Health and quality of care from older peoples' and formal caregivers' perspective

Aim: The overall aim of this thesis was to gain a deeper understanding of older people's view of health and care while dependent on community care. Furthermore to describe and compare formal caregivers' perceptions of quality of care, working conditions, competence, general health, and factors associated with quality of care from the caregivers' perspective. Method: Qualitative interviews were conducted with 19 older people in community care who were asked to describe what health and ill health((I), good and bad care meant for them (II). Data were analyzed using content analysis (I) and a phenomenological analysis (II). The formal caregivers; 70 nursing assistants (NAs) 163 enrolled nurses (ENs) and 198 registered nurses (RNs), answered a questionnaire consisting of five instruments: quality of care from the patient's perspective modified to formal caregivers, creative climate questionnaire, stress of conscience, health index, sense of coherence and items on education and competence (III). Statistical analyses were performed containing descriptive statistics, and comparisons between the occupational groups were made using Kruskal-Wallis ANOVA, Mann-Whitney U-test and Pearson's Chi-square test (III). Pearson's  product moment correlation analysis and multiple regression analysis were performed studying the associations between organizational climate, stress of conscience, competence, general health and sense of coherence with quality of care (IV). Results: The older people's health and well-being were related to their own ability to adapt to and compensate for their disabilities and was described as negative and positive poles of autonomy vs. dependence, togetherness vs. being an onlooker, security vs. insecurity and tranquility vs. disturbance (I).  The meaning of good care (II) was that the formal caregivers respected the older people as unique individuals, having the opportunity to live their lives as usual and receiving a safe and secure care. Good care could be experienced when the formal caregivers had adequate knowledge and competence in caring for older people, adequate time and continuity in the care organization (II). Formal caregivers reported higher perceived quality of care in the dimensions medical-technical competence and physical-technical conditions than in identity-oriented approach and socio-cultural atmosphere (III). In the organizational climate three of the dimensions were close to the value of a creative climate and in seven near a stagnant climate. The formal caregivers reported low rate of stress of conscience. The RNs reported to a higher degree than the NAs/ENs a need to gain more knowledge, but the NAs and the ENs more often received training during working hours. The RNs reported lower emotional well-being than the NAs/ENs (III). The formal caregivers' occupation, organizational climate and stress of conscience were associated with perceived quality of care (IV). Implications: The formal caregivers should have an awareness of the importance of kindness and respect, supporting the older people to retain control over their lives. The nursing managers should employ highly competent and adequate numbers of skilled formal caregivers, organize formal caregivers having round the clock continuity. Improvements of organizational climate and stress of conscience are of importance for good quality of care.

Internal Control application : Empirical evidence from Sweden

Aim The aim of this study is to explore based on internationally recognised frameworks: 1. how internal control structures are applied in Sweden among different sectors; 2. how organizational size and environment affect internal control structures; and 3. the impact of internal control structures on organizational performance. Methods A quantitative method was used in the data collection and analysis. The sample consisted of 1117 organizations operating in Sweden. A mean analysis was conducted to measure the level of internal control structures among different industries, organizational sizes, and different choices of listing in the stock exchange market. Person’s correlation analysis was then used to explore possible correlations between external environmental factors and internal control structures, and internal control structures and organizational performance. Lastly, a structural model was built to measure the impact of internal control structures on organizational performance. The measurements of internal control structures and organizational performance are based on COSO framework’s principles and objectives. Results This study gives an insight on how internal control structures are applied across industrial sectors in Sweden, with financial institutions and manufacturing organizations having notably higher levels of internal control structures. Additionally, it provides evidence of the impact external environmental factors have on internal control structures. Furthermore, it shows that organizations that are listed in the Swedish stock exchange market have an equivalent level of internal control structures to those registered in the American stock exchange market. In contrast, organisations that are not listed in the stock exchange market have a notably lower level of internal control structures. Lastly, it illustrates the positive impact the presence of internal control structures has on organizational performance. 3 | P a g e Conclusion The results highlight a crucial role the supervisory authority Finansinspektionen (FI) has in regulating the Swedish financial market. They also show that the stability of the Swedish business environment has had a positive impact on the level of internal control structures.