Are empathy and compassion bad for the professional social worker?

Recent studies have shown that social workers and other professional helpers who work with traumatized individuals run a risk of developing compassion fatigue or secondary traumatic stress. Some researchers have hypothesized that helpers do this as a result of feeling too much empathy or too much compassion for their clients, thereby implying that empathy and compassion may be bad for the professional social worker. This paper investigates these hypotheses. Based on a review of current research about empathy and compassion it is argued that these states are not the causes of compassion fatigue. Hence, it is argued that empathy and compassion are not bad for the professional social worker in the sense that too much of one or the other will lead to compassion fatigue.

Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Communication in Smoking Cessation and Self-management : a study at Nurse-led COPD-clinics in Primary Health Care

ABSTRACTThe general aim of this thesis was to investigate behavioral change communication at nurse-led chronic obstructive pulmonary disease (COPD) clinics in primary health care, focusing on communication in self-management and smoking cessation for patients with COPD.Designs: Observational, prospective observational and experimental designs were used.Methods: To explore and describe the structure and content of self-management education and smoking cessation communication, consultations between patients (n=30) and nurses (n=7) were videotaped and analyzed with three instruments: Consulting Map (CM), the Motivational Interviewing Treatment Integrity (MITI) scale and the Client Language Assessment in Motivational Interviewing (CLAMI). To examine the effects of structured self-management education, patients with COPD (n=52) were randomized in an intervention and a control group. Patients’ quality of life (QoL), knowledge about COPD and smoking cessation were examined with a questionnaire on knowledge about COPD and smoking habits and with St. George’s Respiratory Questionnaire, addressing QoL. Results: The findings from the videotaped consultations showed that communication about the reasons for consultation mainly concerned medical and physical problems and (to a certain extent) patients´ perceptions. Two consultations ended with shared understanding, but none of the patients received an individual treatment-plan. In the smoking cessation communication the nurses did only to a small extent evoke patients’ reasons for change, fostered collaboration and supported patients’ autonomy. The nurses provided a lot of information (42%), asked closed (21%) rather than open questions (3%), made simpler (14%) rather than complex (2%) reflections and used MI non-adherent (16%) rather than MI-adherent (5%) behavior. Most of the patients’ utterances in the communication were neutral either toward or away from smoking cessation (59%), utterances about reason (desire, ability and need) were 40%, taking steps 1% and commitment to stop smoking 0%. The number of patients who stopped smoking, and patients’ knowledge about the disease and their QoL, was increased by structured self-management education and smoking cessation in collaboration between the patient, nurse and physician and, when necessary, a physiotherapist, a dietician, an occupational therapist and/or a medical social worker.Conclusion The communication at nurse-led COPD clinics rarely involved the patients in shared understanding and responsibility and concerned patients’ fears, worries and problems only to a limited extent. The results also showed that nurses had difficulties in attaining proficiency in behavioral change communication. Structured self-management education showed positive effects on patients’ perceived QoL, on the number of patients who quit smoking and on patients’ knowledge about COPD.

Hälsofrämjande friskvårdsarbete : En fallstudie om friskvårdsarbete inom kommunal vård- och omsorgsförvaltning

Under senare år har frågan om ett hållbart arbetsliv blivit allt viktigare. Det innebär att goda arbetsförhållanden kommer att bidra till att människor orkar arbeta fram till pensionen. Friskvård har gått från att enbart vara en förmån till att bli en investering för att främja hälsa. Anställdas hälsa och arbetsmiljö är en del av personalfunktionens övergripande arbete för att behålla personal. Fysiskt krävande yrken som omsorgsarbete är ett stort arbetsmiljöproblem som kräver att organisationer försöker förhindra att arbetsrelaterad sjukdom inträffar. Syftet med detta examensarbete är att undersöka vilka förutsättningarna, ur ett medarbetarperspektiv, organisationer bör ta i beaktande för att skapa ett framgångsrikt arbete med hälsofrämjande friskvårdsaktiviteter inom kommunal vård- och omsorgsförvaltning. Arbetet är begränsat till personal inom Ludvika kommun. Friskvård kan förebygga sjukdom, men det kan också öka individens välbefinnande och kan därmed utgöra en framgångsrik strategi för att skapa hälsosammare arbetsplatser. En kombination av metoder användes för datainsamling, i form av en kvantitativ enkätundersökning och en kvalitativ fokusgruppintervju. Resultaten visade bland annat att majoriteten av de anställda är positiva till friskvård på arbetstid och att det är ett fördelaktigt sätt att öka deltagandet, även för dem som är mindre fysiskt aktiva. Tidsbrist och socialt stöd är skäl till varför fysisk aktivitet är lägre eller uteblir. Förutom att de anställda som har ett individuellt ansvar är det chefer, i samråd med organisationen, som har det övergripande ansvaret för att skapa goda förutsättningar för att främja hälsan.

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.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and enhancement of well-being and sexual and reproductive health and rights in receiving countries after migration.

Must teachers be social workers, as well …? : Reflections on the current teacher role in the Swedish upper secondary school and how it affects teacher training

The Swedish upper secondary school has made a transition from a school for the elite to be a school for everybody. When almost every youth nowadays chooses to continue studying, for some of them this is not what they want to do most of all. However, as there in practice is no choice, there come up problems and many upper secondary school teachers experience a growing frustration. We will here discuss some aspects of the following questions: -  How do upper secondary schoolteachers handle their working-conditions in a new situation? - What possible consequences do this have on teacher education?

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

Mellanchefers upplevelser av psykosocial arbetsmiljö inom distributions- och logistikverksamhet – en pendling mellan hög aktivitet och låg stress?

Forskarnas genuina intresse för den psykosociala arbetsmiljön med koppling mellanchefer gav upphov till att dyka djupare inom området och belysa centrala delar i form av krav, kontroll och socialt stöd. Framåtskridandet går mot en ökad medvetenhet kring den psykosociala arbetsmiljön, då ohälsan i arbetslivet ökar och Arbetsmiljöverkets nya föreskrift om organisatorisk och social arbetsmiljö är i fokus. I linje med en ökad medvetenhet som sker kring den psykosociala arbetsmiljön vill vi rikta ett särskilt fokus till mellanchefer som bör ha en förmåga att hantera krav både uppifrån och ned. Studien har främst utgått från Robert Karaseks och Töres Theorells Krav – kontroll – stödmodellen. Syftet är att undersöka mellanchefers upplevelse med fokus på den psykosociala arbetsmiljön i ett privat företag inom distributions- och logistikverksamhet. Metoden har bestått av en kvalitativ metod i form av en fallstudie där semistrukturerade intervjuer ligger som grund med åtta respondenter ifrån distributionscentret. Resultatet uppvisar att mellancheferna har en hög grad av inflytande, upplevelsen av arbetskrav varierar men i koppling till befattningen är kraven rimliga. Det sociala stödet upplevs som bra på arbetsplatsen och anses av funktionscheferna som en viktig och central del i arbetet. Slutsatser som har uppnåtts är att funktionscheferna har rimliga krav och upplever en bra nivå av kontroll i arbetet, men att ha en alltför hög kontroll i arbetet kan leda till negativ stress. En balans i pendlingen mellan aktiva arbeten och lågstressarbeten anses vara en fördel för att bevara en god psykosocial arbetsmiljö. Detta för att motverka de negativa effekterna som kan uppstå av att befinna sig inom varje komponent för länge. I studien har det påvisats att företaget anses ha en god psykosocial arbetsmiljö och därmed kan ses som ett gott exempel i arbetslivet.

Socialarbetares genusmedvetenhet i bedömningar av behov och insatser : En kvalitativ vinjettstudie

The aim of this essay was to study if social workers have a gender awareness in the social work they perform and if it appears in the assessment of needs and intervention. A qualitative vignette study with four social workers who handle adult- and addictive clients have been performed. Gender theory is used to interpret the empirical results. The results of the study show that social workers doesn´t see any differences in the clients situation, or make any different assessment of needs depending on if the client is a man or a woman. Social workers also propose the same interventions to men and women. The interviews was done in two parts, before and after the primary design of the study was unveiled. In the first part the social workers didn´t reflect about gender at all, when they assessed the introduced vignette. In the second part of the interviews, a certain attention appeared concerning gender when the social workers reflected about social interventions that is given to men and women with an addiction. Based on the definition of gender awareness, the empirical material, the analysis of the result, prior research and gender theory the conclusion is drawn that social workers have some gender awareness in the social work they perform.Keywords: Gender, sex, gender awareness, social worker, assessment, equality

Small-Scale Farmers Land Use and Socioeconomic Situation in the Mount Elgon District in Northwestern Kenya : A Minor Field Study - Combined Field Mapping and Interview

This Minor Field Study was carried out during November and December in 2011 in the Mount Elgon District in Western Kenya. The objective was to examine nine small-scale farming household´s land use and socioeconomic situation when they have joined a non-governmental organization (NGO) project, which specifically targets small-scale farming households to improve land use system and socioeconomic situation by the extension of soil and water conservation measures. The survey has worked along three integral examinations methods which are mapping and processing data using GIS, semi structured interviews and literature studies.   This study has adopted a theoretical approach referred to as political ecology, in which landesque capital is a central concept. The result shows that all farmers, except one, have issues with land degradation. However, the extent of the problem and also implemented sustainable soil and water conservation measures were diverse among the farmers. The main causes of this can both be linked to how the farmers themselves utilized their farmland and how impacts from the climate change have modified the terms of the farmers working conditions. These factors have consequently resulted in impacts on the informants’ socioeconomic conditions. Furthermore it was also registered that social and economic elements, in some cases, were the causes of how the farmers manage their farmland. The farmer who had no significant problem with soil erosion had invested in trees and opportunities to irrigate the farmland. In addition, it was also recorded that certain farmers had invested in particular soil and water conservation measures without any significant result. This was probably due to the time span these land measures cover before they start to generate revenue.  The outcome of this study has traced how global, national and local elements exist in a context when it comes to the conditions of the farmers´ land use and their socioeconomic situation. The farmers atMt.Elgon are thereby a component of a wider context when they are both contributory to their socioeconomic situation, mainly due to their land management, and also exposed to core-periphery relationships on which the farmers themselves have no influence.

Attraktivt arbete ur enhetschefers perspektiv : En kvalitativ studie genomförd i Falu kommun

Sedan 1990- talet har de offentliga organisationerna genomgått flera stora förändringar som medfört att enhetschefer inom den kommunala verksamheten fått ökat ansvar och befogenheter, vilket gör enhetschefsrollen mer komplext. Rapporter visar på svårigheter att rekrytera och behålla chefer, därför är viktigt att undersöka hur enhetschefens arbete ska kunna utvecklas till ett mer attraktivt arbete. Ett attraktivt arbete skapas genom att ge medarbetarna bra förutsättningar inom arbetsinnehåll, arbetstillfredsställelse, samt arbetsförhållanden. I chefsyrket ingår tre roller varav en är medarbetarrollen som enligt teorin inte är speciellt prioriterad eller synliggjord. Studiens syfte är att identifiera vad som gör enhetschefyrket till ett attraktivt arbete samt hur det kan utvecklas. I studien har en kvalitativ forskningsmetod används för att uppnå en djupare förståelse kring enhetschefernas arbetssituation. Detta har bidragit till att ett hermeneutiska synsätt valts, då vi strävar efter att få en ökad förståelse. Studien genomfördes på Falu kommun, där sex enhetschefer inom omvårdnadsförvaltningen intervjuades. Resultatet visar att enhetscheferna är tillfredsställda med sin arbetssituation och upplever arbetet som attraktivt. Faktorer som varierande, handlingsfrihet, problemlösning, sociala kontakter och delar av erkänsla hör till attraktivitetsfaktorer i yrket. Enhetscheferna beskriver tre utvecklingsområden för att öka attraktiviteten. Det första innefattar ledarskapet i organisationen där brister förekommer inom kommunikation och planering. Andra utvecklingsområdet handlar om arbetstakten genom att individanpassa arbetsgruppernas storlek samt tid för reflektion och återhämtning. Tredje utvecklingsområdet enhetscheferna belyser är bristen på erkänsla från organisationen. Utöver enhetschefernas brister har vi identifierat ytterligare ett utvecklingsområde för att öka attraktiviteten. Under intervjuerna har det framkommit att det råder stor avsaknad av kollegor att "bolla idéer" med vilket i sin tur medför att arbetet upplevs som ensamt. För att motverka ensamheten är chefsgruppshandledning ett alternativ, där reflektion och feedback ingår. Forskningen visar att detta även leder till ökad självkänsla, engagemang.

Attraktivt arbete i offentlig sektor bland enhetschefer inom vård och omsorg

HR-funktionens uppgift i en organisation är att tillvarata den mänskliga resursen och se till att goda arbetsförhållanden uppnås. Detta för att kunna attrahera, rekrytera, behålla och utveckla kompetens (Kira 2003). På senare år har arbetsförhållanden och arbetsvillkor uppmärksammats på kommuner i Sverige för bland annat enhetschefer i äldreomsorgen. Arbetsförhållandena, arbetsvillkoren och framför allt den höga personalomsättningen bland dessa, har lett till en problematik som var en av valets viktigaste frågor 2014. Syftet med denna studie är att beskriva arbetsförhållanden för enhetschefer inom mindre kommuner i Sverige, inom den sociala sektorn och belysa hur dessa skulle kunna förbättras. Som studieobjekt har Orsa kommun använts. Resultatet av undersökningen visade att arbetssituationen för enhetschefer är övermäktig, då det är hög arbetsbelastning samt dålig struktur i arbetet. Enhetscheferna själva skulle gynnas av en assistent samt en arbetsbeskrivning för att minska arbetsbelastningen och få struktur i arbetet. Vår slutsats är att kommuner i Sverige borde arbeta med att skapa bättre arbetsförhållanden för enhetschefer samt arbeta för att underlätta arbetsbördan. Vårt förslag till Orsa kommun är att ta hjälp av vår handlingsplan och därmed anställa assistenter till enhetscheferna samt skapa arbetsbeskrivningar. Vidare forskning i ämnet skulle kunna belysa mentorskapets betydelse i den offentliga sektorn inom kommuner i Sverige samt organisationsstrukturens bemärkelse för arbetets attraktivitet.

Hälsofrämjande arbete på SSAB i Borlänge : Hälsofrämjande processer i arbetslivet och ledarskapets betydelse för medarbetarens hälsa

Problem: Arbetsmiljön är viktig för människors välbefinnande. Hälsofrämjande faktorer antas inte bara styrka individens fysiska och psykiska hälsa, utan även företagets konkurrenskraft och lönsamhet. I uppsatsen undersöker vi hur företaget SSAB i Borlänge arbetar med hälsa genom att tillämpa ett hälsofrämjande perspektiv och utgå från teorin om Känslan av sammanhang (KASAM). Ledarskapsvärderingar har betydelse för medarbetares hälsa (Hanson, 2004) och vi undersöker vilken uppfattning ett antal chefer har om sina roller i det hälsofrämjande arbetet och deras syn på medarbetarundersökningen HälsoSAM som företagshälsovården på SSAB bedriver. Arbetsbelastningen på medarbetare och chefer ökar till följd av sparkrav, samtidigt som resurserna minskar (Gatu, 2003). Följden blir en större risk för ohälsa och ett sätt att minska sjukfrånvaron är att genomföra hälsofrämjande insatser (Prevent, 2001). Syfte: Syftet med studien är att utifrån ett hälsofrämjande perspektiv förklara vad chefer har för möjligheter att skapa förutsättningar för att främja medarbetarnas hälsa på SSAB i Borlänge. Metod: Den metod som ligger till grund för uppsatsen baseras på ett kvalitativt angreppssätt där semistrukturerade intervjuer samt litteraturstudier genomförts för att samla information. Analys: Ledarens beteende påverkar medarbetarna. Hög arbetsbelastning på SSABs chefer leder till lägre närvaro bland medarbetarna, vilket i sin tur ger sämre förutsättningar för att främja hälsan. HälsoSAM kartlägger medarbetarnas hälsoläge, både välbefinnande och arbetskapacitet. Resultaten är vägledande i det hälsofrämjande arbetet men överbelastning, tidsbrist och kunskapsbrist hos cheferna bidrar till att uppföljningen inte blir systematisk. För ett väl fungerande hälsoarbete krävs systematik. Slutsats: Hälsofrämjande processer i arbetslivet skapas genom balans mellan krav och resurser. På SSAB i Borlänge hindras hälsoarbetet av tidsbrist och kunskapsbrist hos cheferna. Kostnadsbesparingar påverkar hälsoarbetet negativt och systematiken i uppföljningsarbetet blir lidande. Ansvaret för hälsoarbetet läggs på företagshälsovården, men utan stöd från chefer blir inte hälsoarbetet en naturlig del i verksamheten. Det är viktigt att i rådande situation se vad främjande av hälsa kan ge tillbaka till företaget i både ekonomiska och kvalitativa termer. Insikt om detta ökar chefernas incitament att prioritera hälsofrämjande processer och organisera arbetet så att människor har förutsättningar att hantera, kontrollera och klara av sina uppgifter.

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.