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Rättfärdigade prioriteringar: en kvalitativ analys av hur personal i äldreomsorgen hanterar motstridiga verksamhetslogiker
Jönköping University, School of health and welfare. (Kvinna barn familj)
2017 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This dissertation aims at contributing to social scientific knowledge about prevailing prioritizations in eldercarepractice by looking at an economic and a caring logic, and how these logics are overlapping, contradictory or comein conflict with each other. A more concrete aim is to understand how the personnel describe their work with orfor balance between the logics and their justifications prioritizations made in the care of older persons. The researchquestion is: How do personnel and care unit manager at a public nursing home understand and handle the twologics that govern care work for facilitating wellbeing of the residents. The aim and research question led to threesub-aims: 1) to analyze the personnel’s experiences of and meaning making about the care work they carry out, 2)to illuminate and problematize the two logics above, and 3)to analyze how the personnel justify their prioritizationsin prevailing context, and how their accountability have an effect on their professional identities.Empirical material was gathered through 13 individual interviews with care personnel and their care unitmanager at a public nursing home in Sweden. These interviews were complemented by a group interview. Thematerial was analyzed by the use of three methods: phenomenology (Paper I and II), reflexive analysis (Paper III),and a positioning analysis (Paper IV). Paper I found that the personnel understands the residents’ well-being asbeing characterized by feeling of being existentially touched. This essence is constituted by feeling freedom ofchoice, pleasure, and closeness to someone or something. In Paper II, the work for facilitating this kind of wellbeingwas characterized by three ambiguities: (i) freedom of choice for the older persons vs. institutionalconstraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need forroutine vs. the eldercarers' not being able to know what the residents need. Paper III showed that the care unitmanager created a hybrid of the two logics (economy is care and vice versa) and that the personnel oppose thishybrid. The opposition is shaped as the personnel divides their work in care and “those other things”. Thesefindings showed how interaction between the logics expresses itself in practice and that it is the personnel who hasto handle contradictions between the logics in their everyday care work. The positioning analysis in Paper IV hadthree levels. The first level showed how the carers align with their peers and that they find the organizationalframe, within which they have agency, changed due to increased workload. This change led to an order of priorities.The second level showed that the carers relate to three aspects when making accounts: the care itself, the olderpersons, and the media. The third level showed that the carers share a view of administration, cleaning, servingmeals, and filling up supplies, as not being parts of caring.The dissertation’s theoretical framework focused on theories on logics, accountability, and professionalidentity. The conclusion is that both logics are needed in order to facilitate the well-being of the older persons. Therelationships between the two logics are not always clear and if their contradictions are not illuminated, there is arisk for a care practice that does not facilitate the well-being of their residents. An important theoreticalcontribution is that logics of activities should be understood vertically (form political, through management, anddown to the level of practice) instead of horizontally. The practical implications emphasize the importance ofsupporting the personnel’s professional identity on the one hand, and discussing the logics on the other. Byunderstanding differences between definitions on management-level and practice level, a homogeneity can bereached.

Place, publisher, year, edition, pages
Jönköping: School of Health and Welfare , 2017. , 84 p.
Series
Dissertation Series, ISSN 1654-3602 ; 76
Keyword [en]
Eldercare, personnel, logics, accounts, professional identity, qualitative method
Keyword [sv]
Äldreomsorg, personal, logiker, förklarbarhet, professionell identitet, kvalitativ metod
National Category
Other Social Sciences Other Social Sciences not elsewhere specified Social Work
Research subject
Humanities and Social sciences
Identifiers
URN: urn:nbn:se:his:diva-13250ISBN: 978-91-85835-75-1 OAI: oai:DiVA.org:his-13250DiVA: diva2:1058608
Public defence
2017-01-13, Insikten, Skövde, 12:16 (Swedish)
Note

Huvudämne: Välfärd och socialvetenskap

Available from: 2016-12-29 Created: 2016-12-21 Last updated: 2016-12-29Bibliographically approved
List of papers
1. Feeling existentially touched - A phenomenological notion of the well-being of elderly living in special housing accommodation from the perspective of care professionals
Open this publication in new window or tab >>Feeling existentially touched - A phenomenological notion of the well-being of elderly living in special housing accommodation from the perspective of care professionals
2013 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 8, 20587Article in journal (Refereed) Published
Abstract [en]

This article presents a phenomenological analysis of interview material, in which 12 care professionals in elderly care reflect on the elderly's well-being within the frame of special housing accommodation. The perspective of the care professionals is of special interest. The findings show that the well-being is characterized as the elderly's feelings of being existentially touched. The well-being is an existential experience of being acknowledged as a human being and is an approach that classifies the elderly's needs as those of having, loving, and being. The meaning of the phenomenon is elucidated by the constituents: (1) to feel the freedom of choice, (2) to feel pleasure, and (3) to feel closeness to someone or something. The findings contribute new understanding of well-being in the elderly care by its existential dimension of the well-being as "just being'' and of doing things in order to experience meaningfulness. Accordingly, the well-being of the elderly as it is seen from the perspective of the care professionals involves both carers' subjectivity and intersubjectivity between the care professional and the elderly. An implication for promoting elderly's well-being is to develop awareness of these existential dimensions.

Place, publisher, year, edition, pages
CoAction Publishing, 2013
Keyword
Well-being, phenomenology, elderly care, lifeworld, lived experience, existentially touched
National Category
Social Sciences
Research subject
Humanities and Social sciences
Identifiers
urn:nbn:se:his:diva-8573 (URN)10.3402/qhw.v8i0.20587 (DOI)000317964600001 ()23601762 (PubMedID)2-s2.0-84878910405 (Scopus ID)
Available from: 2013-10-24 Created: 2013-10-24 Last updated: 2016-12-21Bibliographically approved
2. Witnessing presence: Swedish care professionals' experiences of supporting resident's well-being processes within the frame of residential care homes (RCH)
Open this publication in new window or tab >>Witnessing presence: Swedish care professionals' experiences of supporting resident's well-being processes within the frame of residential care homes (RCH)
2016 (English)In: Journal of Aging Studies, ISSN 0890-4065, E-ISSN 1879-193X, Vol. 37, 1-9 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this article is to analyse the phenomenon of supportive care for older persons' well-being. The phenomenon is seen from the eldercarers' meaning-making through their lifeworld perspective at a residential care home. Based on primary empirical interview material with twelve professionals in the context of Swedish eldercare, a phenomenological analysis was undertaken. The result shows that the phenomenon of supportive care for older persons' well-being creates certain ambiguities in the professionals' meaning-making. In practice, it balances between the older persons' (from hereon called residents) needs and the conditions of the eldercare organization. The ambiguities (the what) is made up by three constituents: (i) freedom of choice for the older persons vs. institutional constraints, (ii) the residents' need for activation vs. wanting not to be activated, and (iii) the residents' need for routine vs. the eldercarers' not being able to know what the residents need. The conclusions drawn are that this ambiguity has consequences for the eldercarers' choice of handling supportive care for older persons' well-being (the how). They have to navigate between the support for authenticity, dwelling and mobility, and their own presence and time. In performing supportive care for older persons' well-being, the eldercarers have to consider aspects concerning the resident's lifeworld, the social setting of the eldercare ward, and the institutional demands of the organization. The practical implications for supporting well-being in the care of older residents are manifested in the importance of 'the little things', and the eldercarer's ability to give receptive attention, which requires presence.

Place, publisher, year, edition, pages
Elsevier, 2016
Keyword
Supportive care, Well-being, Lived experience, Care professionals, Residential care home
Identifiers
urn:nbn:se:his:diva-12600 (URN)10.1016/j.jaging.2016.01.001 (DOI)000376704700001 ()27131273 (PubMedID)2-s2.0-84960873221 (Scopus ID)
Available from: 2016-06-27 Created: 2016-06-27 Last updated: 2017-05-29

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Citation style
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