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.

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.

Understanding older people’s experiences of home care through the capability approach

The core concepts of CA In the theoretical framework of CA, well-being is constituted by a person’s unique way of functioning and capabilities. This means that a person's well-being is personal and involves freedom of choice which in turn means they have a number of options. Although many people may have the same resources, it is of importance to study how these resources are converted into how they function. Thus, wellbeing is about the person's freedom to achieve in general and the capabilities to function in particular (Sen, 1995). Strength of the capability approach The capability approach is a useful tool for matching objective evaluations with subjective metrics. Furthermore, although one’s individual abilities are in focus, contextual factors, and subjective perceptions and experiences, are taken into consideration. Critiques against the CA The capability approach has been criticized for being too individual-centered and not taking sufficient account to social structures in society. It is difficult to know what a person would choose to do if other options were available. Therefore, to operationalize abilities involves uncertainties.

Mode, senmodernitet, identitet

Fashion, late modernity and identity A common discussion in the late modern era is the role that tradition plays concerning individual identity. This forms a background to our article that focuses on consumer culture and one of its characteristics – fashion. To what extent does consumer culture and fashion contribute to the undermining of traditions, and how does this affect individual identity? We discuss two interpretations of consumption in shaping individual identity: the first interpretation maintains that by consumption individuals obtain an increasing freedom of choicemaking them free from the power of tradition, and thereby responsible for their lifestyle choices. According to the second interpretation, the free choice is illusory. This choiceis strongly influenced by factors such as social class and producers’ manipulative skills. Contrasting classical social theorists with contemporary fashion theory we argue that late modern fashion is characterized by quick changes and pluralism that often stand in contrast to tradition. We further discuss the increased importance of taste and new diffusion patterns as signs of a more individualized fashion, and discuss neo-tribalism as a post-traditional kind of community.

Motstånd och stöd : en studie av svenska muslimska församlingar

Opposition and Support: A Study of Swedish Muslim Congregations Anti-Islamic attitudes are deeply rooted in Western Europe, and Muslims have, especially in the post-September 11 context, experienced discrimination and demonization. But how do anti-Islamic attitudes affect practicing Muslims and their congregations? The aim of this study, the first of its kind in Europe, is to present a statistically representative view of how Muslim congregations in Sweden experienced the reactions from the surrounding community. The results of the survey carried out show that according to the representatives of the local congregations (n=105) half of the congregations have experienced opposition from the local community and in 40 percent of the congregations criminal offences have been committed against active Muslims or their places of worship.  This opposition is closely connected with two types of situations: either international occurrences (i.e. terrorist bombings in, for example, London, Madrid) or local events that have emphasized the presence of Islam in the public sphere. A multivariate analysis of the results of the study shows that the strongest opposition has taken place in small municipalities with a large proportion of immigrants. However, opposition does not preclude support. On the contrary, opposition appears to have a mobilizing effect on those who support the right of Muslims to exercise freedom of religion. However, neither opposition nor support are the key factors affecting whether congregations see themselves as established in the local community. The degree of anchorage depends on the demographic composition of the congregation and on the degree of contact that the members have with the surrounding community.

Biståndshandläggaren och samvetsstressen : En kvalitativ intervjustudie

Syftet med studien var att utforska socialarbetares upplevelse av arbetsrelaterad samvetsstress. Vi ville identifiera vad samvetsstress kan vara för yrkesgruppen socialarbetare vars arbetsuppgift innefattar myndighetsutövning och vad i arbetet som orsakar samvetsstress. Sex stycken kvalitativa intervjuer genomfördes med socialarbetare vars yrke innefattar myndighetsutövning. Resultatet visar att samtliga intervjupersoner upplever samvetsstress när de beskriver sig ha svårt att hantera sitt dåliga samvete och att detta leder till negativa psykiska och fysiska stressymptom. Intervjupersonerna beskriver dock upplevelsen av samvetsstress i olika grad vilka kategoriserades: ständig närvaro av samvetsstress, närvaro av samvetsstress i vissa situationer samt medveten bortträngning av samvetsstress. Resultatet visar vidare att samvetsstress kan skapas av de krav och förväntningar som organisationen, brukare och anhöriga samt socialarbetaren själv har om de upplevs som övermäktiga och motstridiga. Vår studie indikerar på ett behov av vidare forskning om samvetsstress hos socialarbetare.