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- Holmgren, Jessica, associate professor, senior lecturer
(författare)
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Conditions for relatives' involvement in nursing homes
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to describe and analyse how the involvement of relatives is conditioned in nursing homes from different critical perspectives. Gender perspectives, discourse analysis and intersectional theory are applied, based on social constructionist ontology. The thesis comprises three qualitative papers and data are based on ethnographically-focused fieldwork in three municipal nursing homes in the form of formal/informal interviews, participating observations and the analysis of documents.Based on gender perspectives, the routines and reasonings among nursing staff were studied and thematically analysed in relation to how these conditioned the involvement of relatives in the daily caring activities (I). In the second study (II), the nursing staff were interviewed in groups to describe, discursively analyse and identify the biopolitical meaning in the "involvement discourse" that was collectively constructed in the speech of the nursing staff concerning the involvement of relatives. In the last study (III), interviews with relatives were thematically analysed in the context of intersectional theory about their involvement in the nursing homes.The findings show that the conditions for relatives’ involvement were dynamic and constantly in re-negotiation, but also conservative and inflexible. This placed relatives in both privileged and unprivileged social positions in the nursing homes, which were relevant for their involvement. The relatives were considered to be "visitors", which conditioned the characteristics and levels of involvement in the care of the residents and was linked to gendered notions of the division of labor, both within the groups of relatives and between nursing staff and relatives (I). The involvement of relatives was conditioned by the biopolitics of an "involvement discourse" that prevailed in the nursing homes. This built upon family-oriented rhetorics and metaphors that upheld and legitimised notions about relatives. The relatives were considered to be members of the "old" family in relation to the "new" family represented by the nursing staff (II). The relatives described how they were positioned in a betweenship, squeezed between different competing social musts from the older family members, the nursing homes as institutions and the nursing staff (III).Inverting the prevailing picture of the involvement of relatives would make it possible to consider the nursing staff as pedagogical, professional and caring "visitors" in the nursing homes for the benefit of the residents and their relatives. This could be achieved through a constructive change management which emphasises the learning of nursing staff, their responsibility and the emotions of relatives, along with a focus on alternative notions of involvement, where relatives are included in the development of quality of care in Swedish nursing homes.
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| 2. |
- Jacobsson, Ann, 1964-
(författare)
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Exploring firefighters' health and wellbeing
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This thesis supports the assumption that firefighters’ health and mental well-being is important, in order to cope with the stress that the profession implies. As health is an essential part of everyday life, it seems substantially to understand how an almost exclusively male workforce of firefighters construct their discourse in relation to health and well-being. The overall purpose of this thesis is to explore health and ill-health among firefighters in relation to their work environment, including coping strategies, critical incidents and ‘ordinary’ day-to-day work at the fire and rescue service station.Methods: In Study I, 180 firefighters (16 women, 164 men) answered an open-ended question. Qualitative content analysis was used based on free text answers and focused on critical incidents. Study II, was based on a cross-sectional survey measuring burnout, psychosocial work environment and coping strategies. Participants were randomly selected and the final sample consisted of 476 firefighters (58 women, 418 men) and analyzed with multiple linear regression. In Study III and Study IV, a total of 28 fire-fighters (4 women and 24 men) participated in the study. Regarding Study IV a strategic sample of policy documents was also included. For Study III and IV, the research questions was dealt with applying critical discourse analysis on the focus group discussions (FGD) and individual interviews. In Study IV the analysed material also included policy documents.Results: Findings from Study I were presented in four categories; ‘overwhelming critical situations’, ‘risks of delay, ‘risk of failure’ and ‘risks to oneself’. Women in Study I described their experiences in a more distanced account, while men described their experiences more vividly. Results from Study II showed overall low mean values in the burnout scales of emotional exhaustion (EE) and depersonalization (DP) among both women and men. Only 2 % of women and 1% of men scored high levels of EE, and only 2% of women and 3% of men scored high level of DP. A multiple linear regression showed that high demand and lack of social support contributed significantly to predicting EE among men. The coping strategies among firefighters influence the level of EE and DP, and these strategies were different between women and men. In Study III six dominant themes were identified. A strong sense of the firefighter community was articulated as health promoting. The physical exercise at work and the balance between emergency and station work were also two recurrent theme supporting firefighters’ health. Another health-promoting theme concerns clarity of roles among firefighters. Peer support and tolerance in the work group was another common theme, alongside with expressions of the firefighter as hero or helper. Themes described as hindrances to health and well-being in firefighters’ discourse were; diversity, preventive work and education. All hindrance themes were articulated as important struggles in the firefighter discourse against changes in work. In Study IV, we have identified two sides in the struggles, on the one hand we have the ‘insiders’, a majority of male firefighters working in the fire and rescue services representing a collective defending its autonomy and traditions. On the other hand we have the ‘outsiders’, represented by the government, the Swedish Civil Contingencies Agency, (MSB), municipalities, politicians at different levels and academic researchers.Conclusion: Firefighters described critical incidents at work as overwhelming situations, along with negative experiences of organizational and practical tasks. Despite these experiences firefighters were reported as healthy according to EE and DP (Study I and II). Results of Study II also showed a relationship between psychosocial work environment and burnout among men, but not among women. The coping strategies among firefighters influence the level of burnout, and these strategies differ between women and men. The well-being in firefighters’ discourse, at least partly, is gained from a strong sense of belonging to a homosocial group characterized by closeness to each other and peers who take care of each other. The firefighters in our studies articulate this community-sense, and describe the importance of the similarity, rather than diversity (Studies III and IV). Findings from our studies regarding health and well-being, add knowledge to the current explanations relating to firefighters’ resistance to change.
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| 3. |
- Härgestam, Maria, 1963-
(författare)
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Negotiated knowledge positions : communication in trauma teams
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Within trauma teams, effective communication is necessary to ensure safe and secure care of the patient. Deficiencies in communication are one of the most important factors leading to patient harm. Time is an essential factor for rapid and efficient disposal of trauma teams to increase patients’ survival and prevent morbidity. Trauma team training plays an important role in improving the team’s performance, while the leader of the trauma team faces the challenge of coordinating and optimizing this performance.Aim The overall aim of this thesis was to analyse how members of trauma teams communicated verbally and non-verbally during trauma team training in emergency settings, and how the leaders were positioned or positioned themselves in relation to other team members. The aim was also to investigate the use of a communication tool, closed-loop communication, and the time taken to make a decision to go to surgery in relation to specific factors in the team as well as the leader’s position.Methods Eighteen trauma teams were audio and video recorded and analysed during regular in situ training in the emergency room at a hospital in northern Sweden. Each team consisted of six participants: two physicians, two nurses, and two enrolled nurses, giving a total of 108 participants. In Study I, the communication between the team members was analysed using a method inspired by discourse psychology and Strauss’ concept of “negotiated orders”. In Study II, the communication in the teams was categorized and quantified into “call-outs” and “closed-loop communication”. The analysis included the team members’ background data and results from Study I concerning the leader’s position in the team. Poisson regression analyses were performed to assess closed-loop communication (outcome variable) in relation to background data and leadership style (independent exploratory variables). In Study III, quantitative content analysis was used to categorize and organize the team members’ positions and the leaders’ non-verbal communication in the video-recorded material. Time sequences of leaders’ non-verbal communications in terms of gaze direction, speech time, and gestures were identified separately to the level of seconds and presented as proportions (%) of the total training time. The leaders’ vocal nuances were also categorized. The analysis in Study IV was based on the team members’ background data, the results from Study I concerning the leader’s position in the team, and the categorization and quantification of team communication from Study II. Cox proportional hazard regression was performed to assess the time taken to make a decision to go to surgery (outcome variable) in relation to background data, the leader’s position, and closed-loop communication (independent variables).Results The findings in Study I showed that team leaders used coercive, educational, discussing, and negotiating repertoires to convey knowledge and create common goals of priorities in work. The repertoires were used flexibly and changed depending on the urgency of the situation and the interaction between the team members. When using these repertoires, the team leaders were positioned or positioned themselves in either an authoritarian or an egalitarian position. Study II showed that closed-loop communication was used to a limited extent during the trauma team training. Call-out was more frequently used by team members with eleven or more years in the profession and experience of trauma within the past year, compared with team members with no such experience. Scandinavian origin, an egalitarian team leader and previous experience of two or more structured trauma courses were associated with more frequent use of closed-loop communication compared to those with no such origin, leader style, or experience. Study III showed that team leaders who gained control over the “inner circle” used gaze direction, vocal nuances, verbal commands, and gestures to solidify their verbal messages. Leaders who spoke in a hesitant voice or were silent expressed ambiguity in their non-verbal communication, and other team members took over the leader's tasks. Study IV showed that the team leader’s closed-loop communication was important for making the decision to go to surgery. In 8 of 16 teams, decisions on surgery were taken within the timeframe of the trauma team training. Call-outs and closed-loop communication initiated by the team members were significantly associated with a lack of decision to go to surgery.Conclusions The leaders used different repertoires to convey and gain knowledge in order to create common goal in the teams. These repertoires were both verbal and non-verbal, and flexible. They shifted depending on the urgency of the situation and the interaction within the team. Depending on the chosen repertoire, the leaders were positioned or positioned themselves as egalitarian and/or authoritarian leaders. In urgent situations, the leaders used closed-loop communication as part of a coercive repertoire, and called out commands and directed requests to specific team members. This repertoire was important for making the decision to go to surgery; the more closed-loop communication initiated by the leader, the more likely that the team would make a decision to go to surgery. Problems arose if the leaders were positioned or positioned themselves as either an authoritarian or an egalitarian leader. The leaders needed to be flexible and use different repertories in order to move the teamwork forward. It was notable that higher numbers of call-outs and closed-loop communication initiated by the team members decreased the probability of making the decision to go to surgery.
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| 4. |
- Höglund, Erik, 1983-
(författare)
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Non-conveyance within the Swedish ambulance service : A prehospital patient safety study
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThere is an increasing demand for ambulance services and more patients than before are requesting ambulance assistance for low acuity conditions. Ambulance services non-convey patients because they lack acute care needs. Non-conveying patients can be a person-centred, resource- and cost-efficient measure and can allow the ambulance to become available sooner for patients with more acute illnesses or injuries. However, validated non-conveyance guidelines are lacking and non-conveying patients raises patient safety issues.AimThe overarching aim of the research project was to describe the patients that were non-conveyed, to explore if there were any potential patient safety issues with the regional non-conveyance guidelines, and to describe how patients and nurses experience non-conveyance.MethodsAll non-conveyance assignments during one year in a region in Sweden (n=2691) were consecutively and prospectively included. The quantitative data was described, compared, and analysed (Studies I and II). Two interview studies were carried out. Phenomenography and conventional content analysis were used to analyse the qualitative data. In total 14 patients were interviewed in Study III and 20 nurses were interviewed in Study IV.Conclusions Patients of all ages with varying characteristics and complaints were non-conveyed. No patient received intensive care, and few were admitted to in-hospital care or died within seven days after being non-conveyed. Older age increases the risk of hospitalisation and death. Patients could feel ashamed for being non-conveyed, and the ambulance nurse could feel frustration when believing that the ambulance resource was misused
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