |
- Dunlavy, Andrea, 1979-
(författare)
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Between Two Worlds : Studies of migration, work, and health
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis aims to investigate the extent to which work-related factors contribute to the health inequalities often observed between foreign-origin and native-origin persons in Sweden. Four empirical studies using survey data and population-based registers assessed the health impact of different labor market adversities among groups of foreign-origin persons who were both in and outside the labor market relative to native-origin Swedes.Studies I and II examined associations between different measures of working life quality, including adverse psychosocial and physical working conditions and educational mismatch, and self-reported health among the employed. Adverse psychosocial and physical working conditions minimally contributed to the excess risk of poor health found among workers from low- and middle-income countries. Over-education had a stronger association with increased risk of poor health, most notably among foreign-born workers from countries outside of Western Europe. Under-educated women from these countries also demonstrated an elevated risk of poor health. There was no association between educational mismatch and poor health among native-born workers. Studies III and IV focused on the health implications of labor market exclusion, and examined relationships between employment status and risk of all-cause mortality and suicide. The majority of foreign-origin groups that experienced unemployment showed an elevated risk of both mortality and suicide. The magnitude of excess risk varied by generational status and region of origin. Variations in patterns of suicide risk were also evident among migrants by age at arrival and duration of residence. Yet within many foreign-origin groups, health advantages were observed among the employed.The health of migrants is affected by the confluence of several different pre- and post-migration factors. The extent to which health inequalities are found among persons of foreign-origin in Sweden is influenced by the degree to which they experience labor market adversities, as well as differential vulnerability to the negative effects of these adversities across foreign-origin groups.
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| 3. |
- Moström Åberg, Marie, 1969-
(författare)
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Epistemology of practice and its consequences in practice : Educating for knowing-in-action in working life
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Education and competence development are of increased interest in today’s society and organizations, to increase the wellbeing, lifelong learning, and mobility of the labor force, and contribute to companies’ global competition. As a consequence, formal and informal education is growing. However, there are dilemmas when developing professional competence e.g. bridging the gap between theory and practice, trying to increase employability in higher education, and the degradation of professionals’ knowledge. These dilemmas can partly be due to epistemology and the difficulty to act in accordance with one’s epistemology. Previous research has presented Technical Rationality (TR) as the cause of the problems and an epistemology of practice as an alternative approach. The aim of this thesis is to contribute to a deeper understanding of a holistic epistemology, i.e. what an epistemology of practice is, and its consequences for the view of professional competence and educational design in different contexts. Beyond this, the aim is also to analyze the quality of learning needed to reassess one’s epistemology. The theoretical framework is based on Schön’s work on epistemology of practice, the competence of a professional i.e. knowing-in-action, and educational design i.e. the reflective practicum. Mezirow’s theory of Transformative Learning (TL) is used to analyze the quality of learning. The four included studies are used as examples of different educational situations in different contexts; in Studies Ι and ΙΙΙ how managers in a research intervention learn to become enabling managers, in Study ΙΙ, how pupils in a vocational school are learning to minimize work environment risks in their future work, and in Study ΙV how HR students learn to foster collective learning within organizations. The results show the importance of being aware of one’s epistemology, and to act according to it. From an epistemology of practice approach, the overall conclusion is that adding practice is not enough, it is important to balance theory, practice, and reflection to enable knowing-in-action. The role of the teacher/supervisor to handle both theory, practice and reflection using reflection-in/on-action and coaching strategies such as joint experimentation, follow me and hall of mirrors to enable knowing-in-action is emphasized. The design of an education needs to be adapted to the participants’ former experiences and access to work practice. To enable reassessment of epistemology, TL is proposed, since a quality of learning which enables deep learning is needed.
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| 4. |
- Toivanen, Susanna, 1961-
(författare)
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Work-Related Inequalities in Health : Studies of income, work environment, and sense of coherence
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ill health is unevenly distributed across different groups in society, with the disadvantaged groups displaying higher rates of ill health than the more advantaged groups. The aim of the thesis is to study work-related inequalities in health, and to focus on how income, aspects of the physical and psychosocial work environment, and sense of coherence, individually or jointly, generate inequalities in a number of health outcomes in the Swedish working population. The studies are based on survey data and national registers during the period 1990-2003.For cardiovascular disease (CVD) prevalence and mortality, the impact of income was stronger than that of work environment factors. The psychosocial work environment (women and men) and income (men only) were associated with psychological distress. Income (women) and the psychosocial work environment (men) were associated with musculoskeletal pain. Thus, both income and work environment are important in generating health inequalities in the working population.A strong sense of coherence (SOC) moderated the effect of physical demands on musculoskeletal pain in both genders. SOC moderates, yet not consistently, the impact of adverse working conditions on psychological distress and musculoskeletal pain. Hence, the results do not fully support the hypothesis that sense of coherence is a global health-protective factor. However, differential vulnerability in terms of the strength of SOC contributed to work-related inequalities in health.The risk of stroke was higher for women and men in occupations with low job control than for those with high job control. The risk of intracerebral hemorrhage was highest in women in low job-control occupations, while low job control did not significantly increase the risk of brain infarction in women. Job control was related to mortality from stroke in women, but not in men. The effect of job control on stroke mortality in women was consistent in all classes except for upper non-manuals.
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| 5. |
- Wennerholm, Carina, 1964-
(författare)
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Risks for cardiovascular disease in middle-aged women in different social environments
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The importance of the social environment and human life conditions for public health was early recognized in community medicine. Despite major reductions in recent decades, cardiovascular diseases (CVD) is one of the leading causes of mortality and morbidity for both genders in all European countries. Aim: The overall aim of this thesis was to increase our knowledge of factors in the social environment and of individual psychosocial factors that could explain why some women in working ages are affected by cardiovascular diseases.Methods: The Swedish sample comes from the urban population in two major cities in a region in the south-east of Sweden, the Twin cities. According to their social history they could be labelled a “blue-collar” and a “white-collar” city. Cardiovascular morbidity data in all papers for the Twin cities was derived from a computerized population-based administrative Health Care Register (HCR). In Paper IV, we made a comparative study between Sweden and Scotland, the Scottish data comes from the Scottish Health Survey.Results: In Paper I, the cumulative incidence of different cardiovascular diagnoses for younger and also elderly men and women were significantly higher in the population of the blue collar city in all ages and for both sexes. The qualitative interviews of women after an MI, in Paper II, the findings revealed a broad picture of social factors, life circumstances, personalities and, not least, psychosocial factors that are important to middle-aged women who have suffered an MI. Paper III demonstrated that women with a high level of the personality trait “being a Good Girl” reported significantly more psychosocial risk factors for CVD and more commonly report chest pain without seeking medical care, no increased incidence for various CVD-diagnoses were found. The comparative study (Paper IV) clearly showed that Scottish middle-aged women are – relative to Swedish women - particularly affected by a worse profile of CVD risks, even after adjustment for education. Conclusions: The social environment is of importance for cardiovascular risks and cardiovascular morbidity and mortality. This has been shown in Swedish Twin cities context and also in comparative studies between Swedish and Scottish women. The thesis gives strong implications for an upstream public health approach initiating long-term community intervention program in the blue collar city and among Scottish middle-aged women.
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