This chapter provides an overview of key concepts and theoretical perspectives used in the anthology and points out fundamental challenges in the practice of professional welfare. ‘Competence’ and ‘knowledge’ often have different meanings, and there is a need for increased awareness of the understanding of these concepts. This chapter highlights how the managerial discretion, learning, system blindness, power executing and paradoxes may cause tensions and how these in turn may inhibit the realization of required changes. Internal or external job recruitment may have an impact on managers’ freedom to act. To raise the quality and competence within the professional welfare services, it is necessary to be aware of the unique and multi-faceted challenges in the field.
Leaders of municipal nursing homes face challenges when they seek to secure a balance between the quality demands of authorities and the services they provide. In this chapter, we present a qualitative study on the leadership challenges in the municipal nursing homes. The aim is to develop knowledge on leadership challenges and the managerial discretions leaders employ to address the challenges. We interviewed seven middle-level leaders in five nursing homes in three medium-sized Norwegian municipalities using semi-structured interviews. The study revealed challenges connected to temporal nursing home placements made permanent, the time-consuming nature of the search for substitute workers, and the need to improve worker attitudes towards substitute workers’ experience-based knowledge. Attitude change is necessary because different forms of knowledge have different statuses in the nursing homes. The study shows that the leaders seek to meet the challenges connected to nursing home placements by establishing teams of professionals, while they try to persuade the Specialist Health Services to take over the responsibilities for the patients in transition. To meet the substitute worker challenge, the leaders use subjective managerial discretions to develop different strategies, including establishing substitute worker bases, substitute worker lists and delegation of substitute worker search. The leaders promote attitude change by stressing the importance of the substitute workers’ experience-based knowledge in both formal and informal contexts and implementing concrete competence measures. The study indicates that leaders who use subjective managerial discretions save time that they employ to create a balance between different leadership functions. The use of managerial discretions by leaders may affect the learning and organizational changes in nursing homes.
SammendragStudien belyser tre kvinners opplevelser av at deres selvstendige ektefeller får slag og blir sterkt pleietrengende, samt hvordan de opplever samhandlingen med helse-og omsorgstjenesten. Det er benyttet en hermeneutisk-fenomenologisk tilnaerming og semistrukturerte kvalitative intervju. Funnene viser at kvinnene opplever utmattelse, usikkerhet og hjelpeløshet i sin egen rolle som ektefelle, mor og omsorgsgiver, og føler at deres identitet er truet. Informasjonen fra den kommunale helse-og omsorgstjenesten oppleves som mangelfull og kvinnene føler seg satt på sidelinjen og avvist. De føler behov for støtte og omsorg og savner samtalepartnere de kan ha meningsskapende og relasjonsorientert kommunikasjon med. Den nye hverdagen påvirker kvinnenes helse, og over tid utvikler de stressrelaterte lidelser. Det å ha aktiviteter utenfor hjemmet, som jobb og fritidsinteresser, er en viktig mestringsstrategi for å takle den utfordrende livssituasjonen. Det er en tanke at utdanning og likestilling trår fram som en faktor i opprettholdelse av helse og livskvalitet. For å ivareta kvinnenes etterspørsel etter informasjon og oppfølging og styrke samhandlingen mellom brukerne, de pårørende og tjenesteyterne kan ordninger som koordinator, brukers individuelle plan og brukerstyrt personlig assistanse innarbeides som redskaper i det daglige helse-og omsorgsarbeidet.Nøkkelord pårørende, roller, samhandling, koordinator, individuell plan, brukerstyrt personlig assistanse (BPA) AbstractThe study highlights three women's experiences when their independent spouses get a stroke and become strongly dependent on care, as well as how they experience the interaction with the health and care service. The approach to the research field is hermeneutically phenomenological, with the use of qualitative interviews. The findings show that women experience exhaustion, insecurity and helplessness in their own role as spouse, mother and caregiver, and feel that their identity is threatened. The information from the municipal health and care ser-vice is perceived as inadequate and the women feel that they are put on the sideline and rejected. They feel the need for support and care and miss professionals they can have meaningful and relationship-oriented communication with. The new everyday life affects women's health, and over time they develop stress-related disorders. Having activities outside the home, such as jobs and hobbies, is an important strategy for coping with the challenging life situation. Level of education and gender equality emerges as a factor in relation to maintaining health and quality of life. In order to meet the women's demand for information and support, and strengthen the interaction between the users, the relatives and the service providers, arrangements such as the coordinator, the user's individual plan and the user-controlled personal assistant arrangement can be incorporated as instruments in the daily health and care work.
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