Att vårda patienter i rättspsykiatrisk vård som uppvisar självskadebeteende : sjuksköterskors erfarenheter och upplevelser

Deliberate self harm as defined pathologically as well as socially is becoming an increasing phenomenon within forensic psychiatry. Nurses working with patients who have self harm behaviour and are confined to forensic psychiatry face different challenges which affect their feelings and attitudes in different ways, in their nursing practice. Purpose: To explore nurses’ experiences of caring for patients who suffer from deliberate self harm behaviour and are confined to forensic psychiatry. Method: Qualitative semi- structured interview s from eight nurses working within the forensic psychiatric clinic. Interviews were analysed by using a qualitative content analysis. Results: They worked strategically and emphasized the importance of teamwork, good communication and urged for the need to get necessary education, staff focused tutoring and patient focused therapy. Conclusion: Need for necessary education, patient focused therapy and staff focused tutor is needed to empower staff working with patients who are confined within forensic psychiatry and suffer from deliberate self harm behaviour.

Vad kommunikation vill säga : En iscensättande studie om specialpedagogers yrkesroll och kunskapande samtal

This thesis is about the role of special educators in (pre)school and about developing democratic communication. It is based on the theory of argumentation developed by Jürgen Habermas. The aim of the study was to describe the conditions that create possibilities for deliberative communication between special educators, parents, students and colleagues in (pre)school. My overarching aim was to contribute to a more distinct description of special educators´ field of knowledge. I have used a social constructionist approach. The project has been based in the field of action research. A precondition for deliberative dialogues in (pre)schools is to start out from a communicative perspective. That means that (1) some theoretical conditions have been made apparent, (2) knowledge about these conditions have been shown to be crucial for using an aware communicative perspective in a speech act, (3) an aware communicative perspective is revealed through procedures of knowledge. These procedures were understood by and made evident to me as a result of network meeting discussions. A communicative perspective, a special educator as facilitator and procedures of knowledge are found to be crucial for collaboration using a deliberative attitude in (pre)schools. Today there is often a lack of pedagogical professionals in (pre)schools who can act as a link between authorities, organisations, professionals and parents, and who have the authority to pose challenging pedagogical questions. This can be changed if the role of special educators is, instead of teacher, defined as communicative special educators working with dialogues on different levels.

Styrning och ideologiska dilemman i Skolverkets skolutveckling : exemplet ANDT-undervisning

Governing and ideological dilemmas in drug education Drug education (ANT) in Swedish schools has a history over decades. Here, the pedagogical approaches fluctuated between transfer of solid knowledge from the teacher to the pupil, and working with values and have a more pupil-driven teaching – a classic dichotomy. Rhetoric about the school’s way of teaching has thus always been ambivalent and subject to reexamination. The study analyses various textual material on ANT education. As a methodological tool Billigs concept Ideological dilemmas is used, which is a fruitful way to identify the rhetorical building blocks of (school) politics, but also to analyse political talk in more detail. The article analyses the ideological dilemmas under three dichotomies: Knowledge vs. values, teacher control vs. learner control, and prevention vs. promotion. Throughout we can see this question of how teaching could be successful, given the tension between authority and democracy. The article concludes by relating this basic ideological dilemma in a wider discursive context of governance in our time. 

Ledarskap för att främja hälsa hos medarbetare : En fallstudie om hälsoarbete på linjechefsnivå

The author’s common interest for healthy employees, brought reasonto study how line managers can manage and develop this withsupport from HR. Previous research highlights that knowledge ofhow health is promoted is missing. Line managers have a key role inworking with contributors´ health. The aim of the study is toinvestigate how managers are working for the well-being ofemployees and which aid dedicated to line managers from the HRfunction, and how support and the work with employees’ health canbe developed. This study also investigates the approach on healthfrom each party. The method consisted of a case study, includingdata collection through depth interview with HR and focus groupinterview with heads of unit. The result of the HR interview showedoverwhelming support in individual conversations, but lack ofresources for the support function. HR requested additional resourcesand more health promotion work instead of rehabilitation. Heads ofunit are working with a wellness initiative for healthy contributors.Development points were found in increased support, developedwellness options, increased participation and performance appraisalswith a focus on the individual’s health status. The findings showthat heads of units are working with participation, attendance andhealth care but want more focus on the individual’s health status. HRneeds resources in order to support the heads of units in their healthcare. A common approach is missing between HR and heads of unitin their work for health promotion. Education, approach and supportshould be developed on the basis of the organization’s overallcontext.

Hälsofrämjande arbete på SSAB i Borlänge : Hälsofrämjande processer i arbetslivet och ledarskapets betydelse för medarbetarens hälsa

Problem: Arbetsmiljön är viktig för människors välbefinnande. Hälsofrämjande faktorer antas inte bara styrka individens fysiska och psykiska hälsa, utan även företagets konkurrenskraft och lönsamhet. I uppsatsen undersöker vi hur företaget SSAB i Borlänge arbetar med hälsa genom att tillämpa ett hälsofrämjande perspektiv och utgå från teorin om Känslan av sammanhang (KASAM). Ledarskapsvärderingar har betydelse för medarbetares hälsa (Hanson, 2004) och vi undersöker vilken uppfattning ett antal chefer har om sina roller i det hälsofrämjande arbetet och deras syn på medarbetarundersökningen HälsoSAM som företagshälsovården på SSAB bedriver. Arbetsbelastningen på medarbetare och chefer ökar till följd av sparkrav, samtidigt som resurserna minskar (Gatu, 2003). Följden blir en större risk för ohälsa och ett sätt att minska sjukfrånvaron är att genomföra hälsofrämjande insatser (Prevent, 2001). Syfte: Syftet med studien är att utifrån ett hälsofrämjande perspektiv förklara vad chefer har för möjligheter att skapa förutsättningar för att främja medarbetarnas hälsa på SSAB i Borlänge. Metod: Den metod som ligger till grund för uppsatsen baseras på ett kvalitativt angreppssätt där semistrukturerade intervjuer samt litteraturstudier genomförts för att samla information. Analys: Ledarens beteende påverkar medarbetarna. Hög arbetsbelastning på SSABs chefer leder till lägre närvaro bland medarbetarna, vilket i sin tur ger sämre förutsättningar för att främja hälsan. HälsoSAM kartlägger medarbetarnas hälsoläge, både välbefinnande och arbetskapacitet. Resultaten är vägledande i det hälsofrämjande arbetet men överbelastning, tidsbrist och kunskapsbrist hos cheferna bidrar till att uppföljningen inte blir systematisk. För ett väl fungerande hälsoarbete krävs systematik. Slutsats: Hälsofrämjande processer i arbetslivet skapas genom balans mellan krav och resurser. På SSAB i Borlänge hindras hälsoarbetet av tidsbrist och kunskapsbrist hos cheferna. Kostnadsbesparingar påverkar hälsoarbetet negativt och systematiken i uppföljningsarbetet blir lidande. Ansvaret för hälsoarbetet läggs på företagshälsovården, men utan stöd från chefer blir inte hälsoarbetet en naturlig del i verksamheten. Det är viktigt att i rådande situation se vad främjande av hälsa kan ge tillbaka till företaget i både ekonomiska och kvalitativa termer. Insikt om detta ökar chefernas incitament att prioritera hälsofrämjande processer och organisera arbetet så att människor har förutsättningar att hantera, kontrollera och klara av sina uppgifter.

Att bli, att vara och att ha varit - om ingångar i och utgångar ur Jehovas vittnen i Sverige

Summary To become, to be and to have been: about the  Jehovah’s Witnesses The Watchtower Bible and Tract Society, in the following text referred to as the Jehovah’s Witnesses or “the organisation”, is a worldwide Christian organisation with about 6.7 million members. The organisation has many times, without any success so far, proclaimed Armageddon when they expect Jehovah to return to Earth. They interpret the Bible in their own, often very literal way, and require their members to live according to these interpretations. Among the consequences of this, members are forbidden to vote, to do military service or to receive blood transfusions. Apart from attending the three weekly meetings, members are expected to be active in missionary work, known as “publishing”. If a member fails to do a certain number of hours’ publishing, he or she risks being deprived of active membership status Sweden in general is considered to be a society where the population is not very religious. The formerly state-governed Lutheran church has lost its influence and the vast majority of ordinary Swedes do not visit church on other occasions than weddings, funerals or christenings. Expressing one’s own religious values has become somewhat of a private matter where publicity is seldom appreciated, which is contrary to the practice of the Jehovah’s Witnesses. This is one of the reasons why the Jehovah’s Witnesses are commonly perceived by average Swedes as a “suspicious” religious organisation. The aim and methods of the study This dissertation seeks to describe and investigate the entering and leaving of a highly structured and hierarchical religious community, exemplified in this case by the Jehovah’s Witnesses. What are the thoughts and aspirations of someone who is considering becoming a Jehovah’s Witness? What are the priorities and what experiences seem important when a person is going through such a process? And when this person has finally reached his or her goal of becoming a member, is it the same motivation that makes him or her stay in the organisation for longer periods of time, possibly for the rest of their lives, or does it change during the process of entering, or does this motivation change its character during the transition from entering to being a regular member? Why do some of the members change their attitude to the Jehovah’s Witnesses from rejoicing to bitterness? And how does this process of exit manifest itself? In what way is it different from the process of entry? The respondents in this study were chosen from both active members of the Jehovah’s Witnesses in Sweden and those who have left the organisation for personal reasons. Repeated interviews with ten active members of the organisation have been conducted in the course of the study and compared to equal numbers of former members. The interviews have been semi-structured to deal with questions of how a person has come into contact with the organisation; how they retrospectively experienced the process of entry; the reasons for becoming a member. Questions have also been asked about life in the organisation. The group of “exiters” have also been asked about the experience of leaving, why they wanted to leave, and how this process was started and carried out. In addition to this I have analysed a four-year diary describing the time inside and the process of leaving the organisation. This has given me an extra psychological insight into the inner experience of someone who has gone through the whole process. The analysis has been done by categorising the content of the transcribed interviews. An attempt to outline a model of an entry and exit process has been made, based on ideas and interpretations presented in the interviews. The analysis of the diary has involved thorough reading, resulting in a division of it into four different parts, where each part has been given a certain key-word, signifying the author’s emotional state when writing it. A great deal of the information about the Jehovah’s Witnesses has been collected through discussion boards on the Internet, informal talks with members and ex-members, interviews with representatives of the organisations during visits to its different offices (Bethels), such as St. Petersburg, Russia, and Brooklyn, New York, USA. The context Each organisation evolves in its own context with its own norms, roles and stories that would not survive outside it. With this as a starting point, there is a chapter dedicated to the description of the organisation’s history, structure and activities. It has been stated that the organisation’s treatment of its critical members and the strategies for recruiting new members have evolved over the years of its history. At the beginning there was an openness allowing members to be critical. As the structure of the organisation has become more rigid and formalised, the treatment of internal critics has become much less tolerated and exclusion has become a frequent option. As a rule many new members have been attracted to the organisation when (1) the day of Armageddon has been pronounced to be approaching; (2) the members of the organisation have been persecuted or threatened with persecution; and (3) the organisation has discovered a “new market”. The processes for entering and exiting How the entering processes manifest themselves depends on whether the person has been brought up in the organisation or not. A person converting as an adult has to pass six phases before being considered a Jehovah’s Witness by the organisation. These are:  Contact with the Jehovah’s Witnesses, Studying the bible with members of the organisation, Questioning, Accepting, Being active as publisher (spreading the belief), Being baptised.  For a person brought up in the organisation, the process to full membership is much shorter:   Upbringing in the organisation, Taking a stand on the belief, Being baptised. The exit process contains of seven phases:   Different levels of doubts, Testing of doubts, Turning points, Different kinds of decisions, Different steps in executing the decisions, Floating, a period of emotional and cognitive consideration of membership and its experiences, Realtive neutrality.   The process in and the process out are both slow and are accompanied with anguish and doubts. When a person is going through the process in or out of the organisation he or she experiences criticism. This is when people around the adept question the decision to continue in the process. The result of the criticism depends on where in the process the person is. If he or she is at the beginning of the process, the criticism will probably make the person insecure and the process will slow down or stop. If the criticism is pronounced in a later phase, the process will probably speed up. The norms of the organisation affect the behaviour of the members. There are techniques for inclusion that both bind members to the organisation and shield them off from the surrounding society. Examples of techniques for inclusion are the “work situation” and “closed doors”. The work situation signifies that members who do as the organisation recommends – doing simple work – often end up in the same branch of industry as many other Jehovah’s Witnesses. This often means that the person has other witnesses as workmates. If the person is unemployed or moves to another town it is easy to find a new job through connections in the organisation. Doubts and exclusions can lead to problems since they entail a risk of losing one’s job. This can also result in problems getting a new job. Jehovah’s Witnesses are not supposed to talk to excluded members, which of course mean difficulties working together. “Closed doors” means that members who do as the organisation recommends – not pursuing higher education, not engaging in civil society, working with a manual or in other way simple job, putting much time into the organisation – will, after a long life in the organisation, have problems starting a new life outside the Jehovah’s Witnesses. The language used in the organisation shows the community among the members, thus the language is one of the most important symbols. A special way of thinking is created through the language. It binds members to the organisation and sometimes it can work as a way to get back into the normative world of the organisation. Randall Collins’s (1990, 2004) thoughts about “emotional energy” have enabled an understanding of the solidarity and unity in the organisation. This also gives an understanding of the way the members treat doubting and critical members. The members who want to exit have to open up the binding/screening off. A possible way to do that is through language, to become aware of the effect the language might have. Another way is to search for emotional energy in another situation. During the exit process, shame might be of some importance. When members become aware of the shame they feel, because they perceive they are “acting a belief”, the exit process might accelerate.

Dokumentationens dilemman : Förskollärare samtalar om pedagogisk dokumentation

Abstract  Pedagogical documentation is a certain procedure for documenting that, in recent years, has been embraced in several Swedish preschools. Teachers document children’s actions and conversations usually by photos or video recordings. This documentation is to be used for a pedagogical purpose. However, studies and governmental inspections have shown that pedagogical documentation gives rise to many questions among preschool teachers. The purpose of this study is to gain insight into what is being expressed when preschool teachers discuss pedagogical documentation, focusing on themes of content and on the participants’ expressions of their points of view. The data is comprised of transcriptions from audio recordings of discussions conducted in a research circle. The participants are eight preschool teachers that met over the course of one year. Each meeting focused on the documentation provided by a different participant. In that way the contents of the discussions were framed by the teachers own questions and narratives. Theoretically, the study departs from Social Constructionism and Discursive Psychology. The preschool teachers’ utterances have been analyzed using concepts of interpretative repertoires and ideological dilemmas. The results show the main themes to be: Knowledge content in a preschool setting, children’s learning, the teacher’s role and implementation of pedagogical documentation. The participants’ joint position is that the knowledge content at the preschool level is defined by the curriculum for the preschool. Concerning children’s learning and the teacher’s role, two main standpoints are disclosed. Ideologically those standpoints derive from two opposing theories of education. Based on how the standpoints have been expressed I have called them ”predetermined learning” versus ”non-predetermined learning”. One main distinction between the standpoints is that predetermined learning emphasizes the results of learning, while non-predetermined learning emphasizes the processes of learning. The participants’ utterances show that teachers tend to subscribe to the idea that there is only one acceptable way of working with pedagogical documentation. This sometimes creates performance anxiety and feelings of not succeeding and has led to arguments advocating an alternate approach; pedagogical documentation can be done in many ways. The ideological dilemmas within the discourse can be perceived as resources by which the participants argue about knowledge, learning, teaching and about the implementation of pedagogical documentation.

Skolsköterskors uppfattning av samspelet mellan psykisk hälsa och fysisk aktivitet utifrån deras arbete med högstadieelever : En empirisk kvalitativ intervjustudie med fenomenografisk ansats

Bakgrund: Många barn uppvisar symtom på psykisk ohälsa, samtidigt visar studier att barn får en alltmer stillasittande fritid. Exakt hur den fysiska aktiviteten påverkar den psykiska hälsan är oklart då det är en komplex fråga. I sitt arbete erhåller skolsköterskor nära relationer med barn och de får på så vis en inblick i hur den psykiska samt fysiska hälsan ser ut. Syfte: Syftet med studien var att belysa hur samspelet mellan psykisk hälsa och fysisk aktivitet uppfattas av skolsköterskor utifrån deras erfarenhet i elevhälsan bland högstadieelever. Metod: En empirisk kvalitativ intervjustudie med fenomenografisk ansats. Undersökningsgruppen bestod av åtta stycken skolsköterskor i Karlstads kommun som arbetar med elever på högstadiet. Huvudresultat: Skolsköterskorna hade en gemensam erfarenhet av att många barn har en dålig psykisk hälsa och att detta främst observeras bland flickor. De delade även uppfattningen av att den fysiska aktiviteten minskar bland barn. Något som framkom av skolsköterskornas berättelser var att kraven inom idrotten uppfattas av många barn som allt för höga. Konklusion: Många barn upplever allt för höga krav inom idrotten vilket kan leda till psykisk ohälsa hos vissa barn och framförallt bland flickor. För att få barn att öka sin fysiska aktivitet är det viktigt att se över synsättet inom idrotten så att det blir den roliga, sociala och avslappnande aktivitet den är tänkt att vara.

Rapport från projektet Multimodala uppgifter och bedömning i matematik : Video och kollaborativa samtal som metod vid lärares bedömning av elevers matematiska kunskaper

This research will discuss some experiences from a four year school research study. It was conducted in cooperation with teachers from four municipalities in Dalarna. The aim of the research was to examine teachers´ professional development when they participated in collaborative discussions based on video recordings and video edited material from specific lessons in their own practice. The study had two foci one was to investigate methods and tools that teachers can use to develop their ability to assess their students while working on multimodal tasks. The other was to examine how video can be used by teachers wanting to obtain knowledge about assessing students. The study is based on several theories about when teachers collaborate to create new knowledge. The first is the design theoretical approach – where visual ethnography and a semiotic approach contribute to problematize the use and mixture of different modes. A basic assumption of the framework here is that meanings are made and communicated in mathematics through a wide range of semiotic modes. By using video as an essential tool in the research the framework theories concerning visual ethnography, video documentation and individuals as reflective practitioners were also needed. The findings can be divided into the following themes: the use of tasks for assessment, collaborative discussion, equipment, ethical dilemmas. Collaborative discussions were evaluated as a meaningful way of sharing knowledge. The use of video recordings in association with these discussions raised important ethical issues. Working with the assessment framework was of great interest to the teachers but it took a lot of time from their ordinary work. In this way the project highlighted more general aspects of school development. The research also concerns teachers´ use of collaborative discussions in assessment work, multimodal tasks in mathematics and video as a research tool in general.