Rapporten redovisar resultatet av en forskningsstudie om familjestödjande samtal med barn och föräldrar i familjer där mamma och/eller pappa har psykiska problem som föranleder kontakt med vuxenpsykiatrin. Det studerade familjestödet bygger på ett utvecklat samarbete mellan en landstingsdriven vuxenpsykiatrisk mottagning och en familjeenhet inom socialtjänsten i en medelstor kommun i Mellansverige. Den del av familjestödet som har studerats är den serie samtal som erbjuds genom familjeenheten och som genomförs där.

Studiens övergripande syfte var att undersöka hur familjestödjande samtal fungerar och organiseras i samspel mellan barn, föräldrar och professionella. Mer specifikt avsåg studien belysa om och hur barn genom dessa samtal får stöd att prata om föräldrars psykiska problem samt huruvida och på vilket sätt familjestödet kan bistå föräldrarna i deras föräldraskap.

Inom ramen för forskningsstudien samlades data in från 21 familjestödssamtal samt intervjuer med sju föräldrar och fyra barn efter avslutat familjestöd. Dessutom genomfördes sju intervjuer med samtalsledarna som medverkat vid de studerade familjestödssamtalen. Tre familjer följdes genom hela samtalsserien som för dessa familjer omfattade mellan sex och åtta samtal. Samtliga familjestödssamtal spelades in med ljud och bild medan enbart ljud gällde för intervjuerna.

Familjestödssamtalen analyserades med samtalsanalytiska och narrativa metoder. Viktiga teoretiska utgångspunkter var det som brukar kallas institutionella samtal och teorier om socialt samspel i interaktion. Av betydelse var också tidigare forskning om barnsamtal och familje-samtal som kommunikativ praktik och i institutionella kontexter t.ex. familjeterapi, samt internationella och nationella studier om familjestödjande interventioner av typen Beardslees preventiva familjeinterventionoch den finska kortversionen Föra barnen på tal.

Analysen av de studerade familjestödssamtalen – som enskilda samtal och som samtalsserier – visar att familjestödet på flera sätt skiljer sig från många andra institutionella samtal som beskrivs i forskningen, genom att till sin karaktär vara samarbetsinriktade och samtidigt både kartläggande och rådgivande. Familjestödet liknar istället mer terapeutiska möten såsom familjeterapeutiska samtal med den avgörande skillnaden att det i familjestödssamtal är föräldrars psykiska problem som står i fokus medan det klassiska i familjeterapi är att barn är den identifierade patienten.

Inom familjestödet har framför allt föräldrar, men också barn i viss utsträckning, möjlighet till stort inflytande när det gäller upplägg av samtalsserien som trots ett tydligt gemensamt mönster modifieras utifrån varje familjs livsomständigheter och konstellation. Både barn och föräldrar kan också styra vilken information som föras vidare från enskilda samtal till övriga i familjen.

Att det studerade familjestödet har formen av en serie samtal med det övergripande målet att stödja barn genom att ge föräldrar stöd i att samtala med barnet/barnen om sina psykiska problem, innebär också att de olika samtalen i serien – som sker i varierande konstellationer avseende personer och antal deltagare – knyts till varandra genom ett fokus på barnet/barnen och dess/deras behov av information om föräldrars psykisk hälsa/ohälsa.

Tre viktiga aspekter på familjestödet som identifierades var: 1) hur det tycktes öka barns möjlighet att prata om föräldrars psykiska problem utifrån sitt behov av information samt att tydliggöra barns position som anhörig med rätt att få vetskap; 2) den lärande dimensionen av familjestödsamtal; och 3) hur familjestödet realiseras genom en balansakt av de professionella men där barn och föräldrar aktivt deltar.

I relation till andra institutionella samtal med barn och föräldrar, tycktes barnen i familjestödet få sitt perspektiv belyst i relativt hög utsträckning, och barn kom till tals särskilt i barnsamtalen. Ett viktigt tema i familjestödet och speciellt i enskilda samtal med barn, handlade om huruvida barn tog eller kände ett för sin ålder alltför stort ansvar för sin/sina föräldrar. Analysen av barnsamtalen tydliggör dock att det kan krävas mycket samtalstid för att barn på eget initiativ ska ta upp frågor om oro beroende av föräldrars sjukdom. För barn är det krävande att förmedla sina funderingar kring svåra frågor till andra vuxna och särskilt i ett institutionellt sammanhang.

Samtidigt indikerar analysen att barns roll som anhörig inte är självklar eller oproblematisk då barn i hög grad tycktes medverka utifrån föräldrars önskan snarare än en egen uttalad vilja att delta. Inte heller stod det helt klart att barnen fullt ut förstod vilken typ av samtal de skulle medverka i när de kom till sitt första samtal inom ramen för familjestödet.

Den lärande dimensionen av familjestödet hör delvis ihop med den seriekoppling som tydligt skedde mellan olika samtal genom att samtalsledare rekapitulerade tidigare möten, återberättade vad andra familjemedlemmar hade sagt i tidigare möten samt upprepade planen för nästkommande samtal liksom målet för familjestödet i sin helhet. I detta märktes även den utmaning det innebar för de professionella när det gällde att anta ett barnperspektiv då flertalet samtal utgjordes av föräldrasamtal. Anläggandet av ett barnperspektiv kan därför ses både som en professionell hållning och som en del av den lärande aspekten i familjestödssamtalen där just barnperspektivet tycktes bidra till att konstituera familjestödet som en helhet genom t.ex. att hålla fokus och att seriekoppla möten.

Till skillnad från den kamp mellan ett professionellt perspektiv och klientens livsvärlds-perspektiv som ofta beskrivs i tidigare forskning som gällt samtal och samtalsserier inom välfärdsinstitutioner som socialtjänst, hälso- och sjukvård, försäkringskassan och arbetsförmedlingen, visar analysen av familjestödet hur samtalsledaren växlar mellan flera olika perspektiv – föräldraperspektivet, barnperspektivet och ett professionellt perspektiv. Detta sker på ett flexibelt sätt anpassat till samtalens dynamik och föräldrars och barns individuella förutsättningar och utgör på övergripande plan den balansakt de professionella utför.

Analysen av familjestödet visar att det finns tydliga likheter med den struktur som beskrivs för Beardslees preventiva familjeintervention. Därmed kan studien av familjestödet bidra till ökad förståelse också för den typen av samtalsserier med barn och föräldrar och för vilken det saknas naturalistiska studier av autentiska möten.

Increased care worker knowledge has been emphasized for improving quality of care for older persons in organized elder care in Sweden. However, care workers and national policies are not always corresponding, with observations suggesting that care workers emphasize tacit knowledge. The aim of this article is to explore the nature of this kind of knowledge and how it can be identified and described. Field notes from participant observations at two elder care units in Sweden serve as the empirical material. Knowledge use for staff in elder care is part of a process of knowledge making and knowledge shaping. Analysis of the field notes identified the themes of “feeling for work” and “acting and artistry” as parts of a tacit knowledge in elder care. The processes of knowledge and job execution are closely intertwined, making them difficult to separate or even understand without a deeper insight.

This paper addresses the issue of reflective practice, as suggested by Schön. Theaim is to analyze instances of reflective practice in elder care, in order to depictindividual and collective work. Reflective practice is prevailing as a way ofemphasizing the value of practical knowledge and enhancing its status. Reflexivityis thinking about what and why we do something. Moreover, reflexivity is away of incorporating knowledge with our own personal selves, making it a verypersonal matter. Using reflective practice in elder care enables learning, leadingto improved quality of care. However, individual reflection must be accompaniedby collective reflection; this is crucial to improve quality of care.

Rapporten, är ett resultat av doktorandkursen: Brukarmedverkan i forskning och utvecklingsarbete inom hälso- och sjukvård, socialt arbete och omsorg, som gavs under våren 2009 i samverkan mellan fem lärosäten. Antologin bygger på kursens föreläsningar och examinationer och riktar sig till forskare och andra som är intresserade av att arbeta utifrån ett brukarperspektiv. Den riktar sig även till studenter inom vård, omsorg och socialt arbete och verksamma inom olika brukarorganisationer. Boken ger en bild av hur arbetet kan se ut och en vägledning i hur brukare kan vara delaktiga inom forskning.

Pia Bülow och Elisabet Cedersund har tillsammans skrivit kapitlet Brukarens perspektiv och röst. Forskning och utvecklingsarbete med samtalet som grund. Kapitlet Framtidsverkstad som resurs för volontärsarbete vid kvinnojour är skrivet av Birgitta Ander och Ulla Åhnby

This article has a focus on how discursive positioning is carried out during encounters between people in the daily routine of social work, and how a basis for “otherness” can be created through positioning during the social work encounters. Social work practice includes discursive activity between social workers and clients, and the occurrence of stories is seen as a central element in this activity. Narratives have in earlier studies been described as tools used in social work practice, and parts of the narrative are often documented and compiled with the rest of the information gathered to serve as a basis for professionals’ actions. Theories relating to the narrative relayed during the encounter between social worker and client have evolved over the past few decades, and this development is also reflected in social work research. One key theme that has emerged in this research is the use of narratives to categorize the clients in the social services. Analyses carried out in recent years, however, have gradually become ever more refined, and show how people position themselves in relation to others on the basis of words such as “we” and “them”. This article gives an overview of this development in social work research with the use of empirical examples from social work practices in different fields of social services, from the encounters in social work offices, and assessment meetings in eldercare, and from team talk among professionals

The paper uses data from a project concerning communication and social interaction between old people with Alzheimer's disease (AD) and their carers (employed by the municipal social services). The empirical data consist of dyadic conversations between a person with AD and a caregivers. The aim of the project was to investigate naturally occurring conversations between individuals with AD and their caregivers. The analyses did not focus only on the disabilities but also on the communicative abilities of the AD patients. The study explored how communicative abilities may change over time and different situations, and how the communicative behaviour of persons with AD may be influenced by conversational contributions of the healthy interlocutors. The analyses in the paper focused on the following aspects: (a) The care-givers methods of talking with the old person (e.g. to give support, or to make corrections); (b) The narratives produced by the old persons; (c) The construction and co-construction of narratives in this type of care setting. According to the results some of the stories told by the persons with AD have a conventional structure - a classical beginning - middle - end format, with a description of a situation, introduction of characters, the introduction of some kind of problem or dilemma, and a resolution. However, several of the stories take a different form: E.g they do not have a conventional ending with a resolution of the issues raised. These changes may be linked to the old person-s memory difficulties, and the mixing of details from other stories. But just like in other social situations - conversations between people with AD and their care-givers include interplay between the interlocutors. The listeners (i.e. the caregivers) are not passive recipients but active contributors to the shaping of the tellings with their responses. In this paper it is showed how care-givers may assist with the constructions of narratives to help the old persons with AD to articulate their stories.

This is a study of talk between older persons and care staff in encounters in elder care. The empirical data consist of 20 dyadic audio-taped conversations between older persons and care staff.

The conversations were studied as acts of narrative identity positioning in which the participants in the dialogue take positions in order to argue for a specific identity in the context of care.

A discourse analysis of interpretive repertoire subject positions and narrative identity construction were undertaken (Davies and Harré 2001). The results summarize the interpretive repertoires used by old persons and the care staff high-light the construction of subject positions using discursive recourses.

While focusing on communicative practices in the context of elder care, the paper address methodological issues, but the intention is to open up also for discussions on theoretical as well as empirical matters in the study of ageing and later life.

One of the main interests behind this study has been to examine how institutions, such as the social services, deal with people 's troubles and difficulties, how a private problem is transferred to the language used within a public institution. The study deals with the processing of applications for financial assistance, and is based on a documentation of talk and text - from the initial telephone mediated contact to the final written decision - which are produced in the handling of the clients' applications. Even though previous studies of institutional discourse have shown interest in the daily routines of formal organizations, working with the processing of cases, they have often neglected the role that different kinds of texts play in these processes. The present study concems the roJe of text and talk as parts of such routines.

DATA

The study contains a detailed documentation of the processing of appJications for financial assistance involving 25 individual cases. This corpus was compiled <luring 1988 and 1989 in three social welfare offices in two middle-sized Swedish cities. It comprises mainly the following data:

a) telephone conversations between social workers and clients (20 calls are documented by means of participant observations and written notes)

b) face-to-face conversations between social workers and clients (25 audio-taped conversations)

c) application forms and other written documents which form the basis for decisions (copies of the relevant papers from 20 cases)

d) the social workers' written decisions (copies from 20 cases)

e) meetings with the social welfare committee (discuss ions and decisions conceming 3 applications documented by means of participant observation and written notes: copies of the minutes and other kinds of written decisions)

f) interviews with the clients and social workers, who participatedin the study (23 clients and 15 social workers have participated in audio-taped interviews).

ANALYSIS

The recorded conversations and interviews were transcribed in extenso. The analyses are based on the transcriptions as well as the audio-tapes. The conversations have been analysed in several ways, e.g. in terms of sequential structure and contents as well as their function in the institutional context.

The written documents - the applications and decisions etc. - included in the study have been analysed mainly with regard to their significance in the processing of the individual cases. The documents have made it possible to investigate both the relation between spoken and written discourse and the processing of 'cases' through several stages, which is common in many areas of bureaucratic organizations (Jönsson, 1988).

RESULTS

The presentation of the results of this study follows the stages which have been identified in the processing of the cases. This handling of the clients is found to follow a distinct order which includes the following steps: 1) the client's initial telephone call to the social welfare office; 2) the application form which is supposed to be filled in by the client; 3) the social welfare interview; 4) the decision concerning the client's application. In short, the findings may be summarized as follows.

The initial telephone conversation functions as a buffer between the social welfare officer and the applicants. During this stage in the processing of people, a 'screening' takes place. This gives the social worker a chance to make informal judgements as to whether the client should persist in seeking help and also to provide the ' client-to-be' with information concerning other ways of solving her or his financial difficulties. If the client's financial (and social) position seems to fit into some of the categories that make a person eligible for financial  assistance, a slot for the client is found (i.e. this person is offered an appointment for an interview and/or provided with an application form).

The application form is used to collect information about the applicant. This form, however, plays a more prominent role in the different stages than expected, since it gives a structure to many of the routines and procedures used when a client's application is being handled. This procedure may moreover be seen as a way of disciplining clients, and teaching them 'the client role' (cf. Lipsky, 1980, p. 61). When a person has filled in the necessary details on this application form, he or she has been accepted and given a client status in the further relations with the social welfare office.

The social welfare interview gives the client access to the social welfare office and gives him the opportunity of providing more information about his or her financial difficulties. The conversation usually begins with a revision of the application form. In connection with this, the client often talks about the events in the past which are related to the need for financial assistance (cf. Cedersund, 1992). It is during the interview that we are able to observe how the client's financial problems are reformulated in a way that may be accepted within the social welfare organization. This transformation of 'problems' into 'cases' is made possible through the use of a typification where the clients are assigned to certain categories which are usually implicitly expressed in discourse.

The decision is made by the social workers or in some cases her supervisor and/or the district board for social welfare services (Sw. : social distriktsnämnd). The decision is often given to the client in the social welfare interviews and the written decisions are mostly produced after this encounter. These written texts in most cases include a short summary of the specific details of the client's financial difficulties and needs. This summary may be similar to a later version of the client's own oral account of his or her financial difficulties given during the welfare interview. The last part of the written decisions always includes statements which show the approval (or rejection) of the client's application. The written decisions seem to be produced in order to document the processing of the applications within the office rather than as a text to be read by the clients.

This work focuses on the role of talk and text in the processing of people in public organizations. It is a study of communication between citizens and officials in one such organization, namely, the Swedish social services. The aim of the study is to examine some of the micro-level processes which make up the daily operations and routines of this kind of institution.

The work consists of three parts. The first part reports a study of the initial telephone contacts between parents who need day care for their children and the clerks in charge of the 'waiting-list' for municipal day-care services. The data that have been analysed consist of 10 audio-taped telephone conversations between parents and clerks. Theanalyses focus on the local organization of talk and show that the professional dominance is maintained during all the various phases of the call. Starting the conversation with an extensive 'filling-in-the-form phase' turns out to be an effective way of preserving the institutional order. The clerks manage to achieve communicative dominance, while theparents are induced to accept the limited repertoire of bureaucratic expressions as valid descriptions of their own needs and wishes concerning the future day care for their children.

The second part is a study of clients who are applying for financial assistance. It is an attempt to scrutinize the mode in which clients present their financial problems in social welfare interviews. The data consist of 25 audio-taped social welfare interviews. The clients' talk about their financial problems has been analysed in detail and this analysis has served as a basis of a typology, which contains the following basic discursive formats: 1) monological narratives, 2) dialogical talk, 3) minimal contributions from the client.

The third part, which is published as a separate monograph written in Swedish, deals with the processing of applications for financial assistance. This part includes a detailed documentation of the processing of 25 applications. The study is based on a documentation of the following stages in the handling of the cases: 1) the client's initial telephone cali to the social welfare office; 2) the application form which is supposed to be filled in by the client; 3) the social welfare interview; 4) the decision concerning the client's application. One of the main interests behind this part has been to examine how institutions, such as the social welfare bureaucracy, deal with people's troubles and difficulties; how a private problem is transferred to the language used within a public institution.

This work describes how the processing of people relies on standardization of communicative practices where oral discourse is embedded in routines which also comprise the use of texts and other artifacts. The texts are important tools for maintaining the institutional order and they are integral parls in encounters between citizens andofficials in institutional settings. The tools seem to provide for continuity and coherence and to be an important element in the ability of the organization to maintain the 'proper procedures' irrespective of who the individual actor is.

This chapter deals with narratives that, at times, are more unbelievable than any story. The people involved in these narratives are all participants in various types of encounters with social workers: clients speaking with social workers, social workers in encounters with their colleagues, or social work teachers instructing their students by using the narrative form. The discursive dimensions in the typology were mainly related to the following concepts: monologues vs. dialogues; extensive vs. minimal contributions; narratives vs. non-narratives. The literature review indicates that the use of narratives in social work has several different significations and sometimes serves different functions. The creation and co-creation of alternative narratives on ‘reality’ is an important aspect of supporting people so they may exercise control and influence over the development of their own lives and gain an understanding of how their lives have turned out.

The anthology New Tools in Welfare Research presents various tools for qualitative and quantitative research on welfare, building on both new and established theoretical perspectives and research methods. The contributions were developed within the framework of the Nordic Summer University, and were thus influenced by different research traditions at colleges and universities in the Nordic countries.

Research tools that get people involved are described; people's own statements and experiences are utilized and interpreted on the basis of established theoretical perspectives such as phenomenology, hermeneutics, and interactionism. The research approaches presented enable people of different ages to participate in formulating the image of their living conditions. This can be done together with children, adults, or old people in different life situations. It is also shown that comparative approaches may offer new insight into the various dimensions of the welfare system as a cultural practice.

The anthology New Tools in Welfare Research presents various tools for qualitative and quantitative research on welfare, building on both new and established theoretical perspectives and research methods. The contributions were developed within the framework of the Nordic Summer University, and were thus influenced by different research traditions at colleges and universities in the Nordic countries.

Research tools that get people involved are described; people's own statements and experiences are utilized and interpreted on the basis of established theoretical perspectives such as phenomenology, hermeneutics, and interactionism. The research approaches presented enable people of different ages to participate in formulating the image of their living conditions. This can be done together with children, adults, or old people in different life situations. It is also shown that comparative approaches may offer new insight into the various dimensions of the welfare system as a cultural practice.

I denna bok söker vi samla idéer och tankar från olika tidsepoker för att formulera en socialpedagogik för framtiden. För att de idéer som historiskt formulerats om socialpedagogiken ska vara användbara måste de förstås utifrån och kopplas till den nutida situationen. Boken tecknar en aktuell bild av socialpedagogisk verksamhet och forskning i Sverige, kompletterad med internationella utblickar.

Socialpedagogiken och socialpedagogerna verkar i ett samhälle som är statt i förändring. Det gör att socialpedagoger i allt högre utsträckning än förr möter grupper av människor som befinner sig på andra samhällsarenor och i förändrade livssituationer. Detta ger upphov till och ett behov av att beskriva och förstå socialpedagogik på ett förändrat och fördjupat sätt. En ambition med boken är att skapa en förståelse för socialpedagogik och dess kopplingar till människors lärande. Detta sätt att tänka kring socialpedagogik ger en bra grund för den som vill utveckla ett socialpedagogiskt tänkande och förhållningssätt. Boken lyfter fram det socialpedagogiska perspektivets styrkor i dagens och morgondagens välfärdsarbete och ger en ram för det som benämns socialpedagogisk bildning.

Boken vänder sig i första hand till studerande på socialpedagogiska högskoleutbildningar, men även till studenter på socionomprogram och lärarprogram. Boken kan med fördel läsas på avancerad nivå och forskarnivå, men även av studenter på grundnivå.

This paper reports results from a study of meetings between old persons, their relatives and the care managers who work with assessments of home care. According to the Swedish Social Welfare Act old persons who are in need of care are entitled to apply for home care. The formal decision concerning home care is made by the assessment managers who handle these type of applications within the municipality. Old persons and their family members - such as spouses or children - are moreover supposed to have influences on how home care is organized. The issues related to home care may often comprise conflicting interests - both within the family, and between the old persons, their family members and the case managers. The data consist of 20 Swedish home care assessment meetings. The assessments were studied, as institutional practices in which the participants used discursive positioning in order to argue for their version in the decision-making. The results show that the home care assessment meetings functioned as a situated practice in which old persons were positioned both by care managers and their relatives as potential home care receivers. Although the old persons had the final saying in the decision process family members were prominent in constructing the old person as in need of care. This highlights further questions about old persons individual rights within the decision-making in this type of situation. It also poses questions about relatives and their needs in the caring practice for the future development of the old age care system.

Team meetings are central to social workers’ decision-making practices. These meetings often function as a forum for collegial consultations, when applications are processed and recommendations on decisions are discussed. In this paper, we present findings from a case study on team talk and decision-making practices in gerontological social work. The data come from a body of material gathered within the framework of a larger project covering the process of assessing elder care for older persons in three Swedish municipalities. The case concerns an application, due to homelessness, from a couple for an apartment in special housing. The team meeting was analysed using a data-driven perspective within a micro-analytical approach to talk, focusing in detail on how conflicting perspectives in the assessment of the couple’s needs are dealt with, and how tensions between divergent views and opinions are handled in relation to institutional and professional conversational frames. The findings show how the care managers (in Sweden the professional title for social workers working in elder care) negotiated the boundaries of responsibility and power within both the institutional and professional frames, revealing that the institutional frame dominated when it came to making decisions. The findings have implications for practice, as they give insight into the interactional dynamics involved in social workers’ assessments when navigating different conversational frames within their decision-making practices.

Introduction: Despite evidence that older persons want to be involved in care, little is known about how older people with complex health problems living at home experience participation in care provided by different stakeholders. This study investigates the experiences of participation in care by older people, following their involvement in a proactive intervention based on a new health care model called Focused Primary Care. Material and methods: Individual semi-structured interviews were conducted with 20 older persons in five municipalities in Sweden. All the interviewees had participated in the intervention. Results: The older persons highlighted opportunities and limitations for participation on a personal level i.e. conditions for being involved in direct care and in relation to independence. Experiences of participation on an organisational level were reported to a lesser degree. In order to keep care contacts together and improve participation, a coordinating person (called “the spider in the net”) was requested who could safeguard the staff’s relationship with the older person. Conclusions: Primary care should to a greater extent involve older persons more directly in the planning and execution of care. There is considerable potential for developing the health and primary care sector to better target the needs of older persons with complex health problems, and to enhance their participation and independence. Interventions, like the one followed in this project, can play a critical role in realising the needs of older persons, where providing participation in care is recognised as a significant goal to assist them in navigating the care system. 

Kapitlet innehåller en sammanställning över kunskapsläget när det gäller äldre personers upplevelse av ensamhet. Ensamhet kanbeskrivas som en negativ känsla vilken uppkommer och hörsamman med människors brist på sociala relationer. Det kan röra sig om brister när det gäller relationernas antal och/eller kontinuitet. Ensamhet är ett komplext fenomen, och mätningar av andelenäldre som upplever negativ ensamhet ger olika resultat beroende påstudie. Studier genomförda i Sverige har visat att cirka 10 procentav gruppen äldre (65+) uppger att de ofta har en känsla avensamhet. Till detta kan läggas att cirka 40 procent uppger att de ibland upplever ensamhet. Det finns ännu få svenska effektstudierav de satsningar som genomförts med syfte att motverka äldresensamhet.

I denna skrift redovisas resultat från projektet ”Omsorgen om landsbygdens äldsta. Kommunens och civilsamhällets omsorgsnätverk i semi-rurala miljöer”. Syftet med projektet är att öka kunskapen om hur äldre som bor på landsbygden själva ser på sitt åldrande, vad man är engagerad i, hur man vill bo och vilket stöd och vilken hjälp man har och ger till andra. I projektet studeras hur några mindre landsbygdskommuner ordnar äldreomsorgen och hur kommunerna och vissa lokala aktörer förhåller sig till äldres behov och intresse.

Fokus i denna skrift riktas mot kommunens sätt att organisera och genomföra omsorg, samt hur den är kopplad till det civila samhällets aktörer. Materialet som ingår har insamlats i de tre kommunerna Valdemarsvik, Ydre och Åtvidaberg. I denna skrift redovisas resultat från intervjuer som genomförts med representanter för dessa kommuner (kommunalråd, kommunchef, omsorgschef ). Redovisningen av intervjuerna berör de intervjuades syn på den egna kommunens förutsättningar, kommunernas strategier och framtidssyn. Skriften innehåller också resultat från intervjuer med representanter från civilsamhället, seniorföreningar (PRO:s och SPF:s ordförande, vice ordförande, styrelseledamot) och kyrka (diakon, präst). I dessa intervjuer berörs synen på förhållandena för kommunens äldsta, samt civilsamhällets roll som omsorgsaktör.

Trots att de tre kommunerna kan förefalla likartade, visar studiens resultat på skillnader dem mellan. I Åtvidaberg finns ett tydligare centralortsfokus än i de andra två kommunerna. Även om Ydre som är en liten kommun också har en given centralort dit verksamheter koncentreras, finns ett tydligare landsbygdsfokus. Ydre är en skogs- och jordbrukskommun med en hög andel egna företagare. Inom kustkommunen Valdemarsvik förs ett tydligare resonemang om hur man ska kunna erbjuda service i olika kommundelar, något som man upplever att kommuninvånarna är angelägna om. Valdemarsvik består av flera relativt självständiga samhällen vilka tidigare var egna kommuner och som månar om sin egen självständighet. Arbetet i kommunen har även präglats av resonemanget ”hela kommunen ska leva”. I de två kommunerna Ydre och Valdemarsvik, har man poängterat att närheten till sitt lokalsamhälle liksom personkännedom är viktiga faktorer i äldreomsorgen, medan man i Åtvidaberg i större utsträckning har utgått från att man bättre tillfredsställer äldre personers behov genom att äldre kommer närmare service och tillgänglighet i centralorten. Den stora frågan i alla tre kommunerna är hur man ska kunna erbjuda äldreomsorg med samma kvalitet som idag till en växande andel äldre men med minskande skatteintäkter. Här är dock inställningen att det är något som måste lösas på nationell nivå t ex genom utjämningsbidrag för att man ska kunna åldras på jämlika villkor nationellt.

Frågor som är ständigt aktuella i kommunerna gäller hur man ska kunna tillfredsställa tillgänglighet till servicefunktioner för dem som bor längre ut i kommunerna, utanför centralorten eller de större samhällena. Kollektivtrafiken på landsbygden utgör en stor kostnad och turtätheten minskar kontinuerligt. För dem som inte längre kan köra bil kan detta bli en avgörande fråga för om man kan bo kvar eller ej. Färdtjänst täcker en del av behovet liksom anropsstyrd trafik, men fungerar sämre för att upprätthålla sociala kontakter som huvudsakligen sker på kvällstid eller helger. Att kunna erbjuda äldre bra och funktionella bostäder är ytterligare en fråga som tas upp. Man är beroende av att någon vill erbjuda bostäder samt att det finns en betalningsvilja hos äldre personer för den typen av bostäder, båda dessa faktorer upplevs som problematiska. Idén att främja kvarboende kan å ena sidan förstås i ljuset av att det är en kostnadseffektiv strategi i en tid där decentralisering ställer ökade krav på kommuner att själva sörja för sin välgång och där medborgarnas resurser och hälsa blir allt viktigare för utvecklingen i lokala miljöer. Å andra sidan kan kvarboendeprincipen ses som en form av nyliberal vision som betonar inte bara regioners utan också enskilda individers egenansvar, självtillräcklighet och valfrihet.

Sammantaget ter sig ett friskt och aktivt åldrande – förkroppsligat i kvarboende – ofta både nödvändigt och önskvärt. Mycket av strategierna går ut på att den äldre människans vardag ska kunna fortsätta att fungera som förut. Omsorgen går ut på att bevara förmågor. När det gäller att skapa ett äldrevänligt samhälle med goda kommunikationer kommenterade exempelvis en av studiens informanter: ”Så folk ska kunna få sin vardag att, så länge som möjligt, vara ganska lik den man har haft förut”.

Från kommunernas sida räknar man med att verksamheten i större utsträckning kommer att koncentreras till att möta äldres grundläggande behov, något som i skriften betecknas anpassningslogik. Man förutsätter då att andra aktörer än kommunerna ska tillfredsställa övriga behov, men riktigt hur det ska gå till är ibland oklart. Det kan gälla dels privata marknadsaktörer som dock är beroende av ekonomisk lönsamhet, dels frivilligorganisationer och anhöriga. Föreningsliv och kyrkan uppfattas som viktiga komplement av såväl kommunen som av organisationerna själva. De äldre ses som en resurs för den egna gruppen, samtidigt som representanter för kyrkan och frivilligorganisationerna menar att människor inte alltid är benägna att be om hjälp ens av närstående. Föreningar och frivilligverksamheter står för en stor del av aktiviteterna på landsbygden men är beroende av eldsjälar och kontinuiteten är därför osäker. Det finns dock en optimism om att det sker generationsskiften även inom dessa verksamheter som bidrar till att göra fortlevnaden möjlig. Föreningsliv och dylikt blir ett sätt att skapa ringar på vattnet, att vara ett forum där sociala nätverk kan etableras och fortsätta växa på egen hand. I studien framgår även att många äldre själva fyller en viktig roll både som omsorgsgivare och för det sociala livet i stort.

I skriften skisseras olika vägar för att lösa den brännande frågan om hur den mindre kommunen kan möta en framtid med krympande kommunstorlek och samtidigt tillförsäkra god service till en åldrande befolkning. Sannolikt är det så att olika lösningar passar olika väl i olika typer av kommuner och för olika typer av frågor. Ett resultat som framkommer i skriften är att de lokala förhållandena behöver bli en utgångspunkt för den planering som sker för att möta framtiden. Kan hända är det olika lokala initiativ som gör en verklig skillnad, initiativ som kan genomföras med stöd från regional och statlig nivå. Lösningen kan i många fall handla om att finna en balans mellan politiska ambitioner, framåtanda och anpassningslogik.

Objective. Studies of oral health developments increasingly include self-reported assessments of how oral health affects quality of life (QoL), referred to as “oral health-related QoL”. People with dementia are often excluded in studies of oral health-related QoL and thus our aim in this study was to explore this area in elderly persons with dementia. Material and methods. Eighteen elderly individuals (aged between 78 and 94 years) with dementia of varying degrees of severity were interviewed with the aid of an interview guide; pictures and objects were used as stimulus material (triggers). The material was analyzed using grounded theory as point of departure, and a professional assessment of the oral health of the participants was used as reference. Results. Four categories were identified: the ability to chew and eat, independence, oral problems, and teeth are important. These factors are largely consistent with those that have emerged in earlier studies of the elderly, but in some cases less pronounced in persons with dementia. Conclusion. The use of triggers is a positive way to communicate oral health-related QoL among persons suffering from dementia, although the material used in this study needs further evaluation and development.

Summary: This article reports on an empirical research study exploring and describingvariations in how front-line practitioners perceive service user participation (SUP),specifically in interprofessional practice. The settings comprised three Swedish healthand social care organizations where the professionals worked in interprofessionalteams: a program for chronic pain rehabilitation, a program for surgical treatment ofobesity, and a short-term municipal home for older adults. The qualitative study designwas informed by a phenomenographic approach and conducted as semi-structuredindividual interviews with 15 professionals representing nine professions, includingsocial work.

Findings: The main findings show seven qualitative variations in understanding of SUP:1) inclusion in activities and social events, 2) obtaining guidance, 3) having self-determination and choice, 4) getting confirmation from and contact with professionals, 5)negotiating for adjustment, 6) personal responsibility through insight, and 7) circumstance surrounding SUP.

Applications: The interprofessional dimensions discerned in the meaning attributed toSUP are mainly described in terms of amplified opportunities for participation.An interesting aspect of the findings is that in all the variations of perceptions of SUP,there are potentials to reverse to their opposites, that is, paradoxes that can be termed‘the dual faces of service user participation’. These aspects stress the need for continuing reflection on practices among both front-line practitioners and managers in empowering and paternalistic processes and on constantly improving organizational andpolicy conditions to facilitate SUP

Aim. The aim of this paper is to report a study exploring how members of multiprofessional healthcare teams talk about their team. Specifically, the team members' talk was analysed to explore the discursive patterns that emerged and their functions.

Background. Over recent decades there has been an increasing demand in Western countries to change care organizations and to coordinate resources and professional competencies to meet the needs of patients/service users better. Because society promotes this kind of work, it may be valuable to explore the self-presentations of a multiprofessional healthcare team.

Methods. A discourse analysis was carried out on existing empirical data from focus group interviews with a member-identified category sample comprising 32 healthcare professionals in six authentic multiprofessional teams in south-east Sweden. The analysis focused on the participants' discursive constructions of multiprofessional teamwork, on the way they talked about their group, and, in particular, on their use of the pronouns we, they and I.

Findings. The constructions of 'we' by multiprofessional healthcare teams showed discursive patterns that are here referred to as knowledge synergy and trusting support, which included factors such as cross-learning and personal chemistry. The pronoun we was also used as a flexible resource to manage expertise, power and leadership within the teams, and it might also function to ease the pressure for consensus.

Conclusion. These discursive patterns provided powerful rhetorical resources for team members, both to affirm their choice of membership and to claim superiority in relations with the surrounding community (the others) by linking to a societal discourse that promotes collaboration.

I detta kapitel diskuteras hur teamets identitet och medlemmarnas självuppfattning skapas och formas genom språkliga förhandlingar och positioneringar mellan och inom gruppen och gentemot gruppens omgivning. Vilka ord väljer teammedlemmar när de talar om sig själva och om teamet? Beskrivningarna visar att dessa ”självpresentationer” kan vara en resurs för medlemmarna i det tvärprofessionella teamet i det vardagliga arbetet.

How service users conceptualise their personal support services is under researched, even though this understanding is important for responsive policy development and service implementation. This paper tests the proposition that service users understand formal support in three ways: support is a complement to their other arrangements, an intrusion into their personal life and a right. These three concepts were identified using discourse analysis in a Swedish study of older people wanting in-home support services. To test generalisability of these concepts, they were applied to data from an Australian study of people using disability personal support. The analysis found that the three concepts were core to people's views of their support, although the construction of the concepts differed in the two countries. Service users in Sweden asserted their right to services more forcefully than those in Australia, and they had higher expectations that their support needs would be met. These differences reflect the impact of each country's social policy environment on service users' expectations. The analysis suggests that service users and their families want to control their formal support arrangements to complement their informal care and their life preferences and to minimise the intrusive aspects of formal support. The findings imply that the three concepts have utility for theorising service users' perspectives, informing policy and developing implementation strategies which enhance peoples' quality of life.

Physical activity is described in the literature as positive and important, and has come into focus in recent years. An activity-based theoretical approach dominates in Swedish eldercare, and there are also international recommendations on physical activity for older people. Nevertheless, few studies have explored how the need for physical activity is satisfied at assisted living facilities.

The aim of this study was to investigate how professionals working in eldercare think about and act to promote physical activities for elderly people. The empirical data consists of observations and interviews conducted at four assisted living facilities in two different Swedish municipalities.

The results show how cultures and norms are important for how professionals think and act regarding physical activity. There is a contradiction between how professionals discuss elderly people’s need for support for physical activity and how they act in their day-to-day work. There seems to be an acceptance that elderly people’s individual needs cannot be met if professionals have other tasks to perform.

The design of assisted living facilities is an issue that has engaged architects and contractors since they began building the first residential homes. Previous research has shown that participation in everyday activities promotes wellbeing in older people. Many assisted living facilities have locked units that limit the individuals ability to move freely. Our interest is directed towards older peoples opportunities to be physically active in assisted living facilities and how the physical environment affects these opportunities. The aim of this study was to increase the understanding of the importance of the physical environment to enable physical activities in assisted living facilities. The empirical material consists of observations and semi-structured interviews with thirteen residents and seventeen staff in four assisted living facilities in Sweden. The results show how the physical environment influences the opportunities for physical activity. Certain factors in the physical environment can be both promoting and limiting. An unsuitable environment limits the ability of older people to be physically active.

Aim: Physical activity has been described as important for the well-being of all individuals, including the very old. The aim of this study was to investigate how physical activity is performed at assisted living facilities, the situations in which older people were and wanted to be physically active and the role of the physiotherapist at each facility.

Methods: To achieve this aim, an ethnographic study including observations and interviews was conducted at four assisted living facilities.

Results: The results show that physical activity neither was an issue in focus at any of the assisted living facilities, nor were recommendations on physical activity followed. Individuals that were able to exercise themselves could do so, whereas those in need of assistance had but limited possibilities to be physically active. There was a need for physical activity that the staff do not necessarily and sufficiently identify.

Conclusion: The study illustrated that there were major variations in how older people engaged in physical activity and how physical activities were part of everyday life. Physiotherapists played no clear role at the facilities, especially with regard to preventive exercise. Older individuals were not involved in determining which activities should be made available to the residents.

Physical activity is often described as being important for people of all ages, but what different people mean when they talk about physical activity is unclear. A phenomenographic method was used to analyze how 13 older people and 17 professionals answer the question, "If I say physical activity, what does the concept mean to you?" as part of semi-structured interviews conducted in four assisted living facilities in two different municipalities. We identified a number of different perceptions of physical activity, with the older people and professionals having different responses. Elderly and professionals alike, define physical activity as a requirement for life and as an opportunity to maintain the body although they define the concepts in different ways. Elderly define the concept as a way to create meaning and the professionals have the attitude that the concept means everyday activities. The concept of physical activity may be defined in many different ways. This study has shown that elderly and professionals do not define physical activity in the same way. Therefore, professionals need to be aware of these differences when talking with elderly about individual needs in everyday life.

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction.

Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire.

Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models.

This article explores care management as an activity that regulates the distribution of society's resources for home care. It focuses on interaction in assessment meetings, which are part of the planning of services and care for old people in Sweden. The aim was to acquire an understanding of how old people, as applicants, account for their needs for care, and how these accounts are negotiated and positioned in talk. Twenty home care assessments were audio-taped and the data were analyzed using discursive analysis. It was found that the assessment meetings had an institutional structure within, which old people, as applicants and with individual needs for care, were assessed within fixed institutional categories. Furthermore, analysis showed how interaction during assessment meetings functioned as formal problem-solving, in which applicants' accounts of their health issues were negotiated, contributing to the construction of their identity as home care receivers.

Home care arrangements for older people are coordinated via a client-centred assessment process. This article describes how storylines and discursive positioning are used among older people and their relatives when divergent opinions of care needs are expressed. Eleven assessment interviews were studied using discourse analysis. The results show that relatives and older people advanced three major storylines, and positioned themselves within them with respect to the need for help. These storylines were based on whether the persons viewed home care as an intrusion into daily routines and relationships or as a complement and support in everyday life, or as a right. The content of the storylines and the ways in which positions were shaped within them illustrate how positioning is incorporated as part of the ongoing reflexive process in interaction in which participants form an image of the older person's needs. Assessments clarify the views of the participants on home care, but they also reflect the discourses that are prevalent in the aged care community and in society in general. The article raises questions about strengthening older people’s participation in the decision making process and also whether a new communicative practice is needed for assessments, i.e., one that proceeds on the basis of a broader family perspective.

Kapitlet inleds med en beskrivning av det forskningsprogram med rubriken Kommunikation i äldre människors livsmiljö, som bedrivits vid Tema Äldre och åldrande/NISAL sedan starten år 2000. Därefter ges ett exempel från vår forskning om behovsbedömning i äldreomsorgen där samtalsanalys är den metodologiska ansats som används. Vi visar här hur denna typ av forskning kan användas som verktyg för att studera situationer där samtalens deltagare – de äldre själva, deras närstående och handläggarna – har delvis olika åsikter om de äldre personernas hjälpbehov. Kapitlet avslutas med några tankar om vad samtalsanalytisk forskning kan bidra med för typ av kunskap och vad sådana studier i sin tur kan få för konsekvenser för utformningen av äldreomsorgen.

Objective: To explore frail older persons’ perceptions of the future and the end of life.

Design: Qualitative content analysis of individual semi-structured interviews.

Setting: Nine primary health care centres in both small and middle-sized municipalities in Sweden that participated in the intervention project Proactive healthcare for frail elderly persons.

Subjects/Patients: The study includes 20 older persons (eight women and 12 men, aged 76–93 years).

Main outcome measures: Frail older persons’ perceptions of the future and end of life.

Results: The analysis uncovered two main categories: Dealing with the future and Approaching the end of life. Dealing with the future includes two subcategories: Plans and reflections and Distrust and delay. Approaching the end of life includes three subcategories: Practical issues, Worries and realism, and Keeping it away.

Conclusion: This study highlights the diverse ways older people perceive future and the end of life. The results make it possible to further understand the complex phenomenon of frail older persons’ perceptions on the future and the end of life.

Purpose: Despite evidence that older persons want to be involved in care, little is known about how frail older people with significant care needs living at home experience participation in care provided by different stakeholders. This study investigates the experiences of participation in care by older people following their involvement in an intervention of a health care model called Focused Primary care (FPC).'Methods: Individual semi-structured interviews were conducted with 20 older persons in five municipalities in Sweden.Results: The results show that older persons highlighted opportunities and limitations for participation on a personal level i.e., conditions for being involved in direct care and in relation to independence. Experiences of participation on organizational levels were reported to a lesser degree. This included being able to understand the organizational system underpinning care. The relational dimensions of caregiving were emphasized by the older persons as the most central aspects of caregiving in relation to participation .Conclusions: Primary care should involve older persons more directly in planning and execution of care on all levels. An ongoing connection with one specialized elderly team and a coordinating person in Primary care who safeguards relationships is important fo rproviding participation in care for frail older persons with significant care needs living at home.

Limitations are described in the literature in relation to the actual involvement of older people in action research activities. Empirical social research involving any form of data collection has an impact on the people and the setting studied. Researchers should strive to be morally aware of such an impact. The article describes case studies of participatory research in Sweden, Italy and Portugal. It highlights moral issues confronted by researchers. Moreover actual examples of different order of priorities among researchers and participants are provided. The study shows possible spaces for collaboration, while recognizing the difference of interests and priorities among researchers and participants

Aim: The aim is to understand and develop the concept of care and caring Culture and to do so based on the empirical/phenomenological standpoint of nurses lived experiences of working in different environments.

Background: Culture, care and caring are significant concepts mentioned and used in connection with nursing practice. In the nursing literature, the caring culture as a concept is mostly taken for granted, and it is up to the reader to determine what caring culture means.

Method: A phenomenological-hermeneutic method was used to uncover the meaning of lived experiences though interpretation of interviews transcribed as text. Seventeen nurses working oil different wards were interviewed in 2006. A follow-up focus-group discussion was conducted with seven of the nurses I year later for validation of the findings.

Findings: Thematic analyses revealed five themes: you have to adapt to the existing care Culture: seeing the invisible: being Yourself; the strong personalities; the patients must adapt themselves to the circumstances. Adaptation to unwritten routines entails adaptation to the culture and the common value system. On wards described as "homelike", nurses may act in a way that reflects their own values.

Discussion: The care and caring culture can be understood from the perspective of what it means to care and from the perspective of how care provision is accomplished. To attain a caring Culture founded on certain values, for example caritas, love and charity, we must first understand how the organization and personnel understand caring.

Aim: To explore older patients experiences of the intervention Proactive healthcare for frail elderly persons. Background: Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients experiences in taking part of interventions aiming to enhance the care. Methods: Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. Findings: Older patients experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.