Emotioner och värdegrundsarbete : Om lärare, fostran och elever i en mångkulturell skola

This thesis explores aspects of teachers’ obligation to implement and discuss what are referred to in the Swedish national school curricula as “fundamental values” (“värdegrunden” in Swedish). The aim is to describe and analyze dilemmas in interpretations of and teachers’ work with these fundamental values. Four questions are related to this aim. The first addresses difficulties discussed in conversations between seven upper secondary teachers, during nine meetings over the course of one year. In these conversations the teachers reflected upon how to interpret the fundamental values in relation to their daily practice. The second question focuses on the considerable diversity of Swedish schools and examines the work of the teachers through a perspective of intersectionality. The third question concerns how Martha Nussbaum’s theory of emotions as judgments of value could be used for an understanding of the identified dilemmas. The fourth question focuses on ways in which the participating teachers’ discussions may contribute to a wider discussion about possible aims and circumstances of teachers’ work with the fundamental values. Chapter 2 introduces the theoretical framework of the study, Martha Nussbaum’s (2001) ethical thinking on emotions as judgments of value. She argues that emotions have four common cognitive components. They have (1) external objects, and are directed towards these objects. They are (2) intentional, reflecting a person’s particular point of view, his or her special way of beholding the object, and (3) consist of judgments, i.e. views of how things in the world are. According to Nussbaum’s Aristotelian ethics, emotions also (4) mirror the individual’s vision of what a good human life is like, and the vulnerability of it. The concept of eudaimonia, a fulfilled or flourishing life, is central. Chapter 3 focuses on ideas of ethnicity, and on the specific obligation mentioned in the curriculum of counteracting xenophobia and intolerance in a multicultural society. Chapter 4 discusses various aspects of the teachers’ thoughts on religiosity within Swedish society (often depicted as one of most secular in the world) and within the educational system that is non-denominational. Chapter 5 draws attention to different ways in which the teachers view and teach pupils about sexual orientation. Chapter 6 presents conclusions on potential advantages of and challenges involved in Nussbaum’s Aristotelian theory of emotions, when applied to teachers’ views of and practical work with the fundamental values described in the curriculum. One advantage is that emotions may be intellectually scrutinized and morally assessed, on grounds that are known beforehand and discussed in a democratic process. The non-productive division between emotions, on the one hand, and intellectual and moral capabilities, on the other, is transcended by Nussbaum’s theory. An important challenge is to reflect upon when to discuss the cognitive content of pupils’ emotions, and when it is appropriate to state what is right or wrong, and try to influence pupils accordingly. Keywords: Emotions, vulnerability, values education, religious education, teaching, Martha Nussbaum, ethnicity, religion, sexual orientation.

Facilitators and barriers to applying a national quality registry for quality improvement in stroke care

BACKGROUND: National quality registries (NQRs) purportedly facilitate quality improvement, while neither the extent nor the mechanisms of such a relationship are fully known. The aim of this case study is to describe the experiences of local stakeholders to determine those elements that facilitate and hinder clinical quality improvement in relation to participation in a well-known and established NQR on stroke in Sweden. METHODS: A strategic sample was drawn of 8 hospitals in 4 county councils, representing a variety of settings and outcomes according to the NQR's criteria. Semi-structured telephone interviews were conducted with 25 managers, physicians in charge of the Riks-Stroke, and registered nurses registering local data at the hospitals. Interviews, including aspects of barriers and facilitators within the NQR and the local context, were analysed with content analysis. RESULTS: An NQR can provide vital aspects for facilitating evidence-based practice, for example, local data drawn from national guidelines which can be used for comparisons over time within the organisation or with other hospitals. Major effort is required to ensure that data entries are accurate and valid, and thus the trustworthiness of local data output competes with resources needed for everyday clinical stroke care and quality improvement initiatives. Local stakeholders with knowledge of and interest in both the medical area (in this case stroke) and quality improvement can apply the NQR data to effectively initiate, carry out, and evaluate quality improvement, if supported by managers and co-workers, a common stroke care process and an operational management system that embraces and engages with the NQR data. CONCLUSION: While quality registries are assumed to support adherence to evidence-based guidelines around the world, this study proposes that a NQR can facilitate improvement of care but neither the registry itself nor the reporting of data initiates quality improvement. Rather, the local and general evidence provided by the NQR must be considered relevant and must be applied in the local context. Further, the quality improvement process needs to be facilitated by stakeholders collaborating within and outside the context, who know how to initiate, perform, and evaluate quality improvement, and who have the resources to do so.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

Factors facilitating a national quality registry to aid clinical quality improvement : findings of a national survey

Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R2=0.76) with ‘Colleagues’ call for local results’ (p=<0.001), ‘Management Request of Registry data’ (p=<0.001), and it was said to be ‘Simple to explain the results to colleagues’ (p=0.02). Using stepwise regression, ‘Colleagues’ call for local results’ was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.