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Intervening with care: creating new infrastructures for learning and increasing quality of elderly care
Umeå University, Faculty of Social Sciences, Department of Psychology.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Intervention med omsorg : i syfte att skapa nya infrastrukturer för lärande och öka äldreomsorgens kvalitet (Swedish)
Abstract [en]

Substantial changes in public elderly care in Sweden have been resulting in a standing need of updating staff competence to match the new demands and maintain quality. Since the ability to learn is of importance when confronting changing conditions, organizations in general, as well as the authorities responsible for elderly care, invest large amounts of resources in learning in the workplace. However, the success of such investments depends on the interactions among numerous individual and organizational factors.

This thesis has aimed at increasing our understanding of the process and consequences of the learning intervention Steps for Skills in the context of elderly care, by addressing three specific research aims. The first aim focused on the psychosocial environment as a precondition for learning. The perceived learning climate was addressed in Study 1, and correlations were found between leaders’ and employees’ perceived learning climate and, to some extent, between employees’ perceived learning climate and work group skills.

The second aim focused on the consequences of the intervention for employees in terms of their psychosocial environment and the building of new infrastructures for learning. Changes in perceived learning climate and their relation to the transfer of knowledge were addressed in Study 2. It was found that the intervention had influenced the perceived learning climate differently for different groups. In addition, the use of the new knowledge depended on the learning climate. The consequences for employees were also addressed in Study 3 by examining the relation between process and outcome. Results showed that although the same method was used, the content of the improvement work differed, influencing employees’ perceptions of the learning climate, resource adequacy and workload differently.

The third research aim focused on the consequences of the intervention for elderly by addressing elderly care quality, conceived as autonomy-support. The results from Study 4 identified too many constraining interactions for elderly care to be described as an autonomy-supportive. It is concluded that general quality improvement work does not guarantee increased autonomy-support. All in all, these results show that context and process matter, and also provide information concerning quality improvement through learning interventions.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 69 p.
Keyword [en]
learning intervention, learning climate, skills, knowledge, resource adequacy, workload, quality improvement, autonomy-support, elderly care, Sweden
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology
Identifiers
URN: urn:nbn:se:umu:diva-68031ISBN: 978-91-7459-604-5 (print)ISBN: 978-91-7459-603-8 (print)OAI: oai:DiVA.org:umu-68031DiVA: diva2:615512
Public defence
2013-05-03, bt102, Beteendevetarhuset, Umeå universitet, Umeå, 10:00 (Swedish)
Opponent
Supervisors
Projects
Lärande och kunskap i äldreomsorg
Available from: 2013-04-12 Created: 2013-04-10 Last updated: 2013-04-12Bibliographically approved
List of papers
1. Learning climate and work group skills in care work
Open this publication in new window or tab >>Learning climate and work group skills in care work
2009 (English)In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 21, no 8, 581-594 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – The overall aim of the present study was to investigate the learning climate and work group skills perceived by managers and their subordinates in the municipal elderly care, prior to a development project. The specific research questions were: Are managers' and their subordinates' perceptions of the learning climate related? and Does the manager's assessment of the work group skills correlate with the work group's perception of the learning climate?

Design/methodology/approach – A total of 12 managers and 130 of their subordinates were selected, and answered a questionnaire. The subordinates belonged to work groups with five to 19 care assistants working in elderly care. The majority of the participants were women (92 per cent). The mean age was 43 years old, range 20-63.

Findings – Results suggest that the perception of the learning climate has a correspondence between the organisational levels (managers and their subordinates) and that there is a correspondence between managers' ratings of work group skills, in particular skills for effectively managing change, and the work groups' perception of their learning climate, in particular decision autonomy and developmental and collaborative potentials.

Research implications/limitations – The manager sample was small and from one single organisation.

Practical implications – The relations between the learning climate and the assssment of staff skills are important to the actions taken in order to facilitate workplace learning and development.

Originality/value – This study contrasted the managers' assessment of skills with their work groups' perceptions of learning climate, which is quite unusual in learning climate studies.

Place, publisher, year, edition, pages
Emerald, 2009
Keyword
Elder care, Employees, Group dynamics, Learning, Managers, Skills, Sweden
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-26963 (URN)10.1108/13665620910996151 (DOI)
Available from: 2009-11-04 Created: 2009-11-04 Last updated: 2017-12-12Bibliographically approved
2. Developmental intervention, learning climate and use of knowledge in elderly care
Open this publication in new window or tab >>Developmental intervention, learning climate and use of knowledge in elderly care
2012 (English)In: Journal of Workplace Learning, ISSN 1366-5626, E-ISSN 1758-7859, Vol. 24, no 1, 19-33 p.Article in journal (Refereed) Published
Abstract [en]

Purpose – The purpose of this paper is to examine the learning climate in elderly care, its potential improvements after the “Steps for skills”, and its influence on knowledge from formal training. The assumptions were: the different activities of the Steps for skills should enhance the perceived learning climate; differences in working conditions in home help and residential homes should influence the perceived learning climate and its improvements; and changes in the perception of the learning climate should bring changes in the perceived usefulness of new knowledge.

Design/methodology/approach – The study is a case study carried out in the public elderly care in Sweden, and used a repeated measurements design. A total of 270 nursing assistants answered a questionnaire at Time I, and 174 at Time II.

Findings – Results show no improvements of the learning climate for the full sample. When contrasting the learning climate in home help services and in residential homes significant differences are found, and also a tendency for their learning climate to change in opposite directions. The perception of the learning climate seems to influence the perceived usefulness of new knowledge.

Research limitations/implications – The sample was from one single organization.

Practical implications – Developmental interventions should take in to consideration that context matters, and that the perceived learning climate influences the use of new knowledge.

Originality/value – In this study, a 15-items learning climate scale (LCS) is presented. Another contribution is identifying working condition failure as a potential explanation to why interventions usually do not result in expected changes.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2012
Keyword
Sweden, Elder care, Learning organizations, Carers, Developmental intervention
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-50680 (URN)10.1108/13665621211191087 (DOI)
Available from: 2011-12-19 Created: 2011-12-19 Last updated: 2017-12-08Bibliographically approved
3. The content of the quality improvement work: influencing learning climate, resource adequacy and workload
Open this publication in new window or tab >>The content of the quality improvement work: influencing learning climate, resource adequacy and workload
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Despite the popularity of Quality Improvement Collaboratives, the evidence of their positive impact is limited. However, awareness of the mechanisms underlying such interventional efforts, as well as of their outcomes, is crucial for HRD professionals. Thus, the general purpose of this study was to examine the relation between process and outcome by addressing two specific aims. The first aim was to explore the content of the quality improvement work and, the second aim was to examine how the content chosen influences employees’ psychosocial work environment. A mixed-methods design was used in this study, including observations and written documentation of the quality improvement work and questionnaires, distributed on two occasions, to136 nursing assistants. Results showed that (1) the content of the quality improvement work differed both in nature and flexibility, even though the same method was used, (2) the perceived learning climate, workload, and resource adequacy were influenced differently by the different contents chosen. This study offers insights into understanding the complexity around such interventions – which might be powerful in some situations and less appropriate in others. Choosing the right method and assuring that the method is implemented is not enough to guarantee the success of the quality improvement work. It is of vital importance that employees have achievable targets in relation to the resources available. Quality improvement should not be achieved at the expense of employees’ psychosocial work environment; otherwise, the improvement process may become counterproductive.

Keyword
quality improvement collaboratives, mixed-methods, content, learning climate, workload, resource adequacy, elderly care
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-68029 (URN)
Projects
Lärande och kunskap i äldreomsorgen
Available from: 2013-04-10 Created: 2013-04-10 Last updated: 2013-04-12Bibliographically approved
4. Elderly care as an autonomy-supportive environment: from the perspectives of professionals and elderly
Open this publication in new window or tab >>Elderly care as an autonomy-supportive environment: from the perspectives of professionals and elderly
(English)Manuscript (preprint) (Other academic)
Abstract [en]

For people to be intrinsically motivated in contrast to doing something because it leads to a separable outcome, they have to experience their behavior as self-determined. It requires either inner resources or contextual supports for autonomy, that is, the extent to which people feel supported in their ability to function autonomously, make choices and decisions. The more one internalizes the reasons for an action, the more one’s extrinsically motivated actions become self-determined. Since individual autonomy is embedded in relationships and circumstances and contexts can yield autonomous regulation, when autonomy-supportive, awareness about the conditions that nurture regulation and internalization can contribute to optimize people's quality of life. Thus the present interview study aims to examine elderly care as an autonomy-supportive environment from the perspectives of professionals and elderly, and also whether an intervention aimed to improve elderly care quality enhances autonomy-support. Nine elderly care recipients and their contact persons participated at Time I and 7 contact persons at Time II. The results suggest that elderly care (in this study) is not an autonomy-supportive environment due to too many constraining interactions. Moreover, quality improvement work does not automatically increases autonomy-support. However, autonomy and elderly care may not need to be a paradoxical conjunction if autonomy and independence are seen as separate goals of elderly care.

Keyword
autonomy-support, quality improvement work, elderly care, intervention, interview study, content analysis
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:umu:diva-68030 (URN)
Projects
Lärande och kunskap i äldreomsorgen
Available from: 2013-04-11 Created: 2013-04-10 Last updated: 2013-04-12Bibliographically approved

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