| 1. |
- Retamal Montes, Jaime, 1978-
(författare)
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Aspects on ventilation induced stress and strain on regional and global inflammation in experimental acute respiratory distress syndrome
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mechanical ventilation (MV) is a life-saving therapy in acute respiratory distress syndrome (ARDS), a condition that affects 3000 patients/year in Sweden with a mortality rate of about 40%. However, MV may induce or worsen lung injury causing “ventilator-induced lung injury (VILI)”. From a mechanical perspective strain (deformation, or relative change in lung volume) and stress (tension) have been postulated as main determinants of VILI. High respiratory rate is potentially another factor that may exacerbate VILI by amplifying the total energy transmitted to the lungs during MV. In this thesis in animal ARDS models the hypotheses were that 1) lung parenchyma inhomogeneities concentrate stress and amplify lung damage and inflammation, 2) higher respiratory rates increase lung inflammation and lung edema in heterogeneous ARDS, and 3) local lung deformation is related to local inflammation.First, in a rat model the effect on inflammation and structural damage of regional lung collapse on the healthy surrounding lung tissue was assessed. Second, in porcine models the effect of respiratory rate on lung edema and inflammation was studied during two ventilatory modes; a) a permissive collapse mode and b) a homogenized lung parenchyma mode. Finally, lung deformation was correlated with lung inflammation assessed by positron emission tomography using 18F-FDG uptake.It was found that; 1) local inhomogeneities can act as stress amplifiers, increasing lung tissue inflammation and damage in the healthy surrounded lung. 2) high respiratory rate increases lung edema but decreases lung inflammation when permissive lung collapse is used and that these effects are prevented with lung parenchyma homogenization; 3) local lung deformation and inflammation are well correlated.In conclusion, lung inhomogeneities may aggravate VILI, respiratory rate may affect in different ways VILI progression depending on the ventilatory strategy, and finally, lung deformation is closely related to lung inflammation. With the caveat that the studies are performed in animal models, the results suggest that using ventilator strategies that homogenize the lungs, i.e., open collapsed lung regions and prevent re-collapse in ARDS will reduce VILI and in the end may decrease morbidity and the high mortality in this condition.
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| 2. |
- Andersson, Peter, 1980-
(författare)
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Hot, våld och emotionellt arbete på de särskilda ungdomshemmen : Personalens berättelser
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this dissertation is to describe how staff working at secure units define violence, the ways in which they say violence affects them emotionally, and the ways they emotionally handle violence. The secure units (särskilda ungdomshem) are managed by the Swedish National Board of Institutional care (Statens Institutionsstyrlese, SiS). The daily work of staff members is often described in terms of various dilemmas, challenges and tensions. Staff work in a context where they are at the intersection between care and punishment. How they respond to these dilemmas, challenges and tensions can affect how they handle violence. The organization (i.e. the institution) requires staff to induce or suppress emotions in order to sustain outward attitudes that produce a proper state of mind. Therefore, secure units are defined as an emotional place for both youth and staff.The dissertation consists of four articles that explore different forms and directions of violence in the daily work of staff, and the ways that staff describe the impact of violence on their professional and private lives. The empirical data consist of 53 individual staff interviews (articles 1–3) and five focus groups with 27 staff members (article 4). Three overarching theoretical concepts are deployed: emotional work, narrative and violence.The main findings from these papers can be summarized as follows: Staff talked about the extent and forms of violence that characterize their everyday work (articles 1 and 4), mostly in the form of stories where they described being exposed to both psychological and material violence. The frequency of this violence ranged from occasional to daily. Staff also talked about how they emotionally handled both perceived and acted-out violence, and how such violence can affect their professional role (articles 2 and 3). A common strategy seems to be role-taking. That is, staff members think they are exposed to violence in their role as “staff”, not as private individuals. This paves the way for the normalization of violence as a strategy for dealing with everyday professional life. Furthermore, staff attribute violence to youth in an explicit way. This means that staff members find it difficult to reflect on their own responsibility and the fact that they are, in fact, co-creators of most incidents of violence.The overall results of the four papers are additionally organized around three themes: (1) the position of the young person: perpetrator, (2) working with violence in a caring context and (3) prohibited workplace emotions. Traces of these themes can be found in all four articles and they are clearly linked to the dissertation’s theoretical concepts. In conclusion, it is possible to describe these three themes as an expression of organizational shortcomings in which the staff are trapped.
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| 3. |
- Aronsson, Pia, 1950-
(författare)
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Det professionella projektets framväxt inom ramen för en forskningscirkel : en manipulativ eller frigörande praktik?
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The thesis looks back on an important transitional period for the municipal social services, a transition between different social models and ideals. During this transi-tional period, in the mid-90s, there was a process of change from the community ideal to market liberalism, the latter being characterized by the client-provider model as a form of governance for the municipal organization. Users of social services were becoming customers and professionals were moving towards increased specialization and centralization of social work. The process of change within the municipal organization is a recurrent theme giving this thesis present timeliness although the process of change presented in the thesis took place almost three decades ago.The overall aim of the thesis was to contribute with in-depth knowledge of the professionals' possibilities to exert influence over a process of change in a politically controlled organization using an empirical example as a starting point. The research approach was based on the action research tradition and primarily towards critical action research.The empirical example, the research circle, where professionals met with the prac-tice of social work and the practice of research for a mutual knowledge formation became a temporary action arena where the “professional project” was developed during the years 1994 to 1996.In the thesis politically adopted policy documents are analyzed, the content of which outlined the direction for the future organization and the content of social work, the "Political Project". The analysis reveals the power relations where the political and administrative domain worked to separate and centralize social work while the professionals worked to maintain a decentralized and integrated individual and family care using new working methods and approaches such as open social counseling, group-oriented social work and city district networks as a basis for social service.The thesis shows that the professionals' influence in the process of change was limited by politically adopted decisions in accordance with the conditions of representative democracy, and that only parts of the professional project, which did not challenge overall organizational structures, could be implemented.Before future reorganizations, it is recommended that those affected by the reorganization should be involved in the process early on in order to expand the decision makers knowledge base by including the professionals' opinions, knowledge and will.The development towards a market-liberal form of organization was a lengthy process but has today become the dominant form of organization within municipal administration.
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| 4. |
- Forssell, Anna, 1980-
(författare)
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Better safe than sorry? : Quantitative and qualitative aspects of child-father relationship after parental separation in cases involving intimate partner violence
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The relationship between a child and its parents (caregivers) is essential for the child’s development and well-being. When one of these parents uses violence against the other parent (intimate partner violence, IPV), this will affect the child one way or another: physically, psychologically, cognitively, socially. When two parents separate, the circumstances surrounding contact between the child and its parents change. The aim of this thesis is to analyse – in the context of Swedish parenting ideals and family norms – aspects of children’s relationships (after parental separation) with a father who has used violence against the mother in order to bring forward a foundation to discuss if and under what circumstances a continued contact is in the best interest of the child. The empirical basis for the thesis consists of two different sets of data. The first is qualitative interviews with children living at a women’s shelter (n=10). The second is a subset of data from a large evaluation study investigating support tochildren who had witnessed IPV. The latter material comprises interviews with and psychometric data on 165 mothers and 165 children. Results from the first article show that a majority of the children (75%) had continued contact with their fathers after parental separation, and that even in cases where there were indications of child abuse, about 50% of the children had unsupervised face-to-face contact with their fathers. This high rate can possibly be explained by the assumption (supported in legislation) that children have a need for contact. Further, the second article shows that children with and without contact do not differ in their level of well-being; i.e. contact with a violent father does not have the positive effect on children that has been found in general samples. In the third article, the violent fathers are described by the children as lazy and unreliable. Child–father contact is discussed in terms of why, when and how contact is in the child’s best interest.
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| 5. |
- Hämberg, Eva, 1958-
(författare)
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Tillsyn i teori och praktik : om statlig styrning och kontroll av socialtjänstens individ- och familjeomsorg
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to deepen the understanding about the function of control in the inspection process and to increase the knowledge about the legitimacy and impact from inspection on different types of social and welfare services. In the thesis the form and legitimacy of the inspection process are studied in two types of social services in Sweden: a less complex service where the task to investigate and make decisions about social care dominates (IAD), and a more complex service where the task to provide treatment interventions dominates (TI). The data consists of policy documents, inspection reports, casefile documentation, and interviews with inspectors, politicians, managers and social workers. The inspection process is discussed in relation to theories about control systems and legitimacy processes. Inspection is a policy instrument whose standards are derived from legislations and where those subject to the inspection are obliged to meet the demands made by the inspectorates. This form of disciplinary control has been questioned given that its complexity makes it hard to regulate the practice of social work through detailed rules. By including a less disciplinary form of control the instrument’s ability to impact on more complex aspects of social services are expected to increase. The results show a difference in how the inspection process is set up in the two types of services. In the IAD services the process takes the form of a disciplinary control system, whereas the process in TI services initially takes the form of a non-disciplinary system. In spite of the differences observed in the initial stages of the process, the results show that the judgments of inspectors in both types of services are almost exclusively based on information about concrete and detailed aspects. This entails that the judgements of inspectors in both types of services mostly take the form of statements on simple observable and concrete conditions, whereas judgments about more complex aspects are rarely made. The study also shows that although the propriety and relevance of the inspectors’ judgements are questioned more in TI organisations inspections seem to have greater validity and impact on TI than on IAD organisations. The results of the thesis point to two explanations. One explanation is that the costs of dealing with the problems underlying the identified deficiencies are lower for TI than IAD organisations. This in turn leads to greater acceptance of carrying out the proposed measures in TI than in IAD organisations. Another possible explanation is that the potential sanctions are greater for TI than IAD organisations.
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| 7. |
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| 8. |
- Petersén, Anna, 1981-
(författare)
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Evaluations that matter in social work
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A great deal of evaluations are commissioned and conducted every year in social work, but research reports a lack of use of the evaluation results. This may depend on how the evaluations are conducted, but it may also depend on how social workers use evaluation results. The aim of this thesis is to explore and analyse evaluation practice in social work from an empirical, normative, and constructive perspective. The objectives are partly to increase the understanding of how we can produce relevant and useful knowledge for social work using evaluation results and partly, to give concrete suggestions on improvements on how to conduct evaluations. The empirical data has been organised as four cases, which are evaluations of temporary programmes in social work. The source materials are documents and interviews. The results show that findings from evaluations of temporary programmes are sparingly used in social work. Evaluations seem to have unclear intentions with less relevance for learning and improvement. In contrast, the evaluators themselves are using the data for new purposes. These empirical findings are elaborated further by using the knowledge form phronesis, which can be translated into practical wisdom. The overall conclusion is that social work is in need of knowledge that social workers find relevant and useful in practice. In order to meet these needs, researchers and evaluators must broaden their knowledge view and begin to include practical knowledge instead of solely relying on scientific knowledge when conducting evaluations. Finally, a new evaluation model is suggested. It is called phronesis-based evaluation and is argued to have great potential to address and include professionals’ praxis-based knowledge. It advocates a view that takes social work’s dynamic context into serious consideration and acknowledges values and power as important components of the evaluation process.
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| 9. |
- Brauer, John, 1988-
(författare)
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Labour Market Policies : Structure and Content, Space and Time
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Labour market policies has two aims: cushioning the economic hardship caused by unemployment and increasing employment rates. In many welfare states, responsibilities for such policies are divided between different political-administrative levels. This dissertation aims to enhance the understanding of labour market policies and especially the involvement of sub-national governmental actors, by analysing the role of municipalities in the Swedish context. The dissertation also investigates the involvement of social work and social workers within labour market policies. A theoretical framework consisting of four pillars, structure, content, space, and time, is used to analyse labour market policies. The analysis combines a historical review with empirical data. The findings show that the involvement of municipalities, in active labour market policies, has taken place against the background of three processes: the multi-level governance of financial support, the shifting role of active labour market policies, and the dialectic relationship between financial support and active labour market policies. The divided responsibility for financial support generates incentives for municipal measures that qualify social assistance recipients for nationally funded social insurances. The fear of work disincentives has also been a driving force in the development of municipal activation. The reliance on municipalities to design and deliver active labour market policies opens for greater crossmunicipal differences. An ongoing reform of the Public Employment Service, the national agency that provides active labour market policies, that decreases the number of local offices and increases the reliance on private service providers, is likely to change the role of municipalities within active labour market policies. Many scholars criticise the involvement of social workers, within labour market policies, given the use of conditionality through activation. This criticism calls for further empirical investigation, not least in terms of how practicing social workers position their work.
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| 10. |
- Lindahl, Robert, 1984-
(författare)
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Socialsekreteraren och det familjehemsplacerade barnet : Om relationen, erkännandet och de institutionella förutsättningarna
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to study, analyze and understand the relationship between children and youth in foster care and their responsible child welfare workers. The empirical material consists of qualitative interviews with foster children (n=53, three interviews/child, in total 159) and child welfare workers (n=17) conducted in a national evaluation of a pilot project with supervision representatives, and two focus groups conducted for the thesis. Examples of central theoretical concepts in the thesis are institution, role, professionalism and recognition. The interviewed children highlighted that the relationship with child welfare workers is negatively affected by a lack of time, availability, and trust. The children desire close and trustful relationships with child welfare workers, but generally they expect a relationship characterized by distance and formality. The child welfare workers emphasized that the relationships are affected by organizational constraints, such as time pressure and lack of continuity. Further, the work is characterized by role conflicts and contradictory expectations of professionalism. On the one hand, the child welfare workers stress the importance of closeness and trust in the relationships. On the other hand, they are expected to maintain formality, distance and functional specificity. The current relationship is affected by institutional prerequisites that are made visible by prevailing regulative, normative, and cultural-cognitive expectations. These different expectations shape and constrain the child welfare workers’ discretion, at the same time as they also create internal conflicts. By applying the theory of recognition, it becomes evident that the foster child is expected to be recognized through closeness, rights, and solidarity by the child welfare worker. Under current institutional conditions, tensions arise between these different forms. The discussions focuses on which form of recognition should constitute the starting-point for the relationship, and how closeness versus distance is affected by recognition through rights.
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