"Vad som behövs? Det är sällan glasklart!" : En studie kring en organisations tillväxt och växtvärksproblematik

I en organisation belägen på Dalarnas landsbygd framkommer det i en medarbetarundersökning att ett ökande missnöje finns hos de anställda, där flera av problemen kan kopplas till den kraftiga expansion som organisationen just nu genomgår. Även en positiv organisationsförändring som tillväxt kan alltså bidra till problem hos de anställda. Denna studie har avsett att undersöka vilka utmaningar och möjligheter som upplevs hos de anställda i organisationen kopplat till den tillväxtfas de genomgår. Detta genom åtta djupintervjuer där urvalet var såväl chefer, medarbetare som HR-ansvariga. Utifrån respondenternas upplevelse av situationen fann vi fyra stora problemområden; avsaknad av gemensamma rutiner, otydliga roller, bristfällig information och kommunikation samt brist på proaktivt arbete för att säkerställa medarbetarnas kompetens. Vårt empiriska material tyder på att organisationen har ett gap när det kommer till utvecklingen av såväl de mänskliga resurserna, arbetssystem som ledarskapet. Antalet anställda ökar i en högre takt än organisationens infrastrukturella processer, något som kan ses som en organisatorisk växtvärk. Med utgångspunkt från resultatet ger vi förslag på vilka aktiviteter HR-funktionen bör fokusera på. För att bemöta utvecklingsgapet samt förhindra att fler växtvärkssymptom uppstår anser vi att HR bör fokusera på ett proaktivt arbete. En nyckelfaktor som vi genom vår utvecklade modell visar är att ledaren är av stor vikt för hur organisationen och dess medarbetare hanterar en växtvärkssituation. HR bör därför ha en klar bild över vilket stöd verksamhetens ledare behöver för att kunna skapa värde för organisationen, ledarna och medarbetarna. Några generella förslag på HR-aktiviteter går däremot inte att ge eftersom, precis som tidigare forskning visar, verksamheters individuella situation och kontext avgör vilka aktiviteter som är aktuella.

Patient participation : what it is and what it is not

In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions. Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation. The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation. The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context. In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

Lifestyle and health status in a sample of Swedish women four years after pregnancy : a comparison of women with a history of normal pregnancy and women with a history of gestational diabetes mellitus

Background: Despite the recommendations to continue the regime of healthy food and physical activity (PA) postpartum for women with previous gestational diabetes mellitus (GDM), the scientific evidence reveals that these recommendations may not be complied to. This study compared lifestyle and health status in women whose pregnancy was complicated by GDM with women who had a normal pregnancy and delivery. Methods: The inclusion criteria were women with GDM (ICD-10: O24.4 A and O24.4B) and women with uncomplicated pregnancy and delivery in 2005 (ICD-10: O80.0). A random sample of women fulfilling the criteria (n = 882) were identified from the Swedish Medical Birth Register. A questionnaire was sent by mail to eligible women approximately four years after the pregnancy. A total of 444 women (50.8%) agreed to participate, 111 diagnosed with GDM in their pregnancy and 333 with normal pregnancy/ delivery. Results: Women with previous GDM were significantly older, reported higher body weight and less PA before the index pregnancy. No major differences between the groups were noticed regarding lifestyle at the follow-up. Overall, few participants fulfilled the national recommendations of PA and diet. At the follow-up, 19 participants had developed diabetes, all with previous GDM. Women with previous GDM reported significantly poorer self-rated health (SRH), higher level of sick-leave and more often using medication on regular basis. However, a history of GDM or having overt diabetes mellitus showed no association with poorer SRH in the multivariate analysis. Irregular eating habits, no regular PA, overweight/obesity, and regular use of medication were associated with poorer SRH in all participants. Conclusions: Suboptimal levels of PA, and fruit and vegetable consumption were found in a sample of women with a history of GDM as well as for women with normal pregnancy approximately four years after index pregnancy. Women with previous GDM seem to increase their PA after childbirth, but still they perform their PA at lower intensity than women with a history of normal pregnancy. Having GDM at index pregnancy or being diagnosed with overt diabetes mellitus at follow-up did not demonstrate associations with poorer SRH four years after delivery.

Hanteringen när medarbetares privata problem inverkar negativt på arbetsplatsen : En studie ur ett ledarskapsperspektiv

Uppsatsens syfte var att undersöka hur ledare hanterar situationer där medarbetares privata problem inverkar negativt på arbetet för både arbetsgivare och övriga medarbetare. För att få svar på det har vi inspirerats av vinjettstudie som utgår från diskussioner av fiktiva fall. Vi har genomfört studien med fyra enskilda semistrukturerade intervjuer och en fokusgruppsintervju där vi först introducerade respondenterna med vinjetterna. Deltagarna till undersökningen valdes ut genom ett subjektivt urval där vi riktade in oss på ledare, angående vilken organisation de tillhörde var av mindre vikt. I teoridelen introducerades teorierna ledarskap, medarbetarskap, individen i gruppen, ekonomi, hälsa, lagar, organisationskultur och föreskrifter samt försäkringskassans roll. Resultatet analyserades sedan mot teorierna och vi kan konstatera att respondenterna generellt menade att det var viktigt att prioritera kommunikation och relationer. Betydelsefullt var att relationerna etablerades innan problemen uppstår eftersom det anses vara svårt att skapa relationer i konfliktfyllda lägen. Tiden har betydelse vid hantering av problem av den orsaken att gränsen för vad som är acceptabelt förflyttas med tidens gång. Beroende på problem varierade graden av toleransnivå hos chefer och övriga medarbetare i vår undersökning. Resultatet visade att gränsen för privatlivets påverkan på arbetslivet går när arbetet blir misskött och när kunder och andra medarbetare påverkas. Utifrån ett genusperspektiv ansåg intervjupersonerna att det saknade betydelse om chefen var en man eller kvinna när det handlade om att hantera problem som uppkom, det ansågs vara personligt.

The importance of body-mass exponent optimization for evaluation of performance capability in cross-country skiing

Introduction Performance in cross-country skiing is influenced by the skier’s ability to continuously produce propelling forces and force magnitude in relation to the net external forces. A surrogate indicator of the “power supply” in cross-country skiing would be a physiological variable that reflects an important performance-related capability, whereas the body mass itself is an indicator of the “power demand” experienced by the skier. To adequately evaluate an elite skier’s performance capability, it is essential to establish the optimal ratio between the physiological variable and body mass. The overall aim of this doctoral thesis was to investigate the importance of body-mass exponent optimization for the evaluation of performance capability in cross-country skiing. Methods In total, 83 elite cross-country skiers (56 men and 27 women) volunteered to participate in the four studies. The physiological variables of maximal oxygen uptake (V̇O2max) and oxygen uptake corresponding to a blood-lactate concentration of 4 mmol∙l-1 (V̇O2obla) were determined while treadmill roller skiing using the diagonal-stride technique; mean oxygen uptake (V̇O2dp) and upper-body power output (Ẇ) were determined during double-poling tests using a ski-ergometer. Competitive performance data for elite male skiers were collected from two 15-km classical-technique skiing competitions and a 1.25-km sprint prologue; additionally, a 2-km double-poling roller-skiing time trial using the double-poling technique was used as an indicator of upper-body performance capability among elite male and female junior skiers. Power-function modelling was used to explain the race and time-trial speeds based on the physiological variables and body mass. Results The optimal V̇O2max-to-mass ratios to explain 15-km race speed were V̇O2max divided by body mass raised to the 0.48 and 0.53 power, and these models explained 68% and 69% of the variance in mean skiing speed, respectively; moreover, the 95% confidence intervals (CI) for the body-mass exponents did not include either 0 or 1. For the modelling of race speed in the sprint prologue, body mass failed to contribute to the models based on V̇O2max, V̇O2obla, and V̇O2dp. The upper-body power output-to-body mass ratio that optimally explained time-trial speed was Ẇ ∙ m-0.57 and the model explained 63% of the variance in speed. Conclusions The results in this thesis suggest that V̇O2max divided by the square root of body mass should be used as an indicator of performance in 15-km classical-technique races among elite male skiers rather than the absolute or simple ratio-standard scaled expression. To optimally explain an elite male skier’s performance capability in sprint prologues, power-function models based on oxygen-uptake variables expressed absolutely are recommended. Moreover, to evaluate elite junior skiers’ performance capabilities in 2-km double-poling roller-skiing time trials, it is recommended that Ẇ divided by the square root of body mass should be used rather than absolute or simple ratio-standard scaled expression of power output.