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Sökning: hsv:(SAMHÄLLSVETENSKAP) > Högskolan i Skövde

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1.
  • Cregård, Anna, et al. (författare)
  • A critique on physicians as managers in the healthcare sector coping with contradictions in managerial and medical logics
  • 2012
  • Konferensbidrag (refereegranskat)abstract
    • In the healthcare sector the physicians more and more often become managers, in Sweden as well as in many other countries. This is a global trend, which is motivated by better quality, higher efficiency and an increased possibility to control professional actors in the organization. Managing professions are perceived as difficult for many reasons and the appointment of physicians as managers is supposed to solve this problem. Our aim is to critically discuss the appointment of physicians on traditional management positions in healthcare sector and what it might result in. We recognize that there are positive effects, but they do not align with the rhetoric concerning these appointments. We also discuss an alternative way of organizing the management of professionals in healthcare organizations. We use two theoretical concepts to discuss this phenomenon: principles of control and shift in trust. The concepts are used to categorize and analyze our empirical data, which consist of deep interviews with 15 physicians and nurses, five focus groups consisting of physicians (managers) and five texts on the relationship between politics, administration and professions, written by physicians (managers) in management training. We also develop the concepts of medical and managerial logics. Our respondents recognize the principles of control as rational, and they perceive them as important. But there are contradictions between medical and managerial logics. The management discourse alter the care and raises questions they themselves cannot answer, for example “Is it right to treat people who themselves are responsible for their sickness”? They also discuss medical concepts as being altered, for example the course of treatment being completed. Nowadays the concepts concern strictly medical issues, which is not necessarily good in a health perspective. The shift in trust concerns four levels: the trust between individuals, between professional groups, between organizational levels and between the whole society and the healthcare system. For example the respondents mean that the staff sometimes are questioning if the physician as a manager have enough medical day-to-day practice, and there are examples where the staff try to steer away complicated surgery from their superior. The staff also question if he or she is competent enough in management. Another example is that there is a risk of a decrease in trust in the healthcare system as a whole. Gains and losses are described in monetary terms, and the business language is not recognised as appropriate in this kind of organization. In our conclusions we discuss that there are a chance that appointing physicians on administrative assignments might bring the ears of the colleagues, increased transparency in the everyday care and perhaps a better understanding of overall decisions. But there are also some negative effects and risks – which we discuss using the concepts of medical and managerial logics. Appointing physicians as managers result in two contradicting logics pressed into one individual, who are supposed to handle the contradictions on an individual basis. For example, this means that the principles of ethics will collide with a different rhetoric – from the rationality of medical logics (with equivalence principle and loyalty to the patient) to the rationality of business logics (with cost minimization, production maximization and loyalty to the organization). We summarize the risks below. —Risk 1: When the physician loses skill, or perceived as less competent than earlier, there will be consequences for both the physician and the patient.—Risk 2: When trust in the physician manager decreases, he/she will not gain support by other physicians.—Risk 3: When the trust between different levels, groups and individuals in the organization decreases, it will also decrease for care in general.—Risk 4: When important values in the service domain are pushed aside, this will favour the values in the administrative domain (efficiency over quality).                  Finally we discuss other ways of handling uncontrollable professional organizations, for example by refining administrative and medical roles, by establishing medical management as a speciality within medical education, and by re-strengthen the medical logic. Most important is to alter and nuance the discourse around physicians as managers.
2.
  • Lundin, Anette (författare)
  • Rättfärdigade prioriteringar en kvalitativ analys av hur personal i äldreomsorgen hanterar motstridiga verksamhetslogiker
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • 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.
3.
  • Berg, Lars-Erik, et al. (författare)
  • Identitet och genus i lek med dockor och figurer i förskolan
  • 2006
  • Ingår i: Nordisk Pedagogik. - Oslo : Universitetsforlaget. - 0901-8050. ; 26:2, s. 124-138
  • Tidskriftsartikel (refereegranskat)abstract
    • Denna text handlar om lek med leksaker som traditionellt varit exkluderade i svensk förskola, t.ex. Barbie och Action Man. Förskolan präglas av värden som står i motsättning till de «genusifierade» värden som förknippas med dessa och liknande leksaker (Almqvist, 1994; Fredricson, 2003). Samtidigt är förskolan en del av samhället med dess stereotypa genusrepresentationer
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4.
  • Organisatorisk resiliens: : Vad är det som gör företag och organisationer livskraftiga
  • 2014
  • Samlingsverk (redaktörskap) (övrigt vetenskapligt)abstract
    • I den här boken beskrivs vad som kan göra företag och organisationer mer motståndskraftiga mot kriser och påfrestningar, samt vad som utmärker organisationer som når goda resultat under långa tidsperioder. Författarna analyserar också varför företag kan hamna i stagnationsprocesser, historiska framgångar till trots. Tolkningarna görs utifrån en ny modell som beskriver hur ekonomiska, tekniska och sociala resurser behöver kombineras med varandra i syfte att hantera omvärldskrav och tillvarata marknadsmöjligheter.
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5.
  • Bergh, Ingrid, et al. (författare)
  • An application of pain rating scales in geriatric patients.
  • 2000
  • Ingår i: Aging (Milan, Italy). - 0394-9532. ; 12:5, s. 380-7
  • Tidskriftsartikel (refereegranskat)abstract
    • This study examined the applicability of three different pain rating scales, the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS) and the Numeric Rating Scale (NRS), in geriatric patients. Data collection was performed in a geriatric clinic at a university hospital. A structured interview was conducted with 167 patients (mean age = 80.5 years). Patients rated their current experience of pain twice with a 5-minute pause in-between on the VAS, GRS and NRS, and were then asked if they experienced pain, ache or hurt (PAH) or other symptoms. The correlations were high and significant both between the ratings of the VAS, GRS and NRS (r = 0.78-0.92; p < 0.001) (alternative-forms reliability), and between the test and retesting (r = 0.75-r = 0.83; p < 0.001) (test-retest reliability). A logistic regression analysis showed that the probability to accomplish a rating on the pain scales decreased with advancing age of the patient, and this was especially marked for the VAS. The probability of agreement between the patients' ratings of pain and the verbal report of PAH tended to decrease with advancing age; this was especially so for the VAS. Patients who verbally denied PAH but reported pain on the scales rated it significant lower (p < 0.001) than those who verbally reported PAH and rated the pain as well. Eighteen percent of patients who denied pain but rated a pain experience verbally expressed suffering or distress. The study suggests that pain rating scales such as the VAS, GRS and NRS can be used to evaluate pain experience in geriatric patients. However, agreement between verbally expressed experience of PAH, and the rated experience of pain tended to decrease with advancing age. This indicates that the pain-evaluating process will be substantially improved by an additional penetration supported by a wide variety of expression of hurt, ache, pain, discomfort and distress.
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6.
  • Bergh, Ingrid, et al. (författare)
  • Assessing pain and pain relief in geriatric patients with non-pathological fractures with different rating scales.
  • 2001
  • Ingår i: Aging (Milan, Italy). - 0394-9532. ; 13:5, s. 355-61
  • Tidskriftsartikel (refereegranskat)abstract
    • Although pain is a frequent problem among elderly patients, they are often omitted in clinical trials and few studies have focused on assessing pain relief in this population. The aim of this study was to compare geriatric patients' verbally reported effect of analgesics with changes in pain experience rated with four different rating scales: the Visual Analogue Scale (VAS), the Graphic Rating Scale (GRS), the Numeric Rating Scale (NRS), and the Pain Relief Scale (PRS). Altogether 53 geriatric patients (mean=82 yrs) with non-pathological fractures in 4 geriatric units at a large university hospital were selected. In connection with the administration of analgesics, the patients were asked to "Mark the point that corresponds to your experience of pain just now at rest" on the VAS, GRS and NRS. This was repeated after 1.5-2 hours, and a direct question was asked about whether the analgesic medication given in connection with the initial assessment had had any pain-alleviation effect. Two comparisons were conducted with each patient. The results show that the probability of accomplishing a rating on the VAS, GRS, NRS, and PRS was lower with advancing age in these elderly fracture patients. The correlations between the ratings of the VAS, GRS and NRS were strong and significant (r=0.80-0.95; p<0.001) both at the initial assessments and at the re-assessments. However, the verbally reported effects of the analgesics were often directly opposite to the changes in rated pain. Therefore, application of the VAS, NRS, GRS and PRS for the purpose of assessing pain relief must be combined with supplementary questions that allow the patient to verbally describe possible experience of pain relief.
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7.
  • Bergh, Ingrid, et al. (författare)
  • Descriptions of pain in elderly patients following orthopaedic surgery.
  • 2005
  • Ingår i: Scandinavian journal of caring sciences. - 0283-9318. ; 19:2, s. 110-8
  • Tidskriftsartikel (refereegranskat)abstract
    • The aims of this study were to investigate what words elderly patients, who had undergone hip surgery, used to describe their experience of pain in spoken language and to compare these words with those used in the Short-Form McGill Pain Questionnaire (SF-MPQ) and Pain-O-Meter (POM). The study was carried out at two orthopaedic and two geriatric clinical departments at a large university hospital in Sweden. Altogether, 60 patients (mean age =77) who had undergone orthopaedic surgery took part in the study. A face-to-face interview was conducted with each patient on the second day after the operation. This was divided into two parts, one tape-recorded and semi-structured in character and one structured interview. The results show that a majority of the elderly patients who participated in this study verbally stated pain and spontaneously used a majority of the words found in the SF-MPQ and in the POM. The patients also used a number of additional words not found in the SF-MPQ or the POM. Among those patients who did not use any of the words in the SF-MPQ and the POM, the use of the three additional words 'stel' (stiff), 'hemsk' (awful) and 'räd(d)(sla)' (afraid/fear) were especially marked. The patients also combined the words with a negation to describe what pain was not. To achieve a more balanced and nuanced description of the patient's pain and to make it easier for the patients to talk about their pain, there is a need for access to a set of predefined words that describe pain from a more multidimensional perspective than just intensity. If the elderly patient is allowed, and finds it necessary, to use his/her own words to describe what pain is but also to describe what pain is not, by combining the words with a negation, then the risk of the patient being forced to choose words that do not fully correspond to their pain can be reduced. If so, pain scales such as the SF-MPQ and the POM can create a communicative bridge between the elderly patient and health care professionals in the pain evaluation process.
8.
  • Bergh, Ingrid, et al. (författare)
  • Pain and its relation to cognitive function and depressive symptoms: a Swedish population study of 70-year-old men and women.
  • 2003
  • Ingår i: Journal of pain and symptom management. - 0885-3924. ; 26:4, s. 903-12
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to investigate the prevalence of pain and its characteristics, and to examine the association of pain with cognitive function and depressive symptoms, in a representative sample of 70-year-old men and women. Data were collected within the gerontological and geriatric population studies in Göteborg, Sweden (H-70). A sample of 124 men and 117 women living in the community took part in the study. A questionnaire was applied which included four different aspects of pain experience: prevalence, frequency of episodes of pain, duration and number of locations. In close connection to this, depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale. The prevalence of pain during the last 14 days was higher in women (79%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />91) than in men (53%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />65) (P&lt;0.001). Women (68%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />78) also reported pain that had lasted for &gt;6 months to a greater extent than men (38%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />46) (P&lt;0.001). The frequency of episodes of pain was also higher among women, 64% (n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />74) reporting daily pain or pain several days during the last 14 days while 37% of the men (n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />45) did so (P&lt;0.001). Women (33%, n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />38) also reported pain experience from ?3 locations more often than men (11%; n<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />=<img src="http://www.journals.elsevierhealth.com/webfiles/images/transparent.gif" />13) (P&lt;0.001). On the other hand, the association between depressive symptoms and pain experience was more evident in men than in women. Women were taking significantly more antidepressants compared to men (P&lt;0.03). The results show that pain is common in 70-year-old people and especially in women. However, associations between depressive symptoms and the four aspects of pain experience were more pronounced among men
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9.
  • Bergh, Ingrid, et al. (författare)
  • SMÄRTA HOS ÄLDRE: Skattningsskalor – förekomst och verbala uttryck för smärta och smärtlindring
  • 2003
  • Ingår i: Incitament. ; :7, s. 516-518
  • Tidskriftsartikel (övrigt vetenskapligt)abstract
    • Smärta är inte en del av det normala åldrandet, men många äldre drabbas av sjukdomar som leder till smärta. Smärta är en subjektiv sensorisk och emotionell obehagsupplevelse med faktisk eller potentiell vävnadsskada. Varje person upplever smärta på sitt sätt och denna uppfattning får avgörande betydelse för hur hälso- och sjukvårdspersonal kan förhålla sig till människor med smärta.Utgångspunkten för denna avhandling var att studera smärtförekomst bland äldre och att evaluera användandet av smärtskalor. Våra resultat visar att skattningsskalor kan vara till hjälp.Artikeln baseras Ingrid Berghs avhandling: Pain in the elderly - Rating scales, prevalence and verbal expression of pain relief
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10.
  • Gulz, Agneta, et al. (författare)
  • Lärande och kognition
  • 2012
  • Ingår i: Kognitionsvetenskap. - Lund : Studentlitteratur. - 9789144051666 ; s. 219-228 (10 s.)
  • Bokkapitel (övrigt vetenskapligt)
  •  
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