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Little evidence exists on whether and why organizations comply with regulations that are not monitored or enforced. To address that shortage, this study evaluates the 2007 repeal of an essentially unenforced regulation mandating private and local government employers in Sweden to post their vacancies publicly at the Public Employment Service. Exploiting the fact that central government employers were not affected, difference‐in‐differences analyses identify a substantial negative effect of the repeal on local government employers' vacancy posting propensity – with similar results for the private sector. At odds with deterrence models of regulatory compliance, these findings hint at an important role for organizational factors related to cultures and norms. Heterogeneity analyses indicate that local governments with more law‐abiding organizational culture and stronger social responsibility commitment were more prone to comply with the unenforced regulation. The results thus simultaneously point to an untapped potential and to some possible preconditions for unenforced regulatory strategies. [ABSTRACT FROM AUTHOR]

The paper unpacks the relationship between local culture and agency to enhance our understanding of local variations of agency. The paper studies two former old industrial places in Sweden; one place characterized by an entrepreneurial culture (Borås), the other with a company town culture (Kiruna). Both cases experienced structural crisis around 1970s. A study period of more than 30 years is used to analyse actions and actors present in different phases of development, using 38 semi-structured interviews. The concepts of change agency and reproductive agency are used to analyse agentic patterns. Cultural transformation is mapped using values, heroes, symbols and rituals. The paper finds that the entrepreneurial culture is an enabling condition for change agency, whereas the company town culture is hampering change agency. The paper also finds that lock-ins can continue to affect actors after a crisis and that opportunities for change agency therefore is actor-specific, i.e. that local agency varies between actors and over time. Reproductive agency is present in both regions to maintain the cultural identity, but the company town culture is more resistant to institutional changes. Yet, both local cultures have changed, and in both cases the changes have opened for more change agency. [ABSTRACT FROM AUTHOR]

This paper illuminates how teachers are influenced by age, gender and sexuality in teaching about sex and relationships. In this analysis grounded in feminist theory, age, gender and sexuality are considered to be enacted as doings. Six interviews with teachers working with sexuality education in K-12 schools in Sweden were chosen from of a larger body of material consisting of 21 interviews with professionals engaged in school-based sexuality education. The six interviewees were selected because they explicitly addressed how teachers' age, gender and/or sexuality come to matter in the classroom. Findings show how male and female teachers organise their teaching in relation to normative expectations of age, gender and sexuality. In sexuality education, the diverse life-courses of (hetero)sexual women offer a wide range of pedagogic possibilities for female teachers to address issues of sexuality, consent and relationships whereas male teachers are constrained to doing safe(r) forms of masculinity by directing attention away from their bodies and experiences. In understanding these results, I argue that the figure of the tant has been key in forming the pedagogic backdrop to Swedish sexuality education, hence embedding a normative 'who' in the 'how' to teach sexuality education. [ABSTRACT FROM AUTHOR]

Contemporary welfare organizations engage in various evaluation practices to assess the quality of their services. In this paper we report a qualitative exploration of how technology-enabled evaluations are understood by organizational members who participate in quality assurance activities in Swedish social services. The study contributes to critical information systems literature, focusing on the tensions professionals experience in relation to the digital systems they use for evaluations. For example, "quantities" take precedence over the qualities of such work, as information systems constrain ambitions to realize knowledge-based social services. The results reveal three tensions in professionals' evaluation-related activities arising from conflicting uses or desires. One is between desires for flexible systems that enable reflection and standardized digital support systems. Another is between uses or desires for indicators that are meaningful at the operational level and for general, comparable measures at the management level. The third is between desires to use evaluation procedures for learning and control. The study contributes to both theory and practice related to technology-enabled evaluation of welfare services, and critical perspectives on information systems. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to provide an understanding of why people are still retiring earlier than would have been expected, despite policies that increase the retirement age. This is a qualitative study in a large public-service organisation in Sweden focusing particularly on how human resource routines aimed at middle management tend to inhibit the promotion of a prolonged working life, despite government efforts aimed at changing these actions. The results highlight three key routines (development talks, salary talks and internal recruitment) that inhibit prolonged working life. These routines seem rational and appropriate to the organisation's managers, because the demands of the job must have priority over employees' capabilities in recruitment routines. Furthermore, it could be considered economically rational to prioritise salary demands of younger employees over those of older employees, and it may appear economically rational to stop further training efforts for older employees. In general, then, it seems reasonable to managers to make decisions based on objective criteria like age. Nevertheless, our results suggest that these routines may need to be redesigned in order to support a prolonged working life and to avoid a discrepancy between accepted prolonged working-life policies and the actions of organisational actors. The study further reveals how intra-organisational institutions (e.g. taken-for-granted mind-sets and norms) embedded in human resource routines may promote or inhibit prolonged working life, suggesting a need for change in those institutions. [ABSTRACT FROM AUTHOR]

Purpose: The study of successful transformational change processes in organizations has been limited. The purpose of this paper is to understand a change process and the type of change that occurred in a pharmaceutical company in Sweden 2005–2014. Design/methodology/approach: An interactive research design was used, and semi-structured interviews were conducted with 19 individuals, asking about their views on the change journey. Meetings and dialogue with leaders from the organization also took place. Observations from feedback meetings with leaders were included in the analysis. The results were analysed using a time-ordered display identifying key events, interpreted by a theoretical lens determining the type of change over a period of 10 years. Findings: This was a transformational change caused by external pressure, supported by visionary and transparent leadership, collaborative methods aiming at broad involvement and systemic understanding. The results indicated a 40 per cent increase in productivity and altered organizational design and culture. Sense-making activities, persistent adoption of quality improvement tools, dispersed power and sequential change activities underpinned the success. Practical implications: The results provide insight into the processes of transformational change. Change leaders were provided with knowledge, inspiration and insight when facing transformations. Social implications: Increased prevalence of transformational change calls for new organizational competencies and altered roles for leaders and employees. There is a need for new ways of developing competence and new recruitment policies for leaders. Originality/value: This case presents unique empirical evidence of a successful cultural transformation led by a leader using post-conventional principles. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to develop a model describing different factors that affect quality and efficiency in transitional care. Design/methodology/approach: A meta-synthesis focusing on the transitions between wards was conducted within a research project. The results from eight studies within that research project have been combined and analysed from a holistic view. Findings: The findings are a model with a description of seven different categories consisting of the identified factors affecting quality and efficiency in transitional care. Those categories are (1) learning organisation, (2) standardising and structuring, (3) applying a holistic view, (4) understanding organisational culture in a health care context, (5) management and leadership, (6) for whom value is created and (7) working together. The results from the study have been verified in previous research. Research limitations/implications: The result of the completed meta-synthesis is based on studies conducted at two medium-sized hospitals in Sweden. The developed model can be used in a similar context to improve quality and efficiency in patient transfers by management and employees working based on the various factors. Originality/value: This model describes factors (success factors, prerequisites, conditions and lack thereof) affecting the ability to achieve quality and efficiency in transitional care that can be used in future research as well as for practical improvements. [ABSTRACT FROM AUTHOR]

Purpose Managerial quality improvement (QI) in terms of accountability management has become central to healthcare institutions. Yet, managerial QI is largely considered irrelevant by healthcare professionals. In consequence, the implementation of managerial QI implementation is hampered. Knowledge brokering is discussed as a means to foster the implementation of (QI) knowledge in healthcare. Yet, the benefit of knowledge brokering for managerial QI has so far been neglected. Therefore, this research asks how knowledge brokering can support the implementation of managerial QI.Design/methodology/approach This article builds on a single case study approach as a unit of analysis. Qualitative data collection comprises 21 semi-structured interviews at the managerial and clinical levels, 220 h of participant observation and document analysis.Findings This paper identifies three strategies of how brokers implement managerial QI into a hospital by means of knowledge brokering: prioritizing, obscuring and redefining. The strategies help to transform multiple external QI demands into one managerial QI strategy. Yet the strategies also reduce non-managerial perspectives on QI, which generates frustration among healthcare professionals.Practical implications The paper works out the benefits and costs of managerial knowledge brokering. This allows to spell out practical implications for managers, nurses and clinicians who have to deal with managerial QI in healthcare organizations.Originality/value This paper fulfils an identified need to study managerial knowledge brokering practices as a means to implement managerial QI into healthcare organizations. By doing that, the article adds to the body of research on knowledge translation in healthcare. [ABSTRACT FROM AUTHOR]

BACKGROUND: As guardians of the public interest, auditors represent a unique occupational group. The group that has shown to experience high level of stress and overload is often being associated with environmentally imposed responsibility as well as organizationally imposed performance demands. It is the latter aspects, represented by the concept of organizational culture, that is being highlighted in this paper and its relationship to auditor's well-being OBJECTIVES: The paper aims to explore organizational culture as an antecedent of auditors' well-being, which is assumed to have important consequences for the quality of auditors' work. METHODS: This study is based on a survey of 207 Swedish auditors. Using established and validated instruments measuring aspects of organizational culture and personal well-being, the study employed correlations and multiple regression analysis in testing the relationship between the two. RESULTS: The results of the study suggest that an increasing degree of collectivistic organizational culture has a positive relationship with three aspects of well-being: Job satisfaction, life balance and life satisfaction. CONCLUSIONS: This study is the first attempt to explore well-being of auditors and its antecedents represented by organizational culture. Contrary to the expectation that auditors take an individualistic approach to their work, this study establishes that auditors feel best in a work environment characterized by a collectivist organizational culture. [ABSTRACT FROM AUTHOR]

This paper explores trade union strategies to protect wages in the face of EU migration after the enlargement of the European Union. We argue that unions have three instruments at their disposal to deal with the risks linked to downward wage pressure: closure through immigration control, equalisation through collective bargaining and minimum wages, and the organisation of migrant workers. Using comparative case studies of Sweden, Germany and the UK, we show how different types of power resources shape union strategies: unions with substantial organisational resources (in Sweden) relied on a large membership to pursue an equalisation strategy and expected to be able to 'afford' openness. German unions with low membership but access to the political system pushed for a mix of closure and equality drawing on political intervention (e.g. minimum wages). British unions, unable to pursue either, focused their efforts on organisation. [ABSTRACT FROM AUTHOR]

Shortage and turnover of registered nurses are worldwide challenges, and work motivation is one factor in retaining staff in the healthcare sector. The aim of this study was to explore registered nurses' motivation expressed in daily communication, using the basic needs in self‐determination theory as a framework. A secondary analysis of ethnographic data, collected through participant observations, informal interviews during observations, and individual interviews, was used. A total sample of all registered nurses employed at a hospital unit in Sweden (n = 10) participated. The data were analyzed thematically through the lens of the basic needs in self‐determination theory: autonomy, competence, and relatedness. Self‐regulation of learning, the possibilities to discuss work‐related challenges with colleagues, and having registered nurses lead dialogues with physicians were factors connected to autonomy. Having a registered nurse and physician solve problems together was a factor connected to competence. A sense of belonging and security in a permissive climate between registered nurses was connected to relatedness. This paper has implications for increased awareness of the three basic motivational needs, which could be used in the development of attractive workplaces. [ABSTRACT FROM AUTHOR]

According to the Swedish Social Services Act, all health personnel are required to report children whom they suspect are subject to maltreatment. This paper describes the organizational and professional conditions in four Swedish children's hospitals regarding the reporting process. Specifically, the study focused on knowledge of risk to children, legal frameworks and the perceptions of organizational support and explored the differences between the hospitals and professional groups. The method used was a quantitative questionnaire, and 295 personnel responded. Hospitals differed in the level of organizational support offered to staff. Importantly, the professional groups showed different levels of knowledge and awareness about structures supporting their reporting obligations, with nurses and nurse assistants showing a lower level of awareness than physicians and hospital social workers. The paper argues that all professional groups need to have equal access to education, with the opportunity to become more involved in the assessment and reporting process and to strengthen multidisciplinary structures. Further, this would reduce risk, dispel the perception that work with children is ‘dirty work’ and counter strategies of avoidance among some professionals. [ABSTRACT FROM AUTHOR]

Background: The countries of the world are becoming increasingly multicultural and diverse, both as a result of growing migration, of people fleeing countries at war but also due to increased mobility related to labour immigration. Culture is a broad concept where the definitions focus on learned and shared values, traditions, and beliefs of a group of individuals. People's culture affects health and perceptions of illness as well as treatment, symptoms, and care. Moreover, people who are at the end of life, live and exist within all levels and contexts of care. Specialized palliative care requires that the nurse has sufficient knowledge and skills to be responsible for meeting the patient's nursing needs also on a cultural level, regardless of cultural affiliation. The aim of the study was to highlight nurses' experiences of the meaning of culture when caring for patients at the end of life in specialized palliative care. Methods: The study was conducted with a qualitative design and inductive approach. Semi-structured interviews were conducted with twelve nurses in western Sweden. Data were analysed using qualitative content analysis. Results: The nurses had an awareness of culture as a phenomenon and how it affected palliative care at the end of life. The results showed two categories, Awareness of the impact of culture on nursing and Culture's impact and influence on the nurse's mindset and approach, consisting of seven subcategories that highlight the nurse's experience. It emerged that there are differences between cultures regarding notions of dying and death, who should be informed, and treatments. There were also challenges and emotions that arose when cultural preferences differed among everyone involved. A person-centred approach allowed for recognition of the dying person's culture, to meet diverse cultural needs and wishes. Conclusion: Providing culturally competent care is a major challenge. There are often no routines or methods prescribed for how nurses should relate to and handle the diversity of cultural notions that may differ from the values and cornerstones of palliative care. Having a person-centred approach as strategy can help to better manage the situation and provide equitable care on terms that respect cultural diversity. [ABSTRACT FROM AUTHOR]

Aims and objectives This systematic review aims to synthesise the existing research on how patients participate in patient safety initiatives. Background Ambiguities remain about how patients participate in routine measures designed to promote patient safety. Design Systematic review using integrative methods. Methods Electronic databases were searched using keywords describing patient involvement, nursing input and patient safety initiatives to retrieve empirical research published between 2007 and 2013. Findings were synthesized using the theoretical domains of Vincent's framework for analysing risk and safety in clinical practice: 'patient', 'healthcare provider', 'task', 'work environment', 'organisation & management'. Results We identified 17 empirical research papers: four qualitative, one mixed-method and 12 quantitative designs. All 17 papers indicated that patients can participate in safety initiatives. Conclusions Improving patient participation in patient safety necessitates considering the patient as a person, the nurse as healthcare provider, the task of participation and the clinical environment. Patients' knowledge, health conditions, beliefs and experiences influence their decisions to engage in patient safety initiatives. An important component of the management of long-term conditions is to ensure that patients have sufficient knowledge to participate. Healthcare providers may need further professional development in patient education and patient care management to promote patient involvement in patient safety, and ensure that patients understand that they are 'allowed' to inform nurses of adverse events or errors. A healthcare system characterised by patient-centredness and mutual acknowledgement will support patient participation in safety practices. Further research is required to improve international knowledge of patient participation in patient safety in different disciplines, contexts and cultures. Relevance to clinical practice Patients have a significant role to play in enhancing their own safety while receiving hospital care. This review offers a framework for clinicians to develop comprehensive practical guidelines to support patient involvement in patient safety. [ABSTRACT FROM AUTHOR]

Background: Although there is growing awareness that early childhood development programs are important for a sustainable society, there is a knowledge gap about how to implement such programs. Successful implementation requires attention to implementation drivers (competency, organization, and leadership) during all phases of the implementation. The purpose of this study was to describe cross-sectoral operational workgroups' perceptions of facilitators, barriers and solutions related to implementation drivers in the preparationphase of implementing an evidence-based early childhood home visiting program. Methods: Quantitative and qualitative data were collected from twenty-four participants, divided into 5 groups, during implementation planning workshops. The workshops were guided by a structured method informed by the principles of Motivational Interviewing and within a framework of implementation drivers. Groups sorted cards with statements representing implementation drivers according to perceptions of facilitators and barriers, and percentages were calculated for each type of implementation determinant, for each type of driver. The groups discussed their card sorting and wrote action plans to address barriers, yielding documentation that was analyzed using deductive qualitative content analysis. Results: A mixed-methods analysis resulted identification of facilitators, barriers, unknowns and solutions in two to three subcategories under each main category of implementation driver. A competent and confident workforce, and enthusiasm and commitment were key facilitators. Key barriers were unclear roles and responsibilities, and insufficient articulation of local vision and goals. Many factors were described as yet unknown. Specific solutions were generated to support the implementation. Conclusions: Our study furthers the scientific understanding of how to take evidence-based early childhood programs from research to practice within an implementation drivers framework. Facilitators, barriers and solutions in key areas during the preparation phase were identified with the help of a novel tool. The results provide useful knowledge for decision makers and organizations preparing similar initiatives in communities striving to attain sustainable development goals. [ABSTRACT FROM AUTHOR]

Aim: To explore if and how nurses' perceived organizational support affects their ability to handle and resolve ethical value conflicts. Design: A mixed methods design with a longitudinal questionnaire survey and focus group interviews. Methods: A questionnaire survey in six hospitals in two Swedish regions provided data from 711 nurses responding twice (November–January 2019/2020 and November–January 2020/2021). A cross‐lagged path model tested the mutual prospective influence between the organizational climate of perceived organizational support, frequency of ethical value conflicts, and resulting moral distress. Four focus group interviews were conducted with 21 strategically selected nurses (April–October 2021). Qualitative data collection and analysis were inspired by Grounded Theory. Results: A climate of perceived organizational support was empowering, contributing to role security. It prospectively decreased the frequency of ethical value conflicts but not the moral distress when conflicts did occur. Conclusion: It is important to facilitate the development of perceived organizational support among nurses, but also to reduce the occurrence of ethical value conflicts that the nurses cannot resolve. Implications for the Profession: By ensuring a shared care ideology, good inter‐professional relations within the entire care organization, providing clear and supportive organizational structures, and utilizing competence adequately, healthcare managers can facilitate and support the development of perceived organizational support among nurses. Nurses who are empowered by perceived organizational support are stimulated by and take pride in their work and experience the work as meaningful and joyful. Impact: The study addressed the question of whether healthcare organizations could support nurses to resolving ethical value conflicts, and thus reduce moral distress. Perceived organizational support is related to factors such as ideological caring alignment and supportive organizational preconditions. This study contributes specific knowledge about how healthcare organizations can empower nurses to effectively resolve ethical value conflicts and thereby reduce their moral distress. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Background: According to shortage of registered nurses, organisational and leadership aspects grounded in person-centrered approach, are highlighted to ensure high quality of care. Therefore, it is interesting to develop knowledge regarding registered nurses working environment. Aim: The aim of the study was to investigate registered nurses' reason to end their employment at a university hospital setting (internal medicine, emergency department). Method: Qualitative content analysis with an inductive methodological approach was used to analyse registered nurses' experiences regarding their former employment. Inclusion criteria; all nurses (n = 55) who ended employment during one year (first of July 2020-30th of June 2021) were invited, and 38 semi-structured interviews were conducted. Results: Three categories were identified: Limited organisational support, Lack of visible leadership, and Limited healthy working environment, followed by six subcategories: Longing for organisational support, Being a tile in a box, Need for professional relationship, Limitation of supportive leadership, Imbalance of work versus personal life, and Ethical stress. Conclusion: To improve registered nurses working environment and commitment to work, balance between time at work and personal life is significant. Therefore, organisational support and leadership skills grounded in a person-centred approach are crucial to develop a healthy working environment. A person-centred leadership could improve collaboration and shared decision-making in partnership with those involved, managers, nurses, and team members. [ABSTRACT FROM AUTHOR]

Purpose: In order to improve cooperation and collaboration between units, clinics and departments, many health care organizations (HCOs) have introduced process orientation. Several studies indicate problems in realizing these ambitions. The purpose of this paper is to explain and understand the success and failure of process orientation in HCOs.Design/methodology/approach: The authors conducted three case studies and applied Actor-Network Theory as an analytic lens.Findings: The realization of process orientation is hindered by neglect or resistance from physicians, who find the process targets to be of low medical priority. However, the authors also see that medical priorities are no stable entities but are susceptible to negotiations. Over time, process organization, process mapping, process measurement activities and the acting of enroled actors may have impact on medical priorities.Originality/value: Contrary to previous research, the findings indicate that New Public Management may not be the main obstacle against processes, that accounting figures may not be hard to disregard and that the role of leadership is not paramount. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to explore the concept of long-term thinking in a non-business context to gain deeper insights into bridging the gap between the theory of long-term thinking and its application as a management strategy. Design/methodology/approach: To explore the concept of long-thinking further in a non-business setting, a grounded theory study was conducted with preschool leaders in a municipality in Sweden to examine how the leaders describe, define and apply the concept of long-term thinking in their schools. Interviews with school leaders, both written and oral, were used for data collection. Findings: This study illustrates that the concept of long-term thinking can be twofold. First, the description can be as an anchor that reflects a mission. Second, the description can be a steering mechanism that guides decision-making. The findings also reinforce the importance of organisations developing an organisational culture that connect their vision and goals with the values and needs of their customers. Research limitations/implications: This study was carried out in a single organisation and shows a snapshot of the organisation's status at the time the data were collected. Therefore, the findings are not generalisable to all organisational settings; rather the findings may be transferable to other settings. Practical implications: The results can be used to help identify areas where preschools in a municipal context can engage with sustainable quality development in order to build systems that support work with quality in a more structured way. Originality/value: Long-term thinking is seen, within both theory and organisations, as necessary to achieve success in terms of sustainable development and quality, and this study contributes with knowledge about the current gap between theories of long-term thinking and practice in organisations. [ABSTRACT FROM AUTHOR]

Aim. To bring insights into how healthcare managers and staffing assistants work to achieve sustainable working hours within a participatory scheduling system. Background. Hospital nurses and assistant nurses often work on rotating shifts, which affects their opportunities for sleep, recovery, and work-life balance. In Sweden, a participatory scheduling approach is commonly used, where working hours are planned in collaboration between employees, managers, and staffing assistants. Influence over working hours is related to positive outcomes among shift workers. However, it also places responsibility on the employee to schedule working hours that promote health and patient safety, i.e., sustainable working hours. Accordingly, the organisation has responsibilities to support the employee in this regard. Methods. Semistructured individual interviews were conducted with 11 managers and 9 staffing assistants from four Swedish regions and analysed using thematic analysis. Results. Several key factors for achieving sustainable working hours within the context of participatory scheduling were described: distribution and clarity of responsibilities, allocating time for scheduling, establishing shared responsibility, considering fairness, fostering an individual relationship with the employee, managing dissatisfaction, providing support, clarifying guidelines for sustainable scheduling, managing inconsistencies between employee requests and sustainable working hours, and considering recovery opportunities and the competence mix on shifts. Additionally, contextual factors, such as staffing levels, working procedures, working time arrangements for night work, and technological support, were highlighted as important. Conclusion. Achieving sustainable working hours within participatory scheduling involves considering the interactions between factors at the levels of the organisation, the individual, and the technological systems. Implication for Nursing Management. Nurse managers and staffing assistants must work closely with their employees during participatory scheduling to ensure sustainable working hours. Key goals in this regard include establishing a shared responsibility, clarifying responsibilities and guidelines for sustainable scheduling, and allocating time for the scheduling process. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite numerous regulatory initiatives to improve health and safety in the construction industry, it still ranks as one of the most accident-prone industries worldwide. A dedicated focus on safety culture has been suggested as a complement to laws, regulations and management systems. OBJECTIVE: This article explores safety culture research conducted in the construction industry, with the aim to provide insight into the specific themes that tend to be in focus as well as what theoretical and methodological approaches that tend to be favored. METHODS: Searches in scientific databases were conducted twice. In a first attempt, searches resulted in 54 hits but only two articles fit the scope of the study. A revision of the search phrase resulted in 124 hits. Ultimately, 17 articles fit the scope of the study and were included. The content of the articles was analyzed and sorted thematically. RESULTS: The results show that four themes are prevalent in the existing literature: 1) unique challenges entail a need for situated applications, 2) models developed to operationalize safety culture, 3) measuring safety culture, and 4) safety management and leadership as key factors. CONCLUSION: Although research focusing on the construction industry has come to favor certain study designs and definitions of safety culture, further research may be enriched by broadening the theoretical and methodological perspectives. Specifically, researchers should conduct more in-depth qualitative studies that take the complexity of the industry into account, including the interpersonal relations between the actors involved. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to examine and establish how sensemaking develops among a group of external change agents (ECAs) engaged to disseminate a national quality register nationwide in Swedish health care and elderly care. To study the emergent sensemaking, the theoretical concept of cognitive shift has been used.Design/methodology/approach The data collection method included individual semi-structured interviews, and two sets of interviews (initial sensemaking and renewed sensemaking) have been conducted. Based on a typology describing how ECAs interpret their work, structural analyses and comparisons of initial and renewed sensemaking are made and illuminated in spider diagrams. The data are then analyzed to search for cognitive shifts.Findings The ECAs’ sensemaking develops. Three cognitive shifts are identified, and a new kind of issue-related cognitive shift, the outcome-related cognitive shift, is suggested. For the ECAs to customize their work, they need to be aware of how they interpret their own work and how these interpretations develop over time.Originality/value The study takes a novel view of the interrelated concepts of sensemaking and sensegivers and points out the cognitive shifts as a helpful theoretical concept to study how sensemaking develops. [ABSTRACT FROM AUTHOR]

The article examines the ongoing paradigm shift on enhancing diversity climates in Swedish human services organizations. Traditional social policy arrangements based on a monocultural style of service provision has been challenged by the growing need for cultural competence and ethnic sensitivity. A study of cultural competence enhancement finds the recruitment of ethnic social workers to be the most efficient strategy for making social services more culturally sensitive. At both the operational and the managerial level, ethnic staff contribute to regular training and the updating of staff cultural competences, as well as to the strategic diversity plans of entire organizations. [ABSTRACT FROM AUTHOR]

This article aims at exploring how community home care of older people is provided and organized at night. In times of welfare decline, organizational changes, and an increasing aged population, questions arise about home care and support for older people. In Sweden, as in many other Western countries, "ageing in place" is a guiding principle in care provision for older people, which put increasing pressure on home care services. Still, nighttime care represents a research gap within health and social care research, nationally and internationally. This telephone interview survey examines 41 operations managers' perceptions of organization and care provision and how they account for the goals and work of home care at nighttime in a selection of 37 Swedish municipalities. The analysis was inspired by thematic content analysis where three central themes were categorized: organizational context of nighttime care, working conditions, and challenges of nighttime care. Our results reveal that organizational context varied depending on the demography and size of the municipality. The work situation was characterized by constantly unforeseen events to manage. Multiple challenges were identified on societal and political levels, as were limited resources and recruitment problems. In conclusion, our analysis has identified unpredictability as a core feature of nighttime care work. The complexity of the provision of nighttime care was not recognized as important for the municipal organization. To provide high-quality care at night in ordinary housing, there is a need both to focus on organizational aspects and to have sufficient resources and time. [ABSTRACT FROM AUTHOR]

This study aims to investigate focal firms' business sustainability relationships in connection with their stakeholders in supply chain networks. A questionnaire survey was sent to a sample consisting of large Swedish firms, with 107 usable questionnaires returned. The results reveal which stakeholders are of interest for firms in sustainability efforts. The results are compared with earlier findings from Norway and Spain in a triangular approach. The former is a similar country, while the latter is different to Sweden in several ways. In addition, the study uncovers which stakeholders in the supply chain network should be considered. The study also demonstrates how firms can implement business sustainability in their supply chain networks and shows the extent to which different stakeholders are considered in sustainability efforts. The study contributes to sustainability research and stakeholder theory in supply chain networks. Opposite to earlier findings, this study showed only minor influences from national culture and institutions on firms' sustainable business practices in supply chain networks. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe experiences of being a manager in the municipal sector in rural northern Sweden. Semi-structured interviews were performed with 15 managers working in the municipal sector. The interviews were subjected to inductive qualitative content analysis. The managers' experiences were interpreted in the main theme, Striving for stability on shaky ground. They struggled within slimmed-down organizations with substitute shortages and reduced means. They expressed being burdened by conflicting demands, a work overload, work conflicts and a requirement to be present. They had to endure the negative consequences of working in small municipalities, and handling health and family life impairments. The managers expressed the importance of being strengthened by inner and outer resources, such as being motivated, having social support and finding strategies to cope. They also expressed benefits of working in small municipalities, such as great opportunities to influence and efficiency in decision-making. This study illuminates managers' adverse psychosocial working conditions, insights into working in a small municipality in the rural context and also the importance of organizational support. Future studies could focus on applying adapted workplace support interventions among managers in the municipal sector in rural northern Sweden. [ABSTRACT FROM AUTHOR]

Aim(s): This study aims to investigate care unit managers' perceptions of how the COVID‐19 pandemic influenced their ability to support the nurses. Background: The COVID‐19 pandemic placed extreme pressure on health care organizations. More knowledge regarding how the pandemic influenced care unit managers' ability to support nurses is central to ensuring high‐quality health care in future crises. Method(s): A mixed‐methods study in Swedish hospitals with a survey (n = 128) and interviews (n = 20) with care unit managers. Results: Approximately half of the managers reported having spent more time available to and supporting the nurses. Availability was positively predicted by their perceived organizational support while negatively by their job demands. These job demands concerned meeting staff anxiety and managing organizational restructuring. Full focus on direct patient care and strong professional and social support were important job resources. Conclusion(s): For care unit managers to effectively support the nurses during a crisis, they need proficient job resources and moderate job demands. Managers' perceived organizational support positively affects the quality of their crisis leadership. Creating arenas in which staff collegiality can form and develop is beneficial for the ability to meet future crises. Implications for Nursing Management: This study specifies important job resources that should be acknowledged and reinforced to strengthen the ability of care unit managers to actively support the nurses during a crisis. [ABSTRACT FROM AUTHOR]

Background: The Primary care manager plays a vital role in promoting a research culture in the healthcare center. The position involves both the implementation of organizational directives and patient care. The research culture and use of evidence influence each individual healthcare professional and ultimately the quality of patient care. Purpose: To describe primary healthcare managers' understanding of evidence-based practice in the Swedish primary healthcare context and their ability to influence its implementation. Methodology: Qualitative content analysis of data collected in individual interviews. Results: In general, managers expressed a positive view toward the use of evidence in daily practice. However, they were sometimes hesitant about fully implementing evidence-based results. This was mostly attributed to the struggle of balancing finances and allocating sufficient time for staff to keep up with and engage in evidence-based practice. Conclusion: The organizational culture impacts the mind-set of all co-workers including managers. Those managers influenced by traditions and norms may fall into the trap of devaluing the benefit of research and evidence. The inherent feeling of being alone and without guidance in some matters related to evidence-based practice inevitably leads to inconsistency and ambiguity. The use of clinical pathways that constitute one form of evidence has become a substitute for proper, careful, individual investigation, implementation, and evaluation of each patient case. This means that managers experience moral and physical stress when trying to meet organizational, staff, and patient demands. Practice Implication: Awareness of managers' influence and experience of working according to evidence-based practice is valuable to gain an insight into how Swedish primary healthcare functions at local level. Illuminating and discussing evidence-based practice is an assurance of quality that contributes to many aspects of the overall safety of care. [ABSTRACT FROM AUTHOR]

Self‐care is the most important cornerstone of diabetes treatment. As self‐care is affected by cultural beliefs, it is important for healthcare professionals to be able to adapt their educational approach and to be culturally competent. The aim of this study was to describe the cultural competence in Swedish healthcare professionals, specialised in diabetes care and to examine related factors for cultural competence. The healthcare professionals' perceived level of cultural competence was measured across three domains—Openness and awareness, Workplace support and Interaction skills—in 279 Swedish healthcare professionals from all 21 regions of Sweden, using the Cultural Competence Assessment Instrument (Swedish version—CCAI‐S). Descriptive statistics were used to describe cultural competence in healthcare professionals, and linear regression was conducted to examine factors related to cultural competence. Of the healthcare professionals studied, 58% perceived that they had a high level of Openness and awareness, 35% perceived that they had a high level of Interaction skills and 6% perceived that they had a high level of Workplace support. Two factors were found to be related to cultural competence, namely, high percentage of migrant clients at the healthcare clinic and whether the healthcare professionals previously had developed cultural competence through practical experience, education and/or by themselves. In conclusion, most healthcare professionals perceived that they had cultural openness and awareness but need more support from their workplace to improve their interaction skills. Cultural competence‐related education could support the healthcare professionals to develop interaction skills. [ABSTRACT FROM AUTHOR]

The focus of this study was on female emergency medical personnel's experiences of treating women who have been raped and on their own experiences of being women themselves working in this situation. We interviewed 12 female medical personnel in four focus groups of two to five participants each. The material was analyzed using inductive thematic analysis. Participants' experiences were structured under two main themes: Prerequisites for care and Effects on oneself. As women, the participants emphasized their understanding of other women and stressed the importance of offering flexible care and taking time with each patient. They described how their work affected them personally, making them increasingly aware of men's violence against women and their need for support from their colleagues. They also discussed structural barriers to both patient care and self-care. If unaddressed, such shortcomings risk negatively affecting raped women seeking medical care and may also be detrimental to the health and well-being of the professional offering care. [ABSTRACT FROM AUTHOR]

The aim with this article is to discuss how changes in technology at workplaces engender both change and restoration of gender constructions within the context of underground mining. The discussions are formed around a constructed case based on material from gender and organizational studies of large-scale industrial mines in different countries, most of them from Sweden. New technologies such as digitalization and automation together with new organizational forms engender changes in mining work, e.g., new types of work tasks, new competence demands, and a move from underground to high-tech control rooms aboveground. One main observation is that the changes challenge the old and recalcitrant blue-collar mining masculinity. On the one hand, the organizational resistance and "lagging" seemed to result in re-gendering and restoration of the male dominance. On the other hand, there were tendencies to adaptation in the workplace cultures, including new ways of forming mining masculinities, perhaps even undoing of gender. The main conclusion is that the most probable development lies somewhere in-between and by analyzing such complex processes of gender, technology, and change future research can get more knowledge of changes of gender constructions in working life. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe nursing staff's experiences of good nursing practice in psychiatric in-patient care for patients with self-harming behavior. The participants were nine nurses and eight nursing assistants working in two in-patient wards in general psychiatry. Four focus group discussions were held and subjected to qualitative content analysis. The findings showed that good nursing practice balanced a person-centred approach with a common staff approach, allowing people who self-harm and staff to share responsibility for structuring everyday life, keeping to the plan, communicating decisions, and finding individual opportunities for relief. Reflective discussions among the staff concerning prejudice, emotional stress, lack of resources, and shortcomings in care planning could also prevent a stigmatizing culture and organizational deficiencies, which would be beneficial for both the people who self-harm and the staff. [ABSTRACT FROM AUTHOR]

Based on a study of Lean management practices at the Swedish Migration Board, we develop a novel theoretical understanding of the translation of management ideas. We show how translation, rather than being reduced to a network of human intentions and actions governing the transformation of organizational practices, can instead be understood as a historically contingent, situated flow of mundane everyday work practices through which social and material translators simultaneously become translated, conditioned to be and act in certain ways. We show how prior actor-centric accounts of translation of management ideas can be understood as performative consequences of a conceptual vocabulary inherited from Callon and Latour. Contrasting this, the non-actor-centric vocabulary of social anthropologist Tim Ingold allows us to background the intentional human actor and foreground the flow of mundane, situated practices. In adopting this vocabulary, we capture how the flow of practices conditions subjects and objects to become enacted as well as act, and develop an understanding of translation as occurring within, rather than distinct from, these practices. In essence, our novel view of translation emphasizes how management ideas are radically unstable, and subject to alteration through the flow of practices rather than as a result of deliberate implementation efforts. [ABSTRACT FROM AUTHOR]

Drawing on stress and justice literature, we argue that perceptions of job insecurity induce feelings of low procedural justice, which has immediate and prolonged negative effects on health (depressive symptoms, sleep difficulties). Moreover, we explore whether the strength of the job insecurity–justice relationship differs between individuals as a function of their average level of job insecurity over time. Finally, we explore whether the procedural justice–health relationship differs between individuals as a function of variability in justice perceptions over time. We analyzed Swedish panel data from permanent workers over four consecutive waves (with a two‐year time lag between waves) using multilevel analysis, separating within‐ and between‐person variance. Results showed that job insecurity associated negatively with procedural justice at the same time point for all waves. Prolonged effects were less stable. We found immediate (but not prolonged) indirect effects of job insecurity on health outcomes via procedural justice. Average levels in job insecurity over time moderated the within‐person job insecurity–justice relationship. However, variability in procedural justice over time did not moderate the within‐person justice–health relationship. In conclusion, disentangling within‐ and between‐person variability of job insecurity and justice perceptions contributes to the understanding of health effects. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine nurses' experiences of working with issues of sexuality in palliative care. Background: Sexuality has value for human lives and relations and is important for one's overall well‐being throughout life. Guidelines for palliative care state that sexuality should be addressed. Previous research shows that the inclusion of sexuality in general health care is deficient, and there is a knowledge gap on how sexuality is addressed in palliative care. Method: Within a qualitative design, the empirical material was obtained through three focus group interviews with eleven registered nurses working in palliative care. The interviews were analysed using qualitative content analysis. Result: Nurses experience that sexuality has an indistinct place in their work, "sexuality" is a word difficult to use, and differing views are held on whether it is relevant to address sexuality, and if so, when? Although they have experiences involving patient and partner sexuality, which is viewed as sexuality in transformation during the palliative care process, nurses seldom explicitly address patient or partner sexuality. Despite the lack of knowledge, routines and organisational support, they acknowledge the importance of addressing sexuality in palliative care, as they express that they want to do right. Conclusion: Overall, nurses appear to follow differing cultural, interpersonal and intrapsychic scripts on sexuality rather than knowledge‐based guidelines. This underlines the importance of managers who safeguard the adherence to existing palliative care guidelines where sexuality is already included. In this work, it is important to be aware of norms to avoid excluding patients and partners that differ from the nurses themselves as well as from societal norms on sexuality. Relevance to clinical practices: The results can be used as a point of departure when implementing existing or new guidelines to include and address sexuality and sexual health needs in palliative care. [ABSTRACT FROM AUTHOR]

The article examines to what extent the position of the Swedish state vis-à-vis the European Union (EU) has been mediated by domestic factors, and in particular how this has affected its subnational authorities, since Sweden joined the EU in 1995. It examines whether path-dependency prevented Sweden from converging with other member states. The article then examines the relevance of subnational mobilization for the relationship of the Swedish state to the EU. It provides an overview of bottom-up activism, subnational capacity building and top-down influence of the EU over conditions at the local and regional levels in Sweden. It is argued that the traditionally strong position of subnational authorities in Sweden, its institutional and administrative culture and a favourable economic situation have mediated EU influence over the Swedish state. This has also made it possible for local and regional government to bypass the state in its activities vis-à-vis the EU. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore how managers describe leading towards person‐centred care in Swedish nursing homes. Background: Although a growing body of research knowledge exists highlighting the importance of leadership to promote person‐centred care, studies focused on nursing home managers' own descriptions of leading their staff towards providing person‐centred care is lacking. Design: Descriptive interview study. COREQ guidelines have been applied. Methods: The study consisted of semi‐structured interviews with 12 nursing home managers within 11 highly person‐centred nursing homes purposively selected from a nationwide survey of nursing homes in Sweden. Data collection was performed in April 2017, and the data were analysed using content analysis. Results: Leading towards person‐centred care involved a main category; embodying person‐centred being and doing, with four related categories: operationalising person‐centred objectives; promoting a person‐centred atmosphere; maximising person‐centred team potential; and optimising person‐centred support structures. Conclusions: The findings revealed that leading towards person‐centred care was described as having a personal understanding of the PCC concept and how to translate it into practice, and maximising the potential of and providing support to care staff, within a trustful and innovative work place. The findings also describe how managers co‐ordinate several aspects of care simultaneously, such as facilitating, evaluating and refining the translation of person‐centred philosophy into synchronised care actions. Relevance to clinical practice: The findings can be used to inspire nursing home leaders' practices and may serve as a framework for implementing person‐centred care within facilities. A reasonable implication of these findings is that if organisations are committed to person‐centred care provision, care may need to be organised in a way that enables managers to be present on the units, to enact these strategies and lead person‐centred care. [ABSTRACT FROM AUTHOR]

This study examined the prevalence and consequences of intragroup conflicts for well-being in three women-dominated occupations from a gender perspective. Using survey data from 1299 nurses, teachers, and social workers, we found that task conflict was the most common type of conflict but it was unrelated to well-being. Relationship conflict was negatively associated with vigor and positively associated with employee stress, burnout, and depression. Process conflicts were positively associated with depression. Our findings revealed that women and men in the same occupation experience intragroup conflicts in the same way. Organizations should therefore primarily reduce relationship conflicts to ensure employee well-being. Practitioner Points: ● Not all types of conflicts at work are destructive. Some types of conflict may in fact be a good thing! ● Task conflict is the most common type of conflict in women-dominated workplaces, but it does not impair employee well-being. Instead, the contesting of ideas may lead to nuanced decisions. ● Managers in women-dominated workplaces should pay close attention to, and try to resolve, relationship conflicts as they may reduce employee well-being. [ABSTRACT FROM AUTHOR]

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This article explores the conditions for extended working life from an organising perspective. Based on the idea that temporality makes up a fundamental organising dimension, it discusses conceptions of internal job mobility, and if and when employees are expected to relocate to a different unit at work. The material consists of interviews with 11 men between the ages of 56 and 74, working in manual and managerial capacities at a foundry of a Swedish branch of a large international steel company. The results show that internal work mobility is regulated by normative assumptions of mobility in terms of on- and off-time. This socio-temporal order constructs younger age groups as the age normality while designating the older employees' transitions as a normative breach. It is also shown that the temporal order constitutes a disciplining element steering employees from an early stage to plan for limitations that may arise as a result of ageism and/or physical changes. The result confirms that transition to less-physically demanding tasks is a prerequisite for continuing working in a physically demanding job. These transitions are not, however, included in the socio-temporal order of the company, but are presented as the older employees' individual problem. All together, these results show the need to introduce organisational practices and corporate strategies in the debate on extended working life. [ABSTRACT FROM AUTHOR]

Introduction: Swedish municipalities face a number of daunting challenges; an aging population, the public's increased demands and expectations on municipality services, and a strained economy to mention some. Welfare technology, a Scandinavian concept launched to promote digitalization, is seen as one solution to meet these challenges. Objective: Despite these promises, few welfare technology applications are offered by local Swedish municipalities and care organizations. Numerous studies have shown that Swedish municipalities have a great interest in welfare technologies. Methods: In this article, we draw on empirical research in one Swedish municipality. Through two case studies it is illustrated how technological change and municipality employment of welfare technologies are employed. Results: These case studies show how core values of care are being lost in the quest for digitalization due to the lack of organizational skills and knowledge in transforming the relationship of caregiving and care-receiving through the use of digital technology. Conclusions: Digitalization and welfare technologies deployed ought to represent and support the core values of caregiving and to receive care. Thus, digital transformation most likely will transform conditions for care receivers and working conditions for care workers. New work processes will evolve, which in turn produce new meanings of home help service work and caregiving. Digitalization and the use of new digital technologies imply changes in care value creation. New digital activities deviate from classic caregiving, which in turn can offer opportunities to expand and enrich the experience of receiving care but it can also have negative effects on the received care if incorrectly employed. Digitalization must be regarded as an evolutionary process, in which mistakes and failures are allowed and corrected. Long-term strategies, infrastructure, clear goals and commitments are key for successful digitalization of eldercare. [ABSTRACT FROM AUTHOR]

Objective: The elderly are an increasing group and large consumers of care in Sweden. Development of mobile information technology shows promising results of interventions for prevention and treatment of chronic diseases. Exploring the elderly patients' beliefs, attitudes, experiences and expectations of e-health services helps us understand the factors that influence adherence to such tools in primary care. Material and methods: We conducted focus group interviews with 15 patients from three primary health care centers (PHCCs) in Southern Sweden. Data were analysed with thematic content analysis with codes and categories emerged from data during analysis. Results: We found one comprehensive theme: 'The elderly's ambivalence towards e-health:  reluctant curiosity, a wish to join and need for information and learning support'. Eight categories emerged from the text during analysis: 'E-health - a solution for a non-existing problem?', 'The elderly's experiences of e-health', 'Lack of will, skills, self-trust or mistrust in the new technology', 'Organizational barriers', 'Wanting and needing to move forward', 'Concerns to be addressed for making e-health a good solution', 'Potential advantages with e-health versus ordinary health care' and 'Need for speed, access and correct comprehensive information'. Conclusions: Elderly patients in Sweden described feelings of ambivalence towards e-health, raising concerns as accessibility to health care, mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly. Key points: Exploring the elderly patients' beliefs, experiences, attitudes and expectations of the fast developing e-health services helps us understand the factors that influence adherence to such tools in primary care. Elderly patients in Sweden reported ambivalence and different experiences and attitudes towards e-health, raising concerns as accessibility to health care, costs and mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly. [ABSTRACT FROM AUTHOR]

Background: The research aim of this study was to analyse aspects of job satisfaction in daily work with people with intellectual disability (ID) in schools, social services and health care. Method: With a comparative approach we collected data via a digital questionnaire with in total 333 respondents. The empirical material was analysed through a thematic content analysis. Results: The result showed that perceptions of job satisfaction could be differentiated into five typological categories: (1) the target group; (2) social rewards; (3) social relations; (4) professional core mission; and (5) results and outcomes. The findings also showed apparent differences in responses, both in terms of frequency and content, which seem to be associated with the respondents’ organisational affiliations. Conclusion: This study suggests that differences in experiences seem to be associated with work assignments, professional identities and organisational affiliation. [ABSTRACT FROM AUTHOR]

This article aims to investigate to what extent social service organisations (SSOs) conceive news management as a means to promote organisational self-interest as opposed to achieving democratic openness. The study is based on a nationally representative telephone survey with persons responsible for communication or public relations in Swedish SSOs (n =91). Against the background of descriptive statistics, the aim is pursued by qualitative analysis of four open-ended questions. The literature on the relations between social work and media has largely painted a negative picture. This study suggests a different image. The statistical analysis of survey data revealed that respondents were largely satisfied with their relations to journalists. It is concluded that increasingly professionalised news management in SSOs has largely served the function of protecting organisational self-interest, at the expense of democratic openness. This is expressed in how respondents talked in terms of promoting the positive aspects of organisational performance, how they applied a marketing perspective and how the goal of addressing criticism was to deflect it rather than embrace the potential it had for improving performance. This approach is problematic and scholars and practitioners alike need to be more detached from the interests of the social work profession and its organisations. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to present a comprehensive approach to studying organizational culture using “soft measures” to facilitate sustainable quality development in organizations. The purpose is also to present, discuss and compare the results from a survey designed to measure a company’s value base.Design/methodology/approach A number of different methods were used to collect soft data to study and measure organizational culture and at the same time influence the culture and the leadership within three organizations. One method, the survey, was used on two different occasions to obtain an overview of the culture within an organization and to investigate if the activities had influenced the culture and the leadership.Findings The application of soft measures used by leaders to study and develop organizational culture resulted in statistically significant positive changes in organizational work culture, according to a pre-post survey after a short period of one year.Practical implications The approach can be used by leaders in different types of organizations as the challenge of changing the organizational culture through the leadership seems to be a common challenge regardless of line of business.Originality/value The study shows the benefits of using a comprehensive approach to assess an organization’s culture based on qualitative measures and analysis. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. Background: The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high‐quality, person‐centred care, it is important to understand how these factors affect patients' experiences and care needs. Design: A focused ethnographic approach. Method: A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. Results: The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high‐tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. Conclusion: Patients with acute abdominal pain were cared for in the high‐tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. Relevance to Clinical Practice: Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well‐being and recovery. [ABSTRACT FROM AUTHOR]

Background Young adults today have grown up in a society where information and communication technology (ICT) support empowerment and social participation. Young adults with mild-to-moderate intellectual disability are at risk for marginalization by the digital divide. The aim was to map and describe how municipal organizations in Sweden organize support in terms of policy and strategies to enable the use of ICT in social care for adults with a mild-to-moderate intellectual disability. Methods A quantitative, cross-sectional survey including all municipalities in Sweden (n = 290) was conducted (response rate: 51%, n = 147). Descriptive statistics were used. Results Findings indicate a lack of organizational support for staff as well as for young adults with mild-to-moderate intellectual disability. Conclusion Municipalities request more knowledge about strategies for making ICT available. Despite the lack of comprehensive strategies for ICT, some Swedish municipalities have taken the initiative in this area. [ABSTRACT FROM AUTHOR]

Background Surgical care plays an important role in the acute hospital's delivery of safe, high-quality patient care. Although demands for effectiveness are high in surgical wards quality of care and patient safety must also be secured. It is therefore necessary to identify the challenges and barriers linked to quality of care and patient safety with a focus on this specific setting. Aim To explore situations and processes that support or hinder good safe patient care on the surgical ward. Method This qualitative study was based on a strategic sample of 10 department and ward leaders in three hospitals and six surgical wards in Sweden. Repeated reflective interviews were analysed using systematic text condensation. Findings Four themes described the leaders' view of a complex healthcare setting that demands effectiveness and efficiency in moving patients quickly through the healthcare system. Quality of care and patient safety were often hampered factors such as a shift of care level, with critically ill patients cared for without reorganisation of nurses' competencies on the surgical ward. Conclusions There is a gap between what is described in written documents and what is or can be performed in clinical practice to achieve good care and safe care on the surgical ward. A shift in levels of care on the surgical ward without reallocation of the necessary competencies at the patient's bedside show consequences for quality of care and patient safety. This means that surgical wards should consider reviewing their organisation and implementing more advanced nursing roles in direct patient care on all shifts. The ethical issues and the moral stress on nurses who lack the resources and competence to deliver good care according to professional values need to be made more explicit as a part of the patient safety agenda in the surgical ward. [ABSTRACT FROM AUTHOR]

Background: Palliative carers constantly face ethical problems. There is lack of organised support for the carers to handle these ethical problems in a consistent way. Within organisational ethics, we find models for moral deliberation and for developing organisational culture; however, they are not combined in a structured way to support carers' everyday work. Research objective: The aim of this study was to describe ethical problems faced by palliative carers and develop an adapted organisational set of values to support the handling of these problems. Research design: Ethical problems were mapped out using focus groups and content analysis. The organisational culture were developed using normative analysis and focus group methodology within a participatory action research approach. Main participants and research context: A total of 15 registered nurses and 10 assistant nurses at a palliative unit (with 19 patient beds) at a major University Hospital in Sweden. Ethical considerations: The study followed standard ethics guidelines concerning informed consent and confidentiality. Findings: We found six categories of ethical problems (with the main focus on problems relating to the patient's loved ones) and five categories of organisational obstacles. Based on these findings, we developed a set of values in three levels: a general level, an explanatory level and a level of action strategies. Discussion: The ethical problems found corresponded to problems in other studies with a notable exception, the large focus on patient loved ones. The three-level set of values is a way to handle risks of formulating abstract values not providing guidance in concrete care voiced in other studies. Conclusion: Developing a three-level set of values adapted to the specific ethical problems in a concrete care setting is a first step towards a better handling of ethical problems. [ABSTRACT FROM AUTHOR]

Aims and objectives To explore successful factors to prevent pressure ulcers in hospital settings. Background Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2·7-36·4%. Design Qualitative semistructured interviews were conducted. Methods A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014. Results Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients. Conclusion The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work. Relevance to clinical practice The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention. [ABSTRACT FROM AUTHOR]