| 1. |
- Kajonius, Petri, 1974-
(författare)
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An Inquiry into Satisfaction and Variations in User-Oriented Elderly Care
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The foundation for this thesis is an ongoing discussion about quality in Swedish elderly care: Which are the most important factors that contribute to elderly care in terms of satisfaction among older persons, and what are the primary reasons for their differences? Aims. The principal aim was to examine what determines satisfaction with elderly care in home care and nursing homes, using the perspective of older persons (Studies I and II). The secondary aim was to analyze why these determinants differ, using the perspective of care workers, managers, and observers (Studies III and IV). Methods. Study I analyzed aggregated statistical data from the level of municipalities and districts (N = 324) based on the Swedish elderly care quality reports “Open Comparisons”, while Study II analyzed individual data based on the original ratings in the annual, nationwide elderly surveys (N = 95,000). Study III describes field observations and interviews with care workers and managers in two municipalities, one with a high rating for user satisfaction and one with an average rating. Study IV describes investigations in these two municipalities concerning their organizing principles and departmental level management climate. Results. The results relating to the principal aim showed that process factors (such as respect, information, and influence) are related considerably more closely than structural factors (such as budget, staffing levels, and training levels) to satisfaction with care. Other process factors (such as treatment, safeness, staff and time availability) were also able to alleviate person factors (such as health, anxiety, and loneliness). Moreover, the results relating to the secondary aim showed that differences in user-oriented elderly care are mainly due to interpersonal factors between the caregiver and the older person. Care workers, however, reported that other factors (such as organizing principles and leadership support) influence the quality of the care process. Overall, older persons who receive home care generally report higher satisfaction with care than those in nursing homes, and feeling less safe. It is possible that differences in the process of aging explain this. Value. This thesis shows that satisfaction with elderly care can be largely explained by psychological quality at the individual level. The sizes of structural resources and organizing principles at the municipal level have minimal effect (< 5%). The thesis also presents a theoretical multiple-level Quality Agents Model to explain the sources of differences in satisfaction with care, and it presents recommendations for elderly care practices. A renewed focus on the psychology of satisfaction may contribute to the development of quality in elderly care.
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| 2. |
- Karlsson, Veronika, 1972-
(författare)
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Att vårdas vaken med respirator : patienters och närståendes upplevelser från en intensivvårdsavdelning
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, light or no sedation has become a common approach in patients who require mechanical ventilation (MV) when cared for in an intensive care unit (ICU). This new approach has resulted in medical advantages as well as a shorter time on MV and in the ICU. Aim: The overall objective of the thesis was to describe, illuminate and interpret patients' and relatives' experiences of caring and communication in connection with MV while the patient is conscious. Methods: The data collection methods were inductive and included interviews and observations, both audiotaped and video-recorded. The study group consisted of patients and relatives; fourteen patients in paper I, twelve in paper II and nineteen in paper III as well as ten relatives in paper IV. In paper I, the video-recorded interviews were analysed using content analysis and hermeneutics. The text in paper II was analysed using the phenomenological-hermeneutic method inspired by Ricoeur. The observations in paper III were analysed by means of a hermeneutic approach based on Gadamer's philosophy. In paper IV, relatives were interviewed on two occasions. The text from these interviews was also analysed using a hermeneutic method inspired by Gadamer. Results: The patients experienced an overall sense of being breathless. While conscious, they were aware of the mechanical ventilator as a life saver. Besides being breathless, being voiceless was considered the worst aspect. Communication was difficult and awkward as it demanded all their will power. Patients' communication patterns varied but there were commonalities; they also developed an individual style of communication. Being subjected to someone else's will and direction meant being painfully aware of one's dependency. Despite this, the patients struggled for independence in various ways as part of the recovery process. Being conscious while receiving MV demands caring communication, which in turn requires proximity, presence and constant attention by a nurse who is "standing by" and prepared to take care of the patient whatever happens. The patients' non-verbal communication through their gaze and facial expression was interpreted as sadness and sorrow, understood as expressions of unuttered suffering. The overall struggle and primary existential aim of relatives in the ICU is to be in contact with the patient, a need which overshadows everything else. Conclusion: Being conscious during MV means being painfully aware of one's dependency while voiceless and helpless. It is possible to endure this situation when the caregivers are "standing by", attentive to the patients' expressions, prepared to act to make sure that the patients are feeling better and do not leave them unattended. Caring for a conscious patient on MV presupposes nurses' ability to understand and be able to "standing by". If this approach is not possible, consciousness might be too painful and sedation should be considered.
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| 3. |
- Axelsson, Malin, 1964
(författare)
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Personality and adherence to medication treatment
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Striving for improved adherence to medication treatment is of vital concern, as low adherence is a major obstacle in treating many prevalent chronic diseases. Several factors have been identified that seem to influence adherence behaviour, but limited research exists on the significance of personality for adherence to medication treatment. According to the Five-Factor Model (FFM), personality can be described in terms of five broad personality traits: Neuroticism, Extraversion, and Openness to experience, Agreeableness, and Conscientiousness. Reports on health-related quality of life (HRQL), asthma control and selfefficacy may also be influenced by personality. Therefore, the overall aim of the present research project was to explore the significance of personality traits in relation to adherence to medication treatment and asthma control, health-related quality of life and self-efficacy.
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| 4. |
- Beckman, Anita, 1961-
(författare)
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Väntan : Etnografiskt kollage kring ett mellanrum
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This dissertation is about waiting. It's about what happens when an ethnographer goes into the field and asks people to fill a small and indeterminate word like waiting with thoughts, experiences and recollections. The study is primarily based on twenty qualitative interviews with thirteen interviewees in Gothenburg. The interviewees were selected from the ethnographer's own circle of acquaintances and constitute a fairly homogenous group of individuals. They are early middle-aged, were brought up in Sweden during the 1960s and 1970s, belong to a relatively well-educated lower middle-class, have artistic/cultural interests and work in the public/cultural sector. In an attempt to put the interviewees' narratives into a wider context, I have collected and used supplementary material in the form of different narratives communicated, for example, through the mass media, fiction, DIY-books, popular science and art. A central point of departure in the study is that the words we use are filled with meanings that we ourselves assign to them, and that an interview is a form of narrative in which knowledge is constructed at that particular moment in time. The aim of this dissertation is to study some of the articulations of waiting. What kind of waiting is highlighted in the narratives of waiting in every day life? Which words, themes, images, characters and motifs are available to use and grapple with? What is the purpose of waiting, and which ideals, norms and perceptions connected with waiting emerge? By listening to and studying the articulations of waiting I capture a time-dimension – that is partly about an everyday perception and organisation of time and partly about a central aspect of becoming a subject at a more existential level. The aspect of time that has been captured here indicates that waiting is about change. When subjectivity is understood as something that happens, an activity, an action or a process, movement is at the core. Being or becoming a subject demands transition and change – the movement from one state to another. Fulfilling oneself means moving between the different positions that one seeks to occupy. Waiting can thus be said to capture the actual passage, which means that this state that we usually define as something stationary and uneventful is actually an important productive mechanism. This then constitutes the actual effort, attempt and charging up involved in being able to attain something else. The driving force in all these processes is different kinds of imagined needs – the need to become a subject and be fulfilled.
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| 5. |
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| 6. |
- Bohlin, Margareta, 1970-
(författare)
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Music and risk in an existential and gendered world
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Adolescents in Western society often expose themselves to high levels of sound at gyms, rock concerts, discotheques etc. These behaviours are as threatening to young people’s health as more traditional risk behaviours. Testing boundaries and risk taking are fundamental aspects of young people’s lives and the processes of developing their identities. There is, however, a need to balance reasonable risk taking and risks that can damage health. The aim of Study I was to analyze the relationship between self-exposure to noise, risk behaviours and risk judgements among 310 Swedish adolescents aged 15-20 (167 men/143 women). The adolescents’ behaviour in different traditional risk situations correlated with behaviour in noisy environments, and judgements about traditional risks correlated with judgement regarding noise exposure. Another finding was that young women judge risk situations as generally more dangerous than young men, although they behave in the same way as the men. We suggest that this difference is a social and culture based phenomenon which underlines the importance of adopting a gender perspective in the analysis of risk factors. Adolescents reporting permanent tinnitus judged loud music as more risky than adolescents with no symptoms and they did not listen to loud music as often as those with occasional tinnitus. The aims of study II were to illuminate the complexity of risk behaviour, the meaning and purpose of adolescent risk-taking in both a traditional sense (e.g. smoking and drug use) and in noisy environments (e.g. discotheques and rock concerts), in relation to norms and gender roles in contemporary society. In total, 16 adolescents (8 men/8 women, aged 15-19) were interviewed individually and in focus groups. The interviewees’ responses revealed social reproduction of gender and class. Main themes of the phenomena for both genders emerged: Social identity and Existential identity of risk taking. The descriptive sub themes, however, which together formed the general structure, were rather diverse for men and women. The incorporation of social and existential theories on gender as basic factors in the analysis of attitudes towards risk-taking behaviours is considered to be of utmost importance. Likewise, research on hearing prevention for young people needs to acknowledge and make use of theories on risk behaviour and similarly, the theories on risk behaviour should acknowledge noise as a risk factor. Study III aims to increase the knowledge about young women’s and men’s risk judgement and behaviour by investigating patterns in adolescent risk activities among 310 adolescents aged 15-20 (143 women; 167 men). The Australian instrument ARQ, developed by Gullone et al, was used with additional questions on hearing risks [1] and a factor analysis was conducted. The main results showed that the factor structure in the judgement and behaviour scale for Swedish adolescents was rather different from the factor structure in the Australian sample. The factor structure was not similar to the Australian sample split on gender and there were differences in factor structures between genders among Swedish adolescents. The results are discussed from a gender and existential perspective on risk taking, and it is emphasized that research on risk behaviour needs to reconceptualize stereotypical ideas about gender and the existential period in adolescence. The aim of Study IV was to investigate possible gender differences regarding psychometric scales measuring risk perception in noisy situations, attitudes towards loud music, perceived susceptibility to noise, and individual norms and ideals related to activities where loud music is played. In addition, the purpose was to analyze whether these variables are associated with protective behaviour, e.g. the use of hearing protection. A questionnaire was administered to a Swedish sample including 543 adolescents aged 16 to 20. The result revealed significant gender differences for all the psychometric scales. Furthermore, all psychometric measures were associated with hearing protection use in musical settings. Contrary to previous studies, gender did not solely contribute to any explanation of protective behaviour in the analysis. One conclusion is that although gender does not contribute solely to the explanation of protective behaviour, gender may affect psychological variables such as risk perception, attitudes and perceived susceptibility and these variables may in turn be valuable for decision-making and protective behaviour in noisy situations. Although women tend to be more ’careful’ psychologically, they nevertheless tend to behave in the same way as men regarding actual noise-related risk-taking.
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| 7. |
- Bolin, Anette
(författare)
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Shifting Subordination : Co-located interprofessional collaboration betweenteachers and social workers
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis is to describe and analyse the practice processes involved in colocated interprofessional collaboration. The study took place in a resource school where social workers and teachers collaborate on an everyday basis around children who are both in receiptof special educational support and interventions from social services. The research questioncentres on the division of labour and the explicit notions and implicit assumptions thatunderpin it. Further, the organisational conditions that influence the division of labour, theprocess involved in the selection of pupils, and the processes of maintenance anddevelopment of professional identities in a close collaborative context are all examined.The study is a qualitative case study of interprofessional collaboration. Through interviews with the teachers and social workers, and via participatory observation of their professionalpractice, empirical data has been generated. This has been used to examine processes ofcollaborative collaboration in accordance with a thematic analytical scheme. A theoretical framework based on theories of the sociology of professions (Abbot, 1988; Evetts, 2006b) and drawing also on the work of Hasenfeld (2010a) on human serviceorganisations and Lipsky (1980) on street level bureaucrats, in conjunction with Strauss’ (1978) theory of negotiations, has been used in analysing the empirical data.The results indicate that the intake process functions primarily to legitimise collaborationfrom an organisational and professional perspective. Further, the teachers and social workerscreate what are termed common and separate grounds for practice. The concept of common grounds describes the processes in which common collaborative relationships are created, such as, forexample, the construction of interchangeability and a common practice ideology. Separate grounds, on the other hand, involves situations in which social workers and teachers are engaged in defining and specifying their profession-specific roles in the context of their everyday work. Another means of maintaining and reinforcing a profession-specific professional identity in co-located collaborative contexts is the use of the spatial design. The results also point to three particular characteristics in the construction of co-located interprofessional collaboration. First, professionals are engaged in what can be termed a form of shifting subordination as a means of both legitimising and developing their professional identities. Shifting subordination is a strategy used to reduce and avoid professional conflict around roles and working tasks. Secondly, they are engaged in constructing a shared professional identity as a means to meet the organization’s imperative of ‘getting the job done’. Thirdly, there is the characteristic of interdependence which shapes the negotiation processes involved in the division of labour.
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| 8. |
- Fredriksson-Larsson, Ulla
(författare)
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Fatigue och återhämtning efter hjärtinfarkt
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Fast and efficient acute medical treatment of myocardial infarction (MI) has developed during recent years and has resulted in a reduced number of days spent in hospital and increased survival. To optimize persons’ recovery, secondary preventive strategies are important. Fatigue has been reported to be the most bothersome symptom in 50% of persons treated for MI and was described as incomprehensible due to its unpredictable occurrence and unknown cause. Today, in cardiac rehabilitation programs there are typically few or no recommendations at all concerning strategies for dealing with fatigue after MI. The main focus was to explore how self-reported fatigue after MI could be measured in a psychometrically valid manner and to describe the symptom of fatigue in relation to other concurrent symptoms, how the heart attack was handled and its consequences in everyday life two months after MI. With a view to creating opportunities to identify and measure fatigue post-MI, the first specific aim was to validate the usefulness of the questionnaire Multidimensional Fatigue Inventory-20 (MFI-20). A psychometric method called Rasch analysis was used. The results showed that the MFI-20 can be used to obtain a global score reflecting an underlying unidimensional trait of fatigue; and transformation of the summarized raw scale scores into interval scale scores was possible. Also, four of the five original dimensions separately fitted the Rasch model and could be used to identify general fatigue, physical fatigue, mental fatigue and reduced activity. One of the specific aims was to examine persons’ experiences of fatigue consequences and strategies used to manage fatigue two months after the heart attack. Interviews were conducted (n= 18) and analyzed using constructivist grounded theory methodology. Grounded in the data, the main consequence of fatigue, as illustrated in the core category was I’ve lost the person I used to be. It indicates a sense of reduced ability to manage daily life due to experiences of fatigue. The core category was developed from the four categories: involuntary thoughts, certainties replaced with question marks, driving with the handbrake on and just being is enough. Another specific aim was to explore fatigue levels two months after myocardial infarction (MI) and examine associations with other concurrent symptoms, sleep quality and the coping strategies used to handle the MI. The results showed that a global fatigue score two months post-MI was associated with concurrent symptoms, such as breathlessness and stress, and coping strategies, such as change of values, intrusion, and isolation. In comparisons of present fatigue dimension levels (general fatigue, physical fatigue, reduced activity and mental fatigue) two months post-MI and baseline measurements (first week in hospital), the results showed that levels of fatigue dimensions had decreased. In comparisons with levels of fatigue four months post-MI in a reference group, we found lower levels of fatigue two months post-MI. In the final study, the aim was to validate a single-item measure of stress symptoms and to explore its association with fatigue in a sample of persons treated for MI. The results confirmed the convergent validity of the single-item measure of stress symptoms. In analyses of relations between stress and fatigue, it was found that the single-item stress measure was strongly associated with both the global fatigue score and all four fatigue dimension scores (general, physical and mental fatigue as well as reduced activity). In conclusion, fatigue two months post-MI had significant consequences because it restricted informants’ potential to function in daily life as they had done previously. The present thesis showed that post-MI fatigue could be identified both globally and multidimensionality. The results could serve as the basis for a future recovery intervention aimed at preventing and relieving post-MI fatigue and based on managing daily life in relation to personal experiences. By facilitating identification of fatigued persons using quantitative measurements and personal narratives about the consequences of fatigue, such an intervention would enable health-care professionals to tailor fatigue relief support during the recovery period. Elaboration of this intervention is a question for further research.
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| 9. |
- Gurdal, Sevtap, 1976-
(författare)
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Children and Parents : Attributions, Attitudes and Agency
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Children and parents are both part of children’s development and research on children and on parenting are both areas that, in some way, have changed in recent decades. These changes are related to the new way of seeing children and that children are no longer seen as ‘becomings’ or adults in the making; rather, children are insteadregarded – and seen – as more active in their development and as social agents. With a new way of viewing children and childhood there is also a new way of explaining or understanding parenthood. The general aim of this thesisis to learn more about how parents think about their parenting and how this can be related to children’s agency. Inaddition, children’s own beliefs about their agency are studied. The aim of Study I was to investigate mothers’ and fathers’ (77 participants from each group) attributions and attitudes in Sweden. The results revealed thatSwedish parents are more polarized in their attitudes than in their attributions. Regarding attitudes, mothers and fathers reported more progressive than authoritarian attitudes. Fathers reported higher adult-controlled failure and child-controlled failure attributions than mothers. In Study II the aim was to assess whether mothers’ and fathers’self-reports of acceptance-rejection, warmth, and hostility/rejection/neglect of their children differ in the nine countries. A total of 1996 parents (998 mothers and 998 fathers) participated in the study. Mothers and fathers reported high acceptance and warmth and low rejection and hostility/rejection/neglect (HRN) of their children inall nine countries. Despite the high levels of acceptance and low levels of rejection across all countries, some systematic differences between countries emerged. In Study III Swedish mothers’ and fathers’ warmth towards their children was examined in relation to their children’s agency. It also studied the longitudinal relation between agency and children’s externalizing, internalizing, and school achievement. Swedish children’s parents (N = 93) were interviewed at three time points (when children were 8, 9, and 10 years old) about their warmth towards their children, children’s agency, children’s externalizing and internalizing behaviors and school achievement. Results from this study indicate that Swedish parents’ warmth is directly related to children’s subsequent perceptions of their agency, which in turn are related to subsequently lower child externalizing and internalizing problems and higher academic achievement. Personal agency is studied in Study IV and the aim of this study was to examine how 10-year-old children perceive their agency in three different contexts, family, school and peer-situations. Interviews were conducted with 103 ten-year-old Swedish children. Vignettes concerning three different situations were presented to the children and their answers were written down for subsequent thematic analysis. The resultsshowed that children perceive their agency differently depending upon which context they find themselves in. The difference is not in how they think adults or peers would react to their agency, but in how they themselves would act if their agency was suppressed. It is mainly with other children that they would show assertiveness and try to find a solution together, while they would be more emotional and powerless with adults.In summary, parents in the studies report higher similarity about parenting in some cases, for example concerning acceptance and warmth and hostility/rejection/neglect, but lower in others, such as the Swedish parents’ reports about attributions. It is also revealed that parents’ warmth is related to children’s agency,and that children’s perceptions of their agency depend on whether they interact with adults or other children. Apossible contribution of this thesis is to generate additional knowledge about parental cognitions and the implications that parenting can have on child agency, but also the shedding of light on the ways in which, depending on the context, children’s beliefs of their agency differ.
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| 10. |
- Hallberg, Jonas, 1978-
(författare)
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Adolescents in a Digital Everyday Environment
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis is to examine different aspects of Swedish adolescents’ everyday environment in a digital world. Drawing on ecological and psychosocial developmental theories I will discuss social, sexual, and biological aspects of the Internet as an everyday environment, an environment in which most adolescents spend a great deal of time. The thesis comprises four studies, all examining different aspects of the developmental stage of adolescence. Study I focused primarily on the extent to which adolescents encounter explicit online content, such as pornographic, violent, and/or hateful material, and how they react to it. What feelings are associated with explicit online content? And how do adolescents deal with those feelings? In study I we analyzed questionnaire data collected from 226 adolescents between the ages of 13 and 15 (47% girls and 53% boys). In line with other studies on the subject, the results showed that many Swedish adolescents are exposed either intentionally or unintentionally to explicit online content. Adolescents in this study showed surprisingly low emotional response to their exposure to explicit content. Their coping strategies center on personal agency, with most choosing to avoid or block unwelcome content rather than turn to parents or siblings for support and advice. Almost no significant gender differences were found in the choice of coping strategies, except that young men were more likely to avoid a site than were young women. Study II focused on the association between various parental and child factors and the parents’ attitudes toward adolescents’ online sexual activities. The study was based on questionnaire data collected from parents (78% mothers) and adolescents (54% girls) in 496 families. Results showed that parental attitudes toward adolescents’ offline and online sexual activities are closely related, although parents are more permissive in the offline setting. Parents’ attitudes toward online sexuality are not only correlated with their attitudes toward sexuality in traditional settings, but also by their preferences on the Internet. Parental attitudes were found to differ by the sex of the parent and the sex and age of the child. The link between fathers’ attitudes and adolescents’ online sexual activities was mediated by parental rules, suggesting that communication is part of the transmission of values. The focus of study III was on the link between adolescent boys’ pubertal timing and their offline and online romantic and sexual activities. The study was based on questionnaire data obtained from 142 early adolescent Swedish boys. Participants reported on stagenormative (physical) and peer-normative aspects of pubertal timing, and on offline and online romantic and sexual activities. Both aspects of pubertal timing were related to romantic and sexual activity offline, but only the stage-normative measure was linked to sexual activities online. In study IV the focus was on the relationship between sexual and romantic activity in a traditional offline context and similar activities online. Longitudinal questionnaire data were obtained from 440 adolescents over three years. Results revealed that both offline and online sexual activity increased over time within the group. We found that results for girls showed a somewhat larger effect, indicating that the link between offline and online sexual activity is largest within the female group. Results also revealed a small but significant increase in the slope for participation in offline sexual activity with online sexual activity as a predictor – but only for boys – indicating that the link between online and offline sexual activity (i.e., the other way around) only exists within the male group. Thus, as boys’ participation in sexual activity increases online, so it also does offline. The article concludes that adolescents’ romantic and sexual activities online are tied to their physical, offline equivalent and so the Internet can be regarded as an important context for sexual development. Taken together, the individual studies suggest that The Internet, as an everyday environment is linked to several aspects of the developmental phase of adolescence. Further studies should continue to explore the effect of the Internet on adolescents’ developmental tasks.
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