Browsing by Author "Astvik, Wanja"

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Arbetsvillkor, återhämtning och hälsa - en studie av förskola, hemtjänst och socialtjänst
(Göteborgs universitet, 2010-10) Aronsson, Gunnar; Astvik, Wanja; Gustafsson, Klas
Sammanfattning Aronsson G, Astvik W & Gustafsson K (2010) Arbetsvillkor, återhämtning och hälsa – en studie av förskola, hemtjänst och socialtjänst. Arbete och Hälsa 2010;44(7) Studiens övergripande syfte var att undersöka arbetsförhållanden som är förknippade med ackumulering av stress och bristande återhämtning och att studera hur återhämtning är relaterat till hälsoaspekter. Studiegruppen var anställda inom förskola, hemtjänst och socialtjänst och kom från två relativt stora kommuner (n = 193). Återhämtning eller brist på återhämtning antogs vara en betydelsefull förmedlande länk mellan arbetsvillkor och hälsa/ohälsa och sjukfrånvaro. Datainsamling skedde genom en enkät och den totala svarsfrekvensen var 79 %. En klusteranalys gav tre kluster "Återhämtade“ och “Ej återhämtade“ är yttergrupper, som omfattar 36 respektive 25 procent av totalgruppen medan mellangruppen utgjorde 39 procent. Gruppen ej återhämtade får ses som en riskgrupp för ohälsa. Gruppen uppvisar hela kedjan av riskfaktorer – problematiska arbetsvillkor på vilka de svarar med ökad ansträngning och kompenserande strategier. Trots betydligt högre ohälsorapportering har de inte högre sjukfrånvaro, vilket sannolikt hör samman med att de ersätter sjukfrånvaro med sjuknärvaro. I socialtjänsten är det hela 43 procent som tillhör den ej återhämtade gruppen. Regressionsanalyser med kontroll för bakgrundsvariabler visar att den icke återhämtade gruppen hade en signifikant högre relativ risk för sämre självskattad hälsa än personer i den återhämtade gruppen. Ännu kraftigare riskökningar fanns för de fem symtom som därutöver analyserades. Avslutningsvis diskuteras praktiska slutsatser och nya forskningsfrågor.
Gränser i omsorgsarbete : En studie om arbetets innehåll, villkor och kvalitet
(Arbetslivsinstitutet, 2001) Astvik, Wanja; Bejerot, Eva; Petterson, Inga-Lill
Boundaries in home care work. A study of work content and its significance for working conditions and quality in care The aim of the study was to investigate work content and its significance for working conditions and quality in home care work. Work content refers to work tasks and client category. 341 home care workers in a Swedish municipality answered a questionnaire concerning work content, working conditions, client relations, quality in care and health (response rate 68 per cent). The workers were categorised according to the client group they worked with (mixed, elderly and demented) and according to work tasks (generalists vs. specialists). Differences between groups were tested using two way analyses of variance. The results reveal that those working with a mixed client group experienced more strain than those working with elderly or demented caretakers and task generalists expressed more problems in work compared to the specialists. Workers with a mixed client group reported lower level of decision latitude and greater qualitative and quantitative work load as well as a more problematic relationship with their clients. They also reported a higher degree of physical exhaustion. The task generalists more often felt they had to many caretakers to attend to and also reported a larger emotional and intellectual workload as well as work related stress. Task generalists who worked with a mixed client group had the most strainful working conditions. Different strategies for specialisation in home care are discussed with respect to quality in work and care.
På väg : En kvalitativ studie av arbete, långtidssjukskrivning och rörlighet
(Arbetslivsinstitutet, 2006) Astvik, Wanja; Mellner, Christin; Aronsson, Gunnar
Long-term sick leave and workplace mobility. A qualitative study This study investigates opportunities of returning to work after long term sickleave. Work history, perceived opportunities and obstacles on the road back to a new work situation were studied from a psychological perspective. The study included 20 individuals that started a rehabilitation programme within an employer circle in Stockholm during the autumn 2004. Data were collected by semi structured interviews as well as by questionnaires. Two categories of critical work demands for returning to work were identified. One was unflexible work demands with no possibilities for individually adjusted work tasks. The individuals in this group (n = 10) suffered mainly from physical health problems. The other was boundaryless work demands, i. e. a high work load, both quantitatively and qualitatively, unclear definitions of work content as well as responsibility. The individuals in this group (n = 8) were mainly on sick-leave due to psychological and stress related problems. The study focused on how unflexible and boundaryless work demands interact with individual coping strategies and further, how previous work history influence the perception of a future work. The results are discussed in relation to traditional and modern work organization, work-place mobility, employability, individual coping strategies and psychological contracts. Keywords: Long-term sick leave, work ability, work environment, coping strategies, rehabilitation, locked in, work-place mobility, employer circle.
Relationer som arbete : Förutsättningar för omsorgsfulla möten i hemtjänsten
(Arbetslivsinstitutet, 2003) Astvik, Wanja
Relating as a primary task Prerequisites for sustainable caring relations in home-care service The overall purpose of this thesis is to examine job content and work conditions in home care for the elderly and disabled from a perspective that considers both occupational health and quality of care. The studies are designed to provide indepth understanding of the psychological demands and strains carers encounter in their work by investigating relationships and difficult meetings with clients, and also by examining organisational and individual resources to handle demands of this kind. The various strategies adopted by carers in their work are analysed with regard to their consequences for the quality of care, and the health and job satisfaction of personnel. Demands and resources are considered from a workorganisational perspective, with special attention paid to various kinds of work division. Study I is based on data collected by a questionnaire to a random stratified sample of home-care workers in the Municipality of Stockholm. In the group of 346 carers, there were 18 who had recently taken disability/early-retirement pensions and 28 who had recently retired from the service. A discriminant analysis was conducted to identify conditions that differentiated the two groups. It was found that there were significant differences between groups with regard to the combination of functional impairment and psychosomatic complaint, and the strategies and experiences of carers in relation to their clients. Study II and Study III were designed to investigate the importance of specialisation or demarcation with regard to tasks and client-group profiles. Study II was performed using qualitative methods, and based on a strategic sample of 10 caring/residential-support groups from three Swedish municipalities. Work groups specialising in clients with a psychiatric diagnosis were compared with those working with a mixed group of clients. Also, the issue of whether the groups differed with regard to demarcation of job tasks was subjected to qualitative analysis. Carers were allocated to four categories, according to whether or not they were specialists in terms of client group and job tasks, so as to analyse how specialisation might be understood in relation to quality of care and work conditions. In order to test the findings of Study II and to further examine client-group and task specialisation, a total population questionnaire-based survey was conducted of home-care workers in an urban municipality (n=341). According to Study II and Study III the best balance between good quality of care and healthy work conditions was found in a work division that combines client specialisation with a generalist approach to tasks. The findings of Study I prompted an in-depth study of carers relationships with clients and their psychological strategies at work (Study IV). The objective of Study IV was to identify different types of difficult encounters in caring work, to examine carers strategies in terms of coping and defence, and to study how various work conditions affect choice of strategy. With the aid of coping theory and psychoanalytic theory concerning defence, in-depth interviews with 16 home-care workers were performed. Nine different types of difficult encounters were identified, and were divided according to a categorisation of constructive and non-constructive strategies. The study shows how job conditions both create difficult situations and also impact on carers action repertoire with regard to choice of strategy. Key tasks for actors involved in the background organisation are to give carers sufficient resources, namely time, knowledge and psychological support. The thesis discusses how high quality of care and good work conditions can be accomplished through the decentralisation of decision-making to the front-line caring personnel and to the encounter with the client. On the basis of various aspects of work division the conclusion is drawn that healthy and productive work is best realised within an organisation characterised by the following: 1) work is organised for the purpose of creating and maintaining continuity in relationships between carer and care recipient; 2) assessment and planning of care are closely linked to implementation of the work itself; and, 3) the organisation creates opportunities for carers to deepen their knowledge and expertise, and enhance their working methods and collaborative relationships. An organisational model based on client-group specialisation is proposed. The thesis further indicates that caring activities of high quality require a wide range of knowledge and expertise within a variety of areas. Not least, caring work imposes considerable psychological demands on carers with regard to being in and managing personal relationships. From this it follows that there are increased demands for knowledge in the arena of psychology, and the development of the ability to analyse interpersonal relationships and one s own personal stances in psychologically demanding situations. If these prerequisites are not met, decentralisation and delegation can involve risks. Such organisational principles, combined with a workload that might exceed the individual carer s resources, may create intense feelings of insufficiency and abandonment, and might prompt carers to adopt coping strategies that are deleterious to both quality of care and personal job satisfaction and health.
Specialister eller generalister : Arbetsvillkor och omsorgskvalitet i hemtjänst- och boendestödsverksamhet
(Arbetslivsinstitutet, 2000) Astvik, Wanja; Aronsson, Gunnar
Home care workers as specialists or generalists : Quality in work and care The study concerns the psychiatric reform and different solutions to organize home care for this client group. The aim of the study was to examine work content and to compare working conditions and care quality between work groups specialized on clients with a psychiatric diagnosis with groups working with a heterogeneous client group (old, young with a wide variety of disablement, including psychiatric disablement). Ten work groups from three municipalities were investigated by qualitative methodologies. The results identify three areas of work content: 1) Work areas focused on basic everyday needs : service and caregiving; 2) Medical care and physiotherapy; 3) Work areas aiming for client's independence social education. Analysis of the combination of work areas and client group led to a fourfold table categorization of the work groups as client specialized versus non specialized and task specialized versus non specialized. The best balance between work conditions and care quality were found in the organizational model that combine client specialization with a generalist competence in tasks. The study describes the emotional and intellectual demands of care work and underlines the significance of a professional support. Keywords: Home care work, work-conditions, work-organization, care quality, professionalization, specialization, stress, support, psychiatric reform.
Svåra möten i omsorgsarbete
(Arbetslivsinstitutet, 2002) Astvik, Wanja
Managing stressful encounters in care work : This study examined stressful client relations in care work. The objective of the study was to identify different types of stressful encounters, to investigate caregivers strategies (coping and defense) in these encounters and finally to examine how work conditions influence these strategies. In-dept interviews were conducted with 16 care workers within the social services and home care for the elderly and functionally impaired. Coping theory and psychodynamic theory were used in the analyses. Nine different types of stressful encounters were identified and different constructive and non-constructive strategies were described. The non-constructive strategies involve different means to reduce psychological and physical contact, emotions and responsibility in relation to the caretakers leading to an impairment of the quality of care. The constructive strategies on the other hand, allow the caregiver to remain an active part in the relationship with the care-taker and to be able to uphold responsibility. Finally, different types of work conditions that enable care workers to employ constructive strategies are discussed.
Vägar tillbaka - En uppföljningsstudie av psykologiska och praktiska förutsättningar för återgång i arbete efter långtidssjukskrivning med stöd av en
(2009-11-13T11:28:02Z) Mellner, Christin; Astvik, Wanja; Aronsson, Gunnar; Stockholms universitet, Mälardalens högskola
Sammanfattning Mellner C, Astvik W & Aronsson G. (2009). Vägar tillbaka – En uppföljningsstudie av psykologiska och praktiska förutsättningar för återgång i arbete efter långtidssjukskrivning med stöd av en arbetsgivarring. Arbete och Hälsa 2009;43(10) Föreliggande rapport utgör andra delen i en studie av 20 långtidssjukskrivna och deras försök att inom ramen för en arbetsgivarring komma tillbaka till arbetslivet. Fokus i den första rapporten låg på en beskrivning av individens arbetshistoria samt upplevda hinder och vändpunkter på vägen mot en ny arbets- och livssituation. I föreliggande studie var syftet att utifrån ett individperspektiv identifiera och analysera individuella förhållningssätt och yttre förutsättningar för arbetsbyten bland de långtidssjukskrivna. I studien ingick 20 personer som under hösten 2004 påbörjat ett samarbete med vägledare vid en arbetsgivarring i Stockholm. Uppföljningsstudien genomfördes vårvintern 2006 och bygger på intervjuer med 19 individer. Resultaten visade att sammanlagt nio av dessa hade kommit ur sin sjukskrivning och helt eller delvis övergått till nya arbetsuppgifter hos den gamla arbetsgivaren, helt ny arbetsplats/yrke eller till studier. I analyserna framträdde betydelsen av psykologiska aspekter såsom trygghet, stöd och självkänsla, men inte oväntat fann vi att återgång också på ett påtagligt sätt hör samman med praktiska förutsättningar i termer av adekvat sjukvård och behandling, ekonomiska förutsättningar, möjligheter till omskolning, väglednings- och arbetsförmedlingstjänster. Det återfanns även ett tydligt samspel mellan dessa praktiska förutsättningar och individens psykiska välbefinnande och förmåga att själv agera för att ta sig ur långtidssjukskrivningen. Studiens resultat visar på behovet av att utveckla en sammanfattande psykologisk teori om processen tillbaka till arbetslivet efter en lång sjukskrivning där individrelaterade begrepp som stöd, trygghet, självkänsla och självförtroende, ansvarsfördelning och strategier är byggstenar, men där också institutionsrelaterade begrepp behöver formuleras och ingå.