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Publications (10 of 18) Show all publications
Öhman, A., Keisu, B.-I. & Enberg, B. (2023). Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations: A grounded theory situational analysis of Swedish elderly care. Physiotherapy Theory and Practice, 39(5), 994-1006
Open this publication in new window or tab >>Professional knowledge development and evidence-based practice in confusing vs. supportive work organizations: A grounded theory situational analysis of Swedish elderly care
2023 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 39, no 5, p. 994-1006Article in journal (Refereed) Published
Abstract [en]

Background: This article focuses on knowledge development and health professionals’ opportunitiesto use evidence-based practice (EBP). We studied registered physiotherapists (PT), occupationaltherapists (OT) and nurses (RN) in Swedish elderly-care institutions, a sector known for highturnover and shortages of competent staff.Objective: To examine the perspectives of healthcare providers on professional knowledge developmentand EBP in their organization.

Methods: We conducted on-site qualitative interviews with a purposive sample of PTs, OTs andRNs, in six elderly care institutions. Situational analysis was used to analyze the material.

Results: Three discursive professional positions were found: 1) Professional ambition in confusingwork organization; 2) Professional ambition in a knowledge-promoting work organization; and 3) Professional indifference with few aspirations for knowledge development. Professional aspirationstoward knowledge development were high in two of these positions, whereas the third representsa slightly different approach with fewer aspirations for knowledge development. Linked to theseprofessional approaches to knowledge development is a continuum of aggravating or facilitatingfactors within the work organization, including varying degrees of support from leadership of theorganization, as well as few opportunities for rewards.

Discussion and conclusions: It is concluded that elderly care needs to develop strategies forevidence-based practice in order for the sector to become a sustainable arena for health professionals’career development, and in order to improve the quality of care for the elderly.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Physiotherapy, occupational therapy, nursing, organization, leadership
National Category
Gender Studies Sociology Nursing
Research subject
physiotherapy; gender studies; Sociology
Identifiers
urn:nbn:se:umu:diva-192211 (URN)10.1080/09593985.2022.2033370 (DOI)000750110900001 ()35089102 (PubMedID)2-s2.0-85124139223 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2011-1140
Available from: 2022-02-04 Created: 2022-02-04 Last updated: 2023-07-13Bibliographically approved
Stenberg, G., Fjellman-Wiklund, A., Strömbäck, M., Eskilsson, T., From, C., Enberg, B. & Wiklund, M. (2022). Gender matters in physiotherapy. Physiotherapy Theory and Practice, 38(13), 2316-2329
Open this publication in new window or tab >>Gender matters in physiotherapy
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2022 (English)In: Physiotherapy Theory and Practice, ISSN 0959-3985, E-ISSN 1532-5040, Vol. 38, no 13, p. 2316-2329Article in journal (Refereed) Published
Abstract [en]

The World Health Organization states that gender has implications for health across the course of a person's life in terms of norms, roles and relations. It also has implications in rehabilitation. In this article, we argue the need of gender perspectives in the field of physiotherapy; gender matters and makes a difference in health and rehabilitation. We highlight a number of central areas where gender may be significant and give concrete examples of social gender aspects in physiotherapy practice and in diverse patient groups. We also discuss why it can be important to consider gender from an organizational perspective and how sociocultural norms and ideals relating to body, exercise and health are gendered. Further we present useful gender theories and conceptual frameworks. Finally, we outline future directions in terms of gender-sensitive intervention, physiotherapy education and a gendered application of the ICF model. We want to challenge physiotherapists and physiotherapy students to broaden knowledge and awareness of how gender may impact on physiotherapy, and how gender theory can serve as an analytical lens for a useful perspective on the development of clinical practice, education and research within physiotherapy.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
clinical practice, Gender, gender theory, physiotherapy, physiotherapy education, physiotherapy research
National Category
Physiotherapy
Identifiers
urn:nbn:se:umu:diva-187700 (URN)10.1080/09593985.2021.1970867 (DOI)000692330800001 ()34470538 (PubMedID)2-s2.0-85114352521 (Scopus ID)
Funder
Umeå University
Available from: 2021-09-23 Created: 2021-09-23 Last updated: 2022-11-28Bibliographically approved
Degerstedt, F., Björklund, M., Keisu, B.-I. & Enberg, B. (2021). Unequal physical activity among children with cerebral palsy in Sweden: A national registry study. Health Science Reports, 4(3), Article ID e342.
Open this publication in new window or tab >>Unequal physical activity among children with cerebral palsy in Sweden: A national registry study
2021 (English)In: Health Science Reports, E-ISSN 2398-8835, Vol. 4, no 3, article id e342Article in journal (Refereed) Published
Abstract [en]

Aim: To examine the extent to which sex, country of birth, and functional aspects influence participation in physical education and physical leisure activity among children with cerebral palsy (CP) in Sweden.

Methods: This national cross-sectional registry study included children with CP aged 6 to 18 years who participated in the Swedish national quality registry, the Cerebral Palsy Follow-up Program, CPUP, in 2015. Comparisons and associations between sex, country of birth, and functional aspects and physical leisure/physical education were examined using chi-squared and multivariable logistic regression analysis.

Results: The study included 1935 children. Of them, 1625 (87%) reported participating in physical education and 989 (53%) reported participating in physical leisure activity. Children born in Sweden had higher odds of participating in physical education (OR: 1.99; 95% CI: 1.20-3.28) and physical leisure activity (OR: 2.51; 95% CI: 1.70-3.72) compared with children born outside Europe. Greater impairment of gross motor function was associated with lower participation levels. Boys participated slightly more frequently in leisure activities than girls.

Conclusion: Enhancing social inclusion with regard to disability, birth country, and sex are important and achievable goals for policymakers and practitioners for promoting participation in physical activity for children and adolescents with CP.

Place, publisher, year, edition, pages
John Wiley & Sons, 2021
Keywords
inequality, leisure, norms, physical education, youth
National Category
Gender Studies Physiotherapy
Research subject
physiotherapy
Identifiers
urn:nbn:se:umu:diva-186647 (URN)10.1002/hsr2.342 (DOI)000700814100054 ()34401523 (PubMedID)2-s2.0-85115821642 (Scopus ID)
Available from: 2021-08-16 Created: 2021-08-16 Last updated: 2023-09-05Bibliographically approved
LaGrone, S., Joseph, C., Johansson, H., Enberg, B. & Franzen, E. (2020). Choreographing life-experiences of balance control in people with Parkinson's disease. BMC Neurology, 20, Article ID 50.
Open this publication in new window or tab >>Choreographing life-experiences of balance control in people with Parkinson's disease
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2020 (English)In: BMC Neurology, E-ISSN 1471-2377, Vol. 20, article id 50Article in journal (Refereed) Published
Abstract [en]

Background: Parkinson’s disease (PD) is a devastating neurodegenerative disorder. Reduced balance is one of the cardinal symptoms of PD, predisposing people living with PD to experience difficulties with the execution of tasks and activities, as well as hindering their involvement in meaningful life areas. The overarching aim of this study was to explore how deficits in balance control manifest in everyday life and how it is managed by people with PD (PwPD).

Methods: Qualitative description was used as methodology, and in-depth interviews were conducted with 18 participants, between the ages of 46 to 83 years, with mild to severe PD. Interview transcripts were analyzed using qualitative content analysis, following an inductive approach.

Results: One theme emerged from the analysis: Increased planning—choreographing life. Within this overarching theme, two categories were identified, namely Limitations in mobility and New restricted functioning in everyday life, each with 3–4 sub-categories. The categories described how PwPD handled decreased balance control in their everyday life by using motor and cognitive strategies as a consequence of not trusting their body’s capacity to control balance. Activities in everyday life, as well as the ability to partake in leisure and social activities were profoundly affected.

Conclusion: People with mild to severe PD used strategies to handle decreased balance and they choreographed their lives around their individual current state of mobility and balance. The knowledge gained from this study can be used to develop targeted interventions addressing the nuances of balance deficits in everyday life.

Place, publisher, year, edition, pages
Springer Nature, 2020
Keywords
Parkinson's disease, Balance control, Activities in daily life
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-169433 (URN)10.1186/s12883-020-01632-4 (DOI)000519978800001 ()32039713 (PubMedID)2-s2.0-85079108444 (Scopus ID)
Funder
Swedish Research Council
Available from: 2020-04-07 Created: 2020-04-07 Last updated: 2023-03-23Bibliographically approved
Degerstedt, F., Enberg, B., Keisu, B.-I. & Björklund, M. (2020). Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden: a national registry study. Acta Paediatrica, 109(4), 774-782
Open this publication in new window or tab >>Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden: a national registry study
2020 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, no 4, p. 774-782Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region.

Method: This national cross‐sectional registry study includes children with Cerebral Palsy aged 0‐18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow‐up programme, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using chi‐square and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom.

Results: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10‐2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed.

Conclusion: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different geographical regions of Sweden. Knowledge of inequity is crucial in order to address the problem.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
adolescents, cerebral palsy, CPUP, inequity, physiotherapy
National Category
Physiotherapy Gender Studies Pediatrics
Identifiers
urn:nbn:se:umu:diva-163637 (URN)10.1111/apa.14980 (DOI)000488167100001 ()31435959 (PubMedID)2-s2.0-85073965380 (Scopus ID)
Available from: 2019-10-01 Created: 2019-10-01 Last updated: 2023-05-10Bibliographically approved
Keisu, B.-I., Öhman, A. & Enberg, B. (2018). Employee effort: reward balance and first-level manager transformational leadership within elderly care. Scandinavian Journal of Caring Sciences, 32(1), 407-416
Open this publication in new window or tab >>Employee effort: reward balance and first-level manager transformational leadership within elderly care
2018 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 407-416Article in journal (Refereed) Published
Abstract [en]

Background: Negative aspects, staff dissatisfaction and problems related to internal organisational factors of working in elderly care are well-known and documented. Much less is known about positive aspects of working in elderly care, and therefore, this study focuses on such positive factors in Swedish elderly care. We combined two theoretical models, the effort–reward imbalance model and the Transformational Leadership Style model. The aim was to estimate the potential associations between employee-perceived transformational leadership style of their managers, and employees' ratings of effort and reward within elderly care work.

Methods: The article is based on questionnaires distributed at on-site visits to registered nurses, occupational therapists, physiotherapists (high-level education) and assistant nurses (low-level education) in nine Swedish elderly care facilities. In order to grasp the positive factors of work in elderly care, we focused on balance at work, rather than imbalance.

Results: We found a significant association between employees' effort–reward balance at work and a transformational leadership style among managers. An association was also found between employees' level of education and their assessments of the first-level managers.

Conclusions: We conclude that the first-level manager is an important actor for achieving a good workplace within elderly care, since she/he influences employees' psychosocial working environment. We also conclude that there are differences and inequalities, in terms of well-being, effort and reward at the work place, between those with academic training and those without, in that the former group to a higher degree evaluated their first-level manager to perform a transformational leadership style, which in turn is beneficial for their psychosocial work environment. Consequently, this (re)-produce inequalities in terms of well-being, effort and reward among the employees at the work place.

Keywords
effort, reward, transformational leadership style, elderly care, first-level manager, quantitative method
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Work Sciences
Research subject
Sociology
Identifiers
urn:nbn:se:umu:diva-140079 (URN)10.1111/scs.12475 (DOI)000426524200042 ()28851057 (PubMedID)2-s2.0-85042565889 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-09-29 Created: 2017-09-29 Last updated: 2023-03-24Bibliographically approved
Degerstedt, F., Wiklund, M. & Enberg, B. (2017). Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives. Global Health Action, 10, Article ID 1272236.
Open this publication in new window or tab >>Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives
2017 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 10, article id 1272236Article in journal (Refereed) Published
Abstract [en]

Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services.

Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective.

Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS).

Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028).

Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

Keywords
youth, adolescent, children, disability, cerebral palsy, habilitation, rehabilitation, physiotherapy, physical activity, gender, gender bias, equal care, equity in health, CPUP registry, register study, Sweden, barn, ungdomar, cerebral pares, habilitering, rehabilitering, fysioterapi, fysisk aktivitet, skolidrott, genus, genusbias, jämlilk vård, CPUP, registerstudie
National Category
Physiotherapy Gender Studies Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Physiotherapy; gender studies
Identifiers
urn:nbn:se:umu:diva-130698 (URN)10.1080/16549716.2017.1272236 (DOI)000417200100002 ()28219314 (PubMedID)2-s2.0-85036581720 (Scopus ID)
Funder
Swedish Research Council, 344-2011-5478
Note

Supplement 2. Special issue: Gender and Health Inequalities: Intersections with other relevant axes of oppression

Författarna tackar Umeå centrum för genusstudier (UCGS).

Available from: 2017-01-29 Created: 2017-01-27 Last updated: 2023-03-24Bibliographically approved
Öhman, A., Keisu, B.-I. & Enberg, B. (2017). Team social cohesion, professionalism, and patient-centeredness: gendered care work, with special reference to elderly care – a mixed methods study. BMC Health Services Research, 17, Article ID 381.
Open this publication in new window or tab >>Team social cohesion, professionalism, and patient-centeredness: gendered care work, with special reference to elderly care – a mixed methods study
2017 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 17, article id 381Article in journal (Refereed) Published
Abstract [en]

Background: Healthcare organisations are facing large demands in recruiting employees with adequate competency to care for the increasing numbers of elderly. High degrees of turnover and dissatisfaction with working conditions are common. The gendered notion of care work as 'women's work', in combination with low salaries and status, may contribute to negative work experiences. There is abundant information about the negative aspects of elderly care health services, but little is known about positive aspects of this work. The study aim was to investigate work satisfaction from a gender perspective among Swedish registered nurses, physiotherapists, and occupational therapists, focusing specifically on healthcare services for the elderly.

Methods: A mixed methods approach was adopted in which we combined statistics and open-ended responses from a national survey with qualitative research interviews with healthcare professionals in elderly care organisations. The survey was administered to a random sample of 1578 registered nurses, physiotherapists, and occupational therapists. Qualitative interviews with 17 professionals were conducted in six elderly care facilities. Qualitative and quantitative content analyses, chi2 and constructivist grounded theory were used to analyse the data.

Results: There was a statistically significant difference in overall work satisfaction between those who worked in elderly care and those who did not (64 and 74,4% respectively, p < 0.001). Nine themes were derived from open-ended responses in the questionnaire. The qualitative interviews revealed four prominent storylines: 'Team social cohesion', 'Career development and autonomy', 'Client-centeredness', and 'Invisible and ignored power structures'.

Conclusions: The results show the complexity of elderly care work and describe several aspects that are important for work satisfaction among health professionals. The results reveal that work satisfaction is dependent on social interrelations and cohesion in the work team, in possibilities to use humour and to have fun together, and in the ability to work as professionals to provide client-centered elderly care. Power relations such as gendered hierarchies were less visible or even ignored aspects of work satisfaction. The storylines are clearly linked to the two central discourses of professionalism and gender equality.

Place, publisher, year, edition, pages
BioMed Central, 2017
Keywords
Work satisfaction, Elderly care, Nurses, Occupational therapists, Physiotherapists, Gender, Mixed methods, Clients, Power relations, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Gender Studies
Research subject
gender studies
Identifiers
urn:nbn:se:umu:diva-135755 (URN)10.1186/s12913-017-2326-9 (DOI)000403106000001 ()28578673 (PubMedID)2-s2.0-85020029920 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, dnr. 2011- 1140
Available from: 2017-06-05 Created: 2017-06-05 Last updated: 2023-03-24Bibliographically approved
Keisu, B.-I., Öhman, A. & Enberg, B. (2016). What is a good workplace?: Tracing the logics of NPM among managers and professionals in Swedish elderly care. Nordic Journal of Working Life Studies, 6, 27-46
Open this publication in new window or tab >>What is a good workplace?: Tracing the logics of NPM among managers and professionals in Swedish elderly care
2016 (English)In: Nordic Journal of Working Life Studies, E-ISSN 2245-0157, Vol. 6, p. 27-46Article in journal (Refereed) Published
Abstract [en]

Neoliberal policies such as new public management (NPM) have been pivotal to the Swedish elderly care system for two decades. This article explores the discourses of NPM and work by focusing on how a good workplace is represented by professionals and managers in Swedish elderly care. Using qualitative interviews with 31 managers, nurses, physiotherapists, and occupational therapists at nine workplaces, we identified four competing meanings (“storylines”) of how a good workplace is constructed among the interviewees within an ongoing struggle between two discourses. Three storylines, i.e., striving to achieve the mission, a desire to work in elderly care, and striving for good working relationships, are linked to the neoliberal discourse of organizational effectiveness. In contrast, the fourth storyline, support and better working conditions, is related to a welfare-state discourse of traditional labor relations with strong historical roots. Four subject positions available to the managers and professionals were identified: the bureaucrat, the passionate, the professional, and the critic. We conclude that NPM is translated on top of existing discourses, such as those of traditional labor relations, care ideals, and practices, that are already established in elderly care workplaces and that counteract the new policy.

Keywords
Elderly care, good workplace, manager, nurse, occupational therapist, physiotherapist, critical discourse psychology
National Category
Sociology (excluding Social Work, Social Psychology and Social Anthropology) Gender Studies Work Sciences
Research subject
Sociology
Identifiers
urn:nbn:se:umu:diva-118049 (URN)10.19154/njwls.v6i1.4884 (DOI)000372068300003 ()2-s2.0-85045678145 (Scopus ID)
Projects
Hur ska äldrevården bli mer attraktiv och kunna rekrytera kompetent personal I en tid av ökande antal äldre i befolkningen? En genusanalys
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, FAS 2011-1140
Note

Special issue

Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2024-01-17Bibliographically approved
Enberg, B., Sundelin, G. & Öhman, A. (2013). Work experiences among nurses and physicians in the beginning of their professional careers - analyses using the effort-reward imbalance model. Scandinavian Journal of Caring Sciences, 27(1), 36-43
Open this publication in new window or tab >>Work experiences among nurses and physicians in the beginning of their professional careers - analyses using the effort-reward imbalance model
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, ISSN 0283-9318, Vol. 27, no 1, p. 36-43Article in journal (Refereed) Published
Abstract [en]

Work experiences among nurses and physicians in the beginning of their professional careers analyses using the effortreward imbalance model The aim of the study was to scrutinise how nurses and physicians, employed by the county councils in Sweden, assess their work environment in terms of effort and reward at the start of their career. The aim was also to estimate associations between work satisfaction and the potential outcomes from the effortreward imbalance (ERI) questionnaire. The study group, 198 nurses and 242 physicians who graduated in 1999, is a subsample drawn from a national cross-sectional survey. Data were collected in the third year after graduation among the nurses and in the fourth year after graduation among registered physicians. The effortreward imbalance questionnaire, together with a question on work satisfaction, was used to evaluate psychosocial factors at work. The results reveal that nurses scored higher on effort, lower on reward and experienced higher effortreward imbalance, compared with physicians. Women scored higher on work-related overcommitment (WOC) compared with men. Among the physicians, logistic regression analysis revealed a statistically significant association between WOC and ERI, sex, effort and reward. Logistic regression analysis also revealed a statistically significant association between WOC and ERI and between WOC and effort among the nurses. Dissatisfaction with work was significantly higher among those who scored worst on all three ERI subscales (effort, reward and WOC) and also among those with the highest ERI ratios compared with the other respondents. In conclusion, to prevent future work-related health problems and work dissatisfaction among nurses and physicians in the beginning of their professional careers, signs of poor psychosocial working conditions have to been taken seriously. In future work-related stress research among healthcare personnel, gender-specific aspects of working conditions must be further highlighted to develop more gender-sensitive analyses.

Keywords
nurses, physicians, county councils, work experiences, effortreward imbalance, healthcare, overcommitment, work satisfaction
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-67589 (URN)10.1111/j.1471-6712.2012.00997.x (DOI)000314819900006 ()2-s2.0-84873476426 (Scopus ID)
Available from: 2013-06-04 Created: 2013-03-25 Last updated: 2023-03-24Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-5979-3648

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