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.

Personlighetsbedömning i samband med rekrytering : En studie om bemanningsbranschens personlighetsbedömning vid en rekrytering

Att medarbetare är av existentiell betydelse för en organisations överlevnad är sedan länge känt. Därmed är rekrytering en av de viktigaste funktionerna inom HR för att attrahera rätt kompetens till organisationen då en misslyckad rekrytering vanligen leder till bortkastad tid och dyra rekryteringsprocesser. Något som kommit att få allt större betydelse vid urvalet och bedömningen av nya medarbetare är kandidaters personlighet. Forskning visar att personlighetsdrag spelar en stor roll när det kommer till framtida arbetsprestationer och förmågan att göra rätt bedömningar av människor är därför central. Teorier om synen på personlighet, kompetens, kompetensbaserad rekrytering och urval samt bedömningsmetoder och personlighetsbedömning används för att analysera studiens resultat. Denna kvalitativa studies övergripande syfte var att öka förståelsen för hur rekryterare bedömer en kandidats personlighet vid en rekryteringsprocess inom bemanningsföretag. Bemanningsföretag är företag som ständigt arbetar med rekrytering och uthyrning av personal, varför ett proaktivt bemanningsarbete krävs för att skapa en konkurrensfördel på marknaden. Inför denna fallstudie kontaktades tre av den svenska bemanningsbranschens största aktörer varav två rekryterare på vardera företag deltog i semistrukturerade intervjuer. Personlighet ansågs generellt som något viktigt som samtliga rekryterare lade stor vikt vid under hela processens gång, från utformandet av kravprofilen till avslutande bedömning. Bedömningen skedde genom såväl test som intervju och referenstagning. Samtliga poängterade vikten av att alltid göra en helhetsbedömning av kandidaten och att det därmed var svårt att vikta exempelvis formella kompetenser mot personliga egenskaper. Resultatet visar att bemanningsbranschens arbete med personlighetsbedömning vid rekrytering utgår ifrån strukturerade bedömningsmetoder. Deras gedigna och proaktiva arbete med rekrytering lever upp till påståendet om att personalen är en organisations viktigaste resurs och vikten av att förstå innebörden av personlighetens betydelse i uttrycket ”rätt person på rätt plats”.

Formal caregivers' perceptions of quality of care for older people : associating factors

Background: Despite the growing number of studies concerning quality of care for older people, there is a lack of studies depicting factors associated with good quality of care from the formal caregivers' perspective. The aim was to describe formal caregivers' perceptions of quality of care for older people in the community and explore factors associated with these perceptions. In total, 70 nursing assistants, 163 enrolled nurses and 198 registered nurses from 14 communities in central Sweden participated in the study. They filled out the following questionnaires: a modified version of Quality from the Patient's Perspective, Creative Climate Questionnaire, Stress of Conscience Questionnaire, items regarding education and competence, Health Index and Sense of coherence questionnaire. The overall response rate was 57 % (n = 431). Results: In the perceived reality of quality of care respondents assessed the highest mean value in the dimension medical-technical competence and physical technical conditions and lower values in the dimensions; identity-oriented approach, socio-cultural atmosphere and in the context specific dimension. The caregivers estimated their competence and health rather high, had lower average values in sense of coherence and organizational climate and low values in stress of conscience. Conculsions: The PR of quality of care were estimated higher among NA/ENs compared to RNs. Occupation, organizational climate and stress of conscience were factors associated with quality of care that explained 42 % of the variance. Competence, general health and sense of coherence were not significantly associated to quality of care. The mentioned factors explaining quality of care might be intertwined and showed that formal caregivers' working conditions are of great importance for quality of care.