| 1. |
- Mattsson, Janet
(författare)
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Uncovering pain and caring for children in the pediatric intensive care unit : nurses’ clinical approach and parent’s perspective
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The thesis has a standpoint in a synthesis of caring science and educationscience from a clinical perspective. Children in a Pediatric Intensive Care Unit (PICU) are in an exposed position, dependent on nurses to acknowledge their needs. The alleviation of children’s pain has been investigated from various perspectives, but undertreated pain remains a problem in the PICU. There is a preponderance of empirical evidence pointing toward the role of nurses in uncovering children’s pain and suffering. How nurses interpret the child’s expressions and judge the clinical situation influences their actions in the clinical care. In a PICU, the basis for nurses’ concerns and interpretation of what is meaningful in the nursing care situation are formed by professional concern, workplace culture, traditions, habits, and workplace structures. This influences how parents interpret the meaning of care as well. Patricia Benner’s theory on clinical judgment forms a reference framework for this thesis. The assumption is that children need to be approached from a holistic perspective in the caring situation in order to acknowledge their caring needs. A nurse’s clinical education and insights allow for the possibility to enhance the quality of care for children and parents in the PICU.Aim: To uncover clinical concerns, from caring and learning perspectives, in caring for children in the Pediatric Intensive Care Unit (PICU) from nurses and parents perspective.Methods: Qualitative methods were used in all studies to unfold and explore the phenomena in the nurses’ and parents’ everyday clinical life world. In Papers I and II, a phenomenographic method was adopted. In Papers III and IV, an interpretive phenomenological approach was adopted.Findings: Nurses that have a holistic view of the child and approach the child from a multidimensional perspective, with a focus on the individual child and his/her caring needs, develop a clinical “connoisseurship” and meet the parents’ expectations of the meaning of care. The nurses express that it is only when they focus on the child that subtle signs of pain are revealed. The meaning of nursing care, in the ideal case, is a holistic care where all aspects are integrated and the child as a person has first priority.Conclusion: The meaning of caring and children’s needs must become elucidated to improve the cultural influence of what can be seen as good nursing care within the PICU.
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| 2. |
- Snickare, Lotta, 1959-
(författare)
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Makt utan magi : En studie av chefers yrkeskunnande
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- What do executives do, and how do their actions impact on the company’s results? Questions such as these are constantly targeted in leadership research. Despite thousands of reports in the field, there is no consensus on what the concept of leadership entails. Nor can companies and organisations be said to have a clear idea of what executives actually do. Nevertheless, the investments in leadership development seem to indicate that executives are considered vital to the company’s results. The vague notions about what executive work entails, together with assumptions concerning their importance to the company or organisation, lend a certain magical aura to their work.In this study, executives are regarded as a professional category, and are consequently examined with a qualitative method whereby the professionals begin by reflecting in writing on their skills, and then take part in a group discussion on their skills based on their written reflections. This method, known as the dialogue seminar method, has been used on other professional categories with good results. Since executives have not previously been studied in terms of their skills, the results have been compared to leadership research. Leadership studies with a gender perspective have shown that gender impacts on the likelihood of obtaining and practising executive positions and skills. Therefore, the results of this study have also been analysed from a gender perspective.The skills of executives and other staff are described as the capacity to follow rules, i.e. interpreting rules and then applying them in concrete situations. A rule says nothing about how it should be followed, however. If the way in which a rule should be followed were to be described in a rule, another rule would be needed to describe how that rule should be followed, and so on, ad infinitum. Thus, rules must be interpreted as something that requires access to an “archive” of examples. One specific executive skill consists of developing co-workers’ rule-following skills.For executives, following the rules involves making decisions based on tacit knowledge. Tacit knowledge, in turn, is based on an inner vision of what is taking place right now in the organisation, and what is crucial to customers, employees, the organisation and the world at large. It also includes understanding people’s urges, thoughts, needs, wishes, and what they are saying. Tacit knowledge develops in the interplay between reflecting over examples and taking strategic action. Decision-making situations can often be unclear and contradictory. Therefore the executive’s skills must include the ability to handle uncertainty in three different ways. The first is by being honest about the fact that all decisions cannot be made, and that some decisions take time. The second is explaining to employees that an organisation cannot be entirely regulated by guidelines, and that judgement in the form of reflected experience is therefore a crucial element in all action. The third is coping with the fact that an executive position does not automatically entail being able to make the right decision. Thus, the executive must accommodate uncertainty in the world at large, the employees’ uncertainty, and his or her own uncertainty.Empirical analysis also highlights another aspect of executive skills. Executives need to be fast, not merely in the sense of having a high work capacity, but in the sense of never saying no or questioning deliveries.Above all, comparisons with leadership research reveal differences in the interpretation of empirical data. The way in which executives follow rules, for instance, is also described in research on leadership, but only as a phenomenon linked with unusual situations, as when executives need to take emergency action in unforeseen circumstances, or make decisions in cases that are not covered by the general rules, rather than as a day-to-day occurrence. Similarly, there is a difference in perspectives on handling uncertainty. In leadership research, this is described as the executive dealing with something that has gone wrong and putting it right. In the study at hand, the concept is expanded, to demonstrate that the executive’s actions can involve accommodating the worries that this uncertainty breeds within the organisation.Empirical data do not show any differences in the descriptions of the executive skills of women and men. Women and men practise these executive skills similarly. Men’s tendency to identify themselves with senior management, however, is interpreted as a sign of homosocial structures in the organisation. The fact that men are more ambivalent than women faced with the opportunity and responsibility of promoting change consequently indicates that admittance into a homosocial structure restricts their freedom of action.There is a difference, however, between the executive skills of women and men in that women, unlike men, have to relate to the issue of their own gender. Their approach to this can vary between two leadership discourses; one that is gender-neutral, and one where gender is significant. Women’s knowledge of how gender is constructed in organisations, in leadership and in other structures and processes, is thus included in the tacit knowledge that comprises their skills.Keywords: executive, manager, management, leadership, gender, skills, tacit knowledge, follow rules, breaking rules, rules, decision-making, accommodate uncertainty, homosocial structures.
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| 3. |
- Gutierrez-Gutierrez, Belen, et al.
(författare)
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Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients
- 2021
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Ingår i: Antimicrobial Agents and Chemotherapy. - : American Society for Microbiology. - 0066-4804 .- 1098-6596. ; 65:11
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Tidskriftsartikel (refereegranskat)abstract
- There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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| 4. |
- Perez-Nadales, Elena, et al.
(författare)
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Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales : The impact of cytomegalovirus disease and lymphopenia
- 2020
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Ingår i: American Journal of Transplantation. - : WILEY. - 1600-6135 .- 1600-6143. ; 20:6, s. 1629-1641
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Tidskriftsartikel (refereegranskat)abstract
- Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score >= 8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score >= 8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
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| 5. |
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| 6. |
- Ekström, Veronica, 1975-
(författare)
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Det besvärliga våldet : Socialtjänstens stöd till kvinnor som utsatts för våld i nära relationer
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I avhandlingen analyseras hur våldsutsatta kvinnors behov tolkas, omförhandlas och anpassas för att kunna hanteras inom socialtjänstens organisation. Avhandlingens övergripande frågeställningar fokuserar på insatser och behov, betydelsen av socialtjänstens organisering och betydelsen av socialarbetarnas handlingsutrymme. Avhandlingen baseras på kvalitativa analyser av statliga propositioner, intervjuer med socialarbetare och med kvinnor som varit utsatta för våld i nära relationer. Det teoretiska ramverket bygger bland annat på Frasers (1989) teoretiska perspektiv som tar sin utgångspunkt i samhällets tolkningar av människors/gruppers behov av stöd, nyinstitutionell teori och teorier om gatubyråkrater. Avhandlingen visar att socialarbetares tolkningar är centrala aspekter av förhandlingen om hur våldsutsatta kvinnors behov och rätt till stöd ska förstås. Ett viktigt resultat i avhandlingen är att stödet till våldsutsatta kvinnor blir så pass olika. Avhandlingen ger inga svar i kvantitativa termer på hur olikheten är fördelad, men den ger exempel på hur olikheten tar sig uttryck. I kommuner där specialiseringen innebär att socialarbetarna på socialkontoret i första hand utreder behov och fattar beslut om insatser, måste det också finnas adekvata insatser att besluta om. Saknas det så erbjuds inte heller något stöd. Stödet till kvinnor som utsatts för våld i nära relationer blir också olika eftersom socialarbetare ställer olika krav eller sätter upp olika trösklar för att kvinnor ska få stöd. Avhandlingen visar att både gemensam kunskap och gemensam syn på sociala problem är centralt för att samarbetet inom den specialiserade socialtjänstens ska fungera och i längden också för vilket stöd människor kommer att erbjudas.
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| 7. |
- Fängström, Karin, 1980-
(författare)
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‘I don’t even remember anything’ : Optimising the choice of method when interviewing preschoolers
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There is increasing need and demand in various contexts to take children’s perspectives into account, including the views and opinions of the youngest children. However, listening to the voices of children is a challenging and complex task, and the field is normatively loaded. There is thus a growing need for valid and reliable methods and techniques that aid children to verbalise their experiences. The overall aim of this thesis was to examine the ability of the In My Shoes computer assisted interview and a Standard verbal interview to elicit accurate information and evaluative content, when used with preschool-aged children and determine their suitability in relation to situationally shy children.Our studies show that the two interview methods, in general, provided equally accurate and complete statements. In addition, the IMS interview can be a more useful and suitable tool during the rapport phase with situationally shy children compared to the Standard verbal method. For non-shy children, the interview methods were equally adequate. In relation to evaluative information, the recommended open-ended questions in the Standard verbal interview were insufficient. Children appeared to need evaluative questions in order to provide evaluative content. Examining the ability of IMS to elicit subjective experiences showed that using IMS aided children to provide detailed and varied descriptions of emotions, somatic experiences, and objects such as toys. Thus, when choosing the optimal child interview method, there are several aspects that need to be considered, including the degree to which children’s statements need to be accurate and complete and/or contain evaluative information and the child’s level of shyness. These studies have increased the number of evaluated methods for interviewing children and contributed to new knowledge about the challenging task of optimising the choice of method for interviewing preschoolers.
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| 8. |
- Grönte, Maria
(författare)
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Skam, moralarbete och faderskap : en studie om mötet mellan socialsekreterare och pappor vid våld i nära relationer
- 2024
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Men's domestic violence and/or abuse (DVA) is a widespread social issue. Often, the men are fathers, and the victims are mothers and children. In Sweden, social workers (SWs) are expected to involve these fathers in child protection investigations (CPIs) and work towards changing their behavior. However, engaging fathers in CPIs has proven to be a challenging task, especially when they involve DVA by fathers. The overall aim of this licentiate thesis is to examine how fathers can be engaged in CPIs initiated as a result of their suspected DVA against the mothers of their children. The licentiate thesis is a compilation thesis that consist of two articles, with the first having been published in a peer-review journal and the second submitted to a journal awaiting review. Using qualitative methods. I conducted semi structured interviews with 15 social workers on a total of 31 occasions during their work with 12 ongoing CPIs. Seven fathers have also been interviewed. The interviewed fathers had been involved in CPIs as a result of their DVA against the mothers of their children and had undergone treatment targeting their violent/abusive behavior.The interviews with the SWs are addressed in the first article, and the interviews with the fathers in the second article. The data were analysed using thematic analysis. The first article examines the strategies used by SWs to achieve cooperation with fathers in CPIs that involve the father being suspected of DVA against the child's mother. This analysis is rooted in the framework of shame, guilt, and social bonds. The results suggest that whether social workers succeed in achieving cooperation with fathers is related to the social workers' strategies of building secure social bonds with the fathers, which may alleviate the fathers' feelings of shame. However, there is a risk that these strategies may lead to DVA being minimized or overlooked. Striking a balance between building a social bond and addressing DVA is crucial, and the timing of addressing DVA plays a central role. The second article highlights fathers' experiences of interactions with SWs in the context of CPIs initiated as a result of their DVA against the mothers of their children. In particular, the focus is directed at how ideals of fatherhood, power relations, and shame influence fathers' experiences of engaging in these meetings. The analysis is guided by shame, guilt and social bonds linked to a gender theoretical framework. The results suggest that DVA contributes to fathers violating moral ideals of good fatherhood, which threatens to deprive them of contact with their children and also triggers feelings of shame. In the CPIs, it is the SWs, often female, who hold power over the processes while fathers are subordinated, which challenges expected power structures and hegemonic masculinity ideals. Fathers' engagement in CPIs is enabled when fathers adopt a subordinate position, which is facilitated by SWs meeting them with care and non-judgmental attitudes. This subordinate position can be a useful means for fathers to maintain an intact masculine position when DVA is exposed, shame is triggered, and their fatherhood and social bonds are threatened. However, SWs need to be attentive to the risk that fathers may both downplay their DVA and adopt positions that may be perceived as caring, egalitarian, and change-oriented even though their dominance – in the form of DVA – may persist.In summary, the study indicates that it is challenging but possible to successfully engage these fathers in CPIs. The study suggests that SWs need to balance building social bonds with the fathers and addressing the violence without imposing further shame. The findings highlight a particularly crucial aspect in the interaction, which is the SWs' ability to meet the fathers in a way that they do not feel judged for who they are - perpetrators of DVA. Instead, focusing on the violence as actions, on what they have done. In doing so, actions are separated from the self and can instead manifest as guilt. This approach can both facilitate fathers' engagement in CPIs and point towards taking responsibility for and changing the violent/abusive behaviors.
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| 9. |
- Iversen, Clara, 1981-
(författare)
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Making Questions and Answers Work : Negotiating Participation in Interview Interaction
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The current thesis explores conditions for participation in interview interaction. Drawing on the ethnomethodological idea that knowledge is central to participation in social situations, it examines how interview participants navigate knowledge and competence claims and the institutional and moral implications of these claims. The data consists of, in total, 97 audio-recorded interviews conducted as part of a national Swedish evaluation of support interventions for children exposed to violence. In three studies, I use discursive psychology and conversation analysis to explicate how interview participants in interaction (1) contribute to and negotiate institutional constraints and (2) manage rights and responsibilities related to knowledge.The findings of study I and study II show that child interviewees actively cooperate with as well as resist the constraints of interview questions. However, the children’s opportunities for participation in this institutional context are limited by two factors: (1) recordability; that is, the focus on generating recordable responses and (2) problematic assumptions underpinning questions and the interpretation of interview answers. Apart from restricting children’s rights to formulate their experiences, these factors can lead interviewers to miss opportunities to gain important information. Also related to institutional constraints, study III shows how the ideal of model consistency is prioritized over service-user participation. Thus, the three studies show how different practices relevant to institutional agendas may hinder participation.Moreover, the findings contribute to an understanding of how issues of knowledge are managed in the interviews. Study II suggests the importance of the concept of believability to refer to people’s rights and responsibilities to draw conclusions about others’ thoughts. And the findings of study III demonstrate how, in evaluation interviews with social workers, children’s access to their own thoughts and feelings are based on a notion of predetermined participation; that is, constructed as contingent on wanting what the institutional setting offers. Thus, child service users’ low epistemic status, compared to the social workers, trumps their epistemic access to their own minds. These conclusions, about recordability, believability, and predetermined participation, are based on interaction with or about children. However, I argue that the findings relate to interviewees and service users in general. By demonstrating the structuring power of interactive practices, the thesis extends our understanding of conditions for participation in the institutional setting of social research interviews.
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| 10. |
- Kenalemang-Palm, Lame Maatla, 1991-
(författare)
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Recontextualising ageing as a choice : A critical approach to representations of successful ageing
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines the intersection between representations of ageing femininities, empowerment, and oppression in marketing and advertising practices, within the context of successful ageing. In the current era of population ageing, debates on gender and ageing are becoming more pronounced. Due to population ageing, there is a visible increase in representations of (successful) ageing in the media. As a result, we are experiencing an expansion in the “grey market” of anti-ageing products and services, e.g., cosmetics, mainly aimed at wealthy older women who constitute an important market segment for such. Given that the media helps form people’s ideas about ageing, there is a need to critically examine this growing market and how older women are represented and/or addressed in it. Such representations are crucial for understanding contemporary feminist discussions on the contestation between women’s empowerment and oppression. To provide a deeper understanding of this phenomenon, I use an intersectional feminist perspective combined with the methodology of Multimodal Critical Discourse Analysis (MCDA). This perspective highlights and deconstructs the complex ways in which power and ideology work to maintain and reinforce existing intersectional structural inequalities based on age, gender, class, and race that marginalise women. This thesis consists of three empirical studies. The findings suggest a shift from the postfeminist gaze towards a neoliberal self-objectifying gaze that closely operates alongside discourses of successful ageing. This self-objectifying gaze encourages women to actively work on and transform the ageing self through intensifying self-surveillance, self-scrutiny, and self-improvement practices. These self-transformation practices are presented as the free choices of empowered, entrepreneurial, and responsibilised subjects. Nonetheless, such choices confine women to never-ending forms of self-governance that promote the internalisation of patriarchal and capitalist ideal standards of beauty, thus reinscribing privilege and oppression.
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