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- 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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| 2. |
- Lindegren, Stina, 1982-
(författare)
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Support and Treatment for Men Convicted of Sexual Offending : Readiness, Change, and Previous Help-Seeking
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Social work plays a crucial role in the prevention of sexual abuse. Such prevention can involve protection for potential victims but also measures directed at those who perpetrate sexual abuse. However, research on desistance among those who have committed sexual offences, their treatment readiness, and help-seeking prior to conviction is scarce.This doctoral thesis aims to explore support and treatment from the perspective of adult men convicted of sexual offences in Sweden. What are their experiences of change after participation in sex offender treatment, and how do they engage in risk-reducing interventions? Particular attention is placed on the roles of relatives and society.Data consist of pre- and post-tests (n = 99) and in-depth interviews with men convicted of sexual crimes (n = 19). The interviews were carried out with both participants (n = 13) and non-participants (n = 6) in sex offender treatment.Participants’ self-reports (n ~ 26) and therapist ratings (n = 46) analysed in paper I suggest that participation in the sex offender programme called SEIF may be associated with changes in criminogenic needs, potentially reducing issues linked to recidivism. However, caution is advised due to methodological limitations. Further studies are needed to determine effectiveness. According to paper II, interviewees who participated in SEIF (n = 13) appeared to have started building new prosocial narrative identities, indicative of early desistance.The findings in paper III suggest that non-rehabilitative, punitive elements within correctional systems can create barriers to readiness. Nevertheless, supportive and non-punitive responses from staff, close ones, or fellow inmates seemed to counteract these negative loops. This hypothesised relational mechanism, promoting readiness, is termed looping disruption. Paper IV examines help-seeking behaviours and indicates that prevention efforts can either succeed or fail at various societal levels. Barriers to seeking help include a lack of awareness of the problem, fear of social consequences, and a neglectful welfare system. Professionals with specific knowledge and focus were seen as providing meaningful support, while the involvement of loved ones was a central motivator.In conclusion, a non-judgmental, person-centred, and supportive approach is recommended, as it seems to increase willingness to change. Professionals may need specific training to tackle the challenges associated with this task. Furthermore, the thesis highlights how the significant stigma associated with sexual offences is a major obstacle when reintegrating individuals convicted of such crimes into society.
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| 3. |
- Bergman, Ann-Sofie, Docent i socialt arbete, 1963-, et al.
(författare)
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Samarbetssamtal vid oenighet om barn
- 2023
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Ingår i: Medling vid konflikter som rör barn och unga. - Stockholm : Norstedts Juridik AB. - 9789139025672 ; , s. 65-90
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 4. |
- Edvall Malm, Disa, 1965-
(författare)
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Det socio-polisiära handlingsnätet : om kopplingar mellan polis och socialtjänst kring ungdomars kriminalitet och missbuk
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Övergripande diskuterar avhandlingen olika aspekter av att samhällets system av stöd och kontroll för barn och unga knyts närmare samman. Det handlar om hur samverkan framställs och uppfattas på olika nivåer och hur den konkretiseras i polisens och socialtjänstens arbete kring unga som utvecklat eller bedöms riskera att utveckla kriminalitet och/eller missbruk. Studieobjektet inbegriper övergripande ideologisknivå, lokal/praktisknivå och individuell nivå. Syftet med avhandlingen är att identifiera, beskriva och analysera polisens och socialtjänstens samverkan kring barn och ungas kriminalitet och missbruk. Utgångspunkten är hur; samverkan mellan myndigheterna framställs i offentliga dokument, hur lokala aktörer uppfattar behovet av men också möjligheter, svårigheter och hinder kring samverkan, hur myndigheterna lokalt är organiserade för att aktualisera, handlägga, behandla och avsluta barn och unga, och slutligen vilka barn och unga som denna samverkan kan omfatta. Avsikten är att få en bild av vad denna samverkan på policynivå innebär och sätta detta i relation till hur polis och socialtjänst förstår och skapar sina respektive och gemensamma uppdrag i förhållande till varandra lokalt. I avhandlingen används tre olika empiriska material och olika metoder för analys: Analys av statliga offentliga dokument, kvalitativa intervjuer med poliser, socialarbetare och deras chefer i en kommun och en kvantitativ kartläggning av aktuella ungdomar i kommunen. Handlingsnät som teoretisk grund används för att studera kopplingar mellan de båda myndigheterna och de tre olika nivåerna av studien. Genom att använda handlingsnät blir det möjligt att se hur polisens och socialtjänstens olika uppdrag kopplas samman kring barn och ungas kriminalitet och missbruk.Resultaten av studien visar att det pågår en ettablering av ett socio-polisiärt handlingsnät på den övergripande ideologiska nivån och den lokala kommunala nivån. I policydokumenten förspråkas ett kontrollerande förhållningsätt gentemot ungas kriminalitet. På den lokala nivån handlade det om ett kontrollstödjande förhållningsätt för att motverka både ungas kriminalitet och missbruk. Resultaten av studien visar att socialtjänsten fått ta ett större ansvar för att utreda och verkställa påföljder för ungas kriminella handlingar, samtidigt som det inom socialtjänsten riskerar att utvecklas en logik mera baserad på straffvärdet av den brottsliga handlingen än den unges individuella behov av hjälp och stöd. Studien visar att i polisens och sociatjänstens arbete med enskilda barn och unga finns få möjligheter till samarbete. Dessutom var det få unga personer som samtidigt var aktuella för både polis och socialtjänst, vilket gör det svårt att uppnå något djupare längre samarbete kring enskilda ungdomar under längre tid. Det kan i bästa fall mera handla om en form av remissförfarande från polis till socialtjänst.
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