Дисертації з теми "Evidence-based practices (EBPs)"
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Vanhook, Patricia M. "Overcoming the Barriers to EBP." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/7451.
Повний текст джерелаHardin, Melissa. "Evidence-Based Child Welfare Screening and Assessment Practices." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5875.
Повний текст джерелаMoreno, Regina Célia Barbosa. "Adaptação e validação do evidence-based practice attitude scale (EBPAS)." Universidade Nove de Julho, 2015. http://bibliotecadigital.uninove.br/handle/tede/1189.
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Nowadays, there is a tendency for the Health Services to demand changes both in the professional practices and in the management in order to improve the organizational performance. In a hospital organization, the Social Service doesn`t remain free from this demand, and this scenario took us to the following question: How to adapt the Evidence-Based Practice Attitude Scale (EBPAS) to the Brazilian Health Social Service, and how to validate it? Thus, this research aims to adapt e validate the Evidence-Based Practice Attitude Scale (EBPAS) to the Brazilian Health Social Service, and it offers a version for EBPAS which can measure the social worker`s attitude related to the systematization of the professional practices; such version can be useful for future studies related to the elaboration of social protocols. The present research works based on the methodology proposed by Beaton, Bombardier, Guillemin & Ferraz (2000); Beaton, Bombardier, Guillemin & Ferraz (2007). The translation and adaptation process contains five steps: (i) translation, (ii) back translation, (iii) synthesis of the translations, (iiii) evaluation by an expert commitee and (iiiii) pretest. For the psychometric validation, the results presented suggests that the instrument presents a convergent validation, and it can be considered a useful instrument to measure the social workers` attitude related to the adoption of the Evidence Based Practice, making possible its use in the health services when the professionals` readiness related to the implementation of innovative practices has to be measured. The instrument presented easy comprehension and showed also semantic, idiomatic, experimental and conceptual validation. It is evident the need to broaden the fields of the psychometric validation, as well as to diversify the sampling plan.
Há uma tendência, nos dias atuais, dos Serviços de Saúde exigirem mudanças nas práticas profissionais e de gestão com objetivo de melhorar o desempenho organizacional. O Serviço Social, dentro de uma organização hospitalar, não fica isento dessa exigência. Este panorama levou ao questionamento: Como adaptar e validar, para o Serviço Social da saúde no Brasil, o Evidence-Based Practice Attitude Scale (EBPAS)? Sendo assim, o estudo tem como objetivo adaptar e validar o instrumento Evidence-Based Practice Attitude Scale (EBPAS) para o Serviço Social da Saúde no Brasil, propondo uma versão do EBPAS que consiga mensurar a atitude do assistente social frente à sistematização das práticas para futuros estudos na criação de protocolos sociais. O estudo assumiu a metodologia proposta por Beaton, Bombardier, Guillemin & Ferraz (2000); Beaton, Bombardier, Guillemin & Ferraz (2007), o processo de tradução e adaptação foi composto de cinco etapas, (i) tradução, (ii) retrotradução, (iii) síntese das traduções, (iiii) avaliação por um comitê de juízes e (iiiii) pré-teste. Para a validação psicométrica os resultados apresentados sugerem que o instrumento apresenta uma validação convergente, podendo ser considerado como instrumento para mensurar a atitude dos assistentes sociais na adoção de Prática Baseada em Evidências - PBE, possibilitando sua aplicação nos serviços de saúde com vista à prontidão para a implementação de práticas inovadoras. O instrumento mostrou-se de fácil compreensão, apresentando validação semântica, idiomática, experimental e conceitual. Fica claro a necessidade de ampliação de domínios na validação de psicometria, bem como diversificação do plano amostral.
Yuen, Kam-tong. "How to promote evidence-based practice (EBP) in clinical oncology by the continuous quality improvement approach." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724323.
Повний текст джерелаYuen, Kam-tong, and 袁錦堂. "How to promote evidence-based practice (EBP) in clinical oncology by the continuous quality improvement approach." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724323.
Повний текст джерелаTheriaque, Tina June. "Educational Training of Staff Nurses for Evidence-Based Practice." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5275.
Повний текст джерелаMaigeh, Elias Peterson. "The perceived attitudes, knowledge and barriers towards evidence-based practice (EBP) amongst physiotherapists in the United Republic of Tanzania." Thesis, University of the Western Cape, 2004. http://etd.uwc.ac.za/index.php?module=etd&.
Повний текст джерелаRospendowiski, Karina 1987. "Adaptação cultural para o Brasil e desempenho psicométrico do instrumento "Evidence-Based Practice Quesntionnaire" (EBPQ)." [s.n.], 2014. http://repositorio.unicamp.br/jspui/handle/REPOSIP/283868.
Повний текст джерелаDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Enfermagem
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Resumo: INTRODUÇÃO: A Prática Baseada em Evidência compreende "o uso consciente, explícito e judicioso da melhor evidência atual para a tomada de decisão sobre o cuidar individual do paciente". Para a implantação da prática de enfermagem baseada em evidências, compete ao enfermeiro a busca de estratégias que permitam a utilização de pesquisa na prática. O instrumento "Evidence-based practice questionnaire" (EBPQ), avalia atitudes, conhecimento e implantação da Prática Baseada em Evidências. Utiliza Escala de Likert com pontuação de um a sete em três domínios: prática, atitudes e conhecimentos relacionados à Prática Baseada em Evidências. Mostrou-se uma ferramenta útil para mensurar a implantação desta prática com enfermeiros no Reino Unido e na Espanha. OBJETIVO: O presente estudo tem como objetivo adaptar culturalmente o instrumento EBPQ para a língua portuguesa do Brasil e avaliar suas qualidades psicométricas. METODOLOGIA: Estudo metodológico em que fizeram parte professores e alunos de uma Universidade Pública e enfermeiros de um Hospital Público. Foram seguidos os passos essenciais de adaptação cultural de instrumentos de medida: tradução do instrumento para a língua portuguesa, síntese, retro-tradução, avaliação pelo comitê de juízes e pré-teste. Foi verificada a confiabilidade por meio da avaliação da consistência interna e da estabilidade pelo teste-reteste e a validade de constructo com abordagem de grupos conhecidos, do qual fizeram parte enfermeiros com pós-graduação em Mestrado ou Doutorado e enfermeiros com graduação completa. RESULTADOS: As etapas de tradução, síntese e retro-tradução foram realizadas satisfatoriamente. A avaliação pelo comitê de juízes resultou em alterações em alguns itens, assegurando as equivalências entre as versões original e traduzida. Durante o pré-teste, foi verificada a compreensão dos itens para torná-los mais claros. Na avaliação das propriedades psicométricas, a versão brasileira do instrumento mostrou-se confiável, com Coeficiente Alfa de Cronbach satisfatório em todos os domínios (0,91 ¿ 0,68). O Coeficiente de Correlação Intraclasse, que avaliou a estabilidade do instrumento mostrou-se satisfatório para o instrumento como um todo (0,90). Na avaliação da validade de constructo, o instrumento foi capaz de demonstrar diferenças nos escores entre os grupos conhecidos, com pontuações mais elevadas no grupo de enfermeiros com Mestrado ou Doutorado. CONCLUSÃO: As etapas necessárias para a adaptação cultural de instrumentos de medida foram concluídas com sucesso. A versão brasileira obtida apresenta propriedades psicométricas confiáveis para a sua utilização nessa população
Abstract: INTRODUCTION: The Evidence-Based Practice comprehends "the conscious, explicit and judicious use of current best evidence for decision making about the individual caring of patients". To implement the evidence-based practice of nursing, the nurse is responsible for searching strategies that allow the use of research in practice. The instrument "Evidence-based practice questionnaire" (EBPQ) assesses attitudes toward, knowledge of and use of evidence-based practice. It uses Likert Scale which is a seven point scale used in three areas: practice, attitudes and knowledge related to Evidence Based Practice. It was proved to be a useful tool to measure the implementation of this practice with nurses in the United Kingdom and Spain. OBJECTIVE: This study aims to adapt culturally the tool EBPQ to the Portuguese Language and to evaluate its psychometric qualities. METHODOLOGY: For this methodological study, the participants were some teachers and students of a Public University and some nurses of a Public Hospital. The essential steps of cultural adaptation of measurement instruments were followed: instrument translation into Portuguese language, synthesis, retro-translation, evaluation by the committee of judges and pretest .The reliability was checked by means of evaluation of internal consistency and the stability by test-retest and the construct validity with known groups approach. The first group was formed by nurses with Masters' degree or PhD and the second group was formed by nurses with bachelor's degree. RESULTS: The steps of translation, retro-translation and synthesis were performed satisfactorily. The evaluation by the expert panel resulted in changes in some items, ensuring the equivalence between the original and translated versions .During the pretest, the understanding of the items was done in order to make them clearer. The Brazilian version was reliable , with satisfactory results , and it was obtained Cronbach's alpha similar to International studies for all domains ( .91 to .68 ) .The intraclass correlation coefficient , which evaluated the stability was satisfactory for the instrument as a whole ( 0,90 ) .In the assessment of construct validity , there was significant difference between groups in relation to evidence-based practice , with higher scores in the group of nurses with master's or PhD. CONCLUSION: The necessary steps for the cultural adaptation of the measurement instruments were finished successfully. The Brazilian version obtained presents reliable psychometric properties for its use in this population
Mestrado
Enfermagem e Trabalho
Mestra em Ciências da Saúde
Carlson, Kristin Wilson. "Perceptions of an EBP Module Mobile Application by New Graduate Nurses." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/4506.
Повний текст джерелаMalcolm, Kimberly Ann Mrs. "The Nurse Executive Role in Implementing Evidence Based Practice (EBP) at the Point of Care." Otterbein University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=otbn1460366135.
Повний текст джерелаTassell, Barbara Kaye. "EBP Knowledge and Confidence in Context of Leadership Responsibilities: A DNP Project." Mount St. Joseph University Dept. of Nursing / OhioLINK, 2020. http://rave.ohiolink.edu/etdc/view?acc_num=msjdn158696591888518.
Повний текст джерелаDe, Leo Annemarie June. "Improving processes for implementing evidence-based practice in midwifery: Development of an eTool(KIT) for midwives." Thesis, Edith Cowan University, Research Online, Perth, Western Australia, 2020. https://ro.ecu.edu.au/theses/2422.
Повний текст джерелаFritz, Nabillia Jocasta. "Clinical and Counselling Psychology Student Attitudes and Receptiveness towards Evidence-Based Practice." University of the Western Cape, 2020. http://hdl.handle.net/11394/7962.
Повний текст джерелаEvidence-based practice (EBP) has been internationally recognised as the gold standard for the provision of safe and compassionate health care, and entails integrating clinical expertise with the best available research evidence in order to make effective decisions about the care of patients. The adoption of EBP remains slow, and this has been identified as a significant public health concern as few people with mental disorders in South Africa are treated using evidence-based psychological treatments (EBTs). Proponents of EBP have argued that the most effective way of sustaining the use of EBTs is by adopting EBP as a guiding pedagogical principle in professional psychology training programmes. For such efforts to be successful, it is pertinent to assess the receptiveness of the target population. Attitudes towards EBP remain the top indicator of successful adoption. The current study explored the attitudes and receptiveness towards EBP among clinical and counselling psychology students (N=57) at 11 accredited institutions nationally. Participation in the study was voluntary and the procedure followed all ethical requirements. All data collection occurred online. Participants completed a general questionnaire, the Evidence-Based Practice Attitudes Scale-15 (EBPAS-15) and the Organisational Culture and Readiness for System-wide Integration of Evidence-based Practice (OCRSIEP) Scale All data collection instruments demonstrated sound psychometric properties. A major finding of this study was that clinical and counselling psychology students reported favourable attitudes and receptiveness towards the adoption of EBP. The overall score on the EBPAS-15 indicated that students were likely to adopt EBP, while results on the ORCSIEP overall score indicated that they were receptive towards EBP and were ready to adopt EBP. An exploration of the association between attitudes and receptiveness towards EBP indicated that no correlation exists. Additionally, factors such as age, gender, psychology programme enrolment and preferred therapeutic orientation were not significantly associated with attitudes and receptiveness towards EBP. In conclusion, the results of this study suggest that there is a sound foundation on which to incorporate EBP into the professional training programmes of psychology students.
Austin, Jennifer E. "The Use of Evidence-based Practices in the Provision of Social Skills Training for Students with Autism Spectrum Disorders: a National Survey of School Psychologists' Training, Attitudes, and Practices." Thesis, University of North Texas, 2011. https://digital.library.unt.edu/ark:/67531/metadc177174/.
Повний текст джерелаWalker-Davidson, Jamie Lea. "An Examination of Evidence-Based Practice (EBP) in Teacher Preparation Programs for Rural School Educators." Thesis, Lindenwood University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10933899.
Повний текст джерелаThe purpose of this study was to examine the perceptions of first-year teachers regarding the use of Evidence-Based Practices (EBPs) within their teacher training programs. Participants in this study included 35 teachers from one of the 46 rural public-school districts in south-central Missouri. The 43 EBPs outlined in Robert Marzano’s (2017) New Art and Science of Teaching: More than Fifty New Instructional Strategies for Academic Success were used to frame the research. A survey with Likert-type statements and open-ended questions regarding EBPs taught in teacher preparation programs was completed by participants. Participants were asked to identify EBP strengths and weaknesses of their preparatory programs. Data revealed participants believed four key areas needed to be covered more in-depth within instructional programs: 1) creating and utilizing assessments, 2) classroom management strategies, 3) engaging and motivating reluctant learners, and 4) time management techniques. Participants also indicated the desire to have spent more time in classrooms completing fieldwork, as they believed this to be a valuable part of the training programs. The data suggested reflective practice of theory and classroom experience should be increased in teacher preparation programs.
Ranney, Andrea. "Efficacy of Video Modeling to Train Teachers to Implement Evidence-Based Instructional Practices for Students with Autism." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1461230879.
Повний текст джерелаHensley, Lauren Elizabeth. "A Replication Comparing Two Teaching Approaches: Teaching Pre-service Teachers to Implement Evidence-Based Practices with Fidelity." The Ohio State University, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=osu1468352869.
Повний текст джерелаBauer, Michael G., Chauney Peck, Aubrey Studebaker, and Naomi Yu. "Art Therapy and Evidence-Based Practice: An Exploration of Interactions." Digital Commons at Loyola Marymount University and Loyola Law School, 2015. https://digitalcommons.lmu.edu/etd/167.
Повний текст джерелаGeist, Thomas. "A Survey of Healthcare Providers’ Attitudes and Knowledge on E-cigarettes Based On Evidence-Based Practice." The Ohio State University, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=osu1533656577013985.
Повний текст джерелаFox, James J., Mary Annette Little, and Seth King. "Preliminary Analysis of a Survey Evaluating Applied Behavior Analysts' Knowledge and Use of Evidence-Based Practices." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/158.
Повний текст джерелаBrown, Lindsey Kathleen. "Use of Child and Adolescent Self-Report Measures by School-Based Speech-Language Pathologists." Miami University / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=miami1366985991.
Повний текст джерелаShibu, Litty Mathew. "Examining the research-practice gap in Physical Therapy (PT) in the United States of America using knowledge translation interventions (KTIs) : a comparative study." Thesis, Brunel University, 2018. http://bura.brunel.ac.uk/handle/2438/17553.
Повний текст джерелаSnyder, Nichole M. "An Examination of Coalition Functioning and Use of Evidence-Based Practices: A Case Study of Four Community Substance Abuse Coalitions." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5393.
Повний текст джерелаGonzález, Torrente Susana. "Factores que influyen en la incorporación de la evidencia científica a la práctica diaria de las enfermeras de Atención Primaria." Doctoral thesis, Universitat de les Illes Balears, 2014. http://hdl.handle.net/10803/284437.
Повний текст джерелаIntroducció Encara que la Pràctica Basada en l'Evidència millora la qualitat de les cures, hi ha una manca d'implementació de la mateixa en l'àmbit d'Atenció Primària (AP). L’objectiu d’aquest estudi és explorar els factors que influeixen en l’ús i l’ implementació d’EBE en AP de Balears. Contingut de la investigació En una primera fase es va dissenyar un estudi observacional transversal multicèntric utilitzant els qüestionaris PES-NWI, que valora l'entorn per a una PBE, i el EBPQ que valora els coneixements, ús i actituds de les infermeres cap a la PBE. Posteriorment es va realitzar un estudi qualitatiu en què es van realitzar cinc grups de discussió des d'una perspectiva fenomenològica. Conclusió L'actitud de les infermeres d'AP cap a l'EBE és molt positiva però no se senten recolzades per l'organització, pel que seria important que les institucions realitzessin una gestió més professional i menys polititzada que facilités l'ús i implementació d'EBE . Bibliografia Brown, C.E., Wickline, M.A., Ecoff, L., Glaser, D., 2008. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65 (2), 371-381. Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., Stillwell, S.B., 2011. Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN The American Journal of Nursing 111 (1), 54. Thompson, D.S., Estabrooks, C.A., Scott-Findlay, S., Moore, K., Wallin, L., 2007. Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science 2 (1), 15. Pericàs, J., González, S., De Pedro, J., Morales, J. M., & Bennasar, M. (2014). Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. International Nursing Review, 61(1), 90-98. doi: 10.1111/inr.12075
Introduction Although Evidence-Based Practice improves the quality of care there is a lack of implementation in Primary Health Care (PHC) services. The aim of this study is to explore the factors that influence on the use and EBN implementation in the Balearics PHC. Research content In the first phase a multicenter cross-sectional study was designed using two questionnaires, the PES-NWI which assessed the environment for EBN, and EBPQ that values knowledge, use and attitudes of nurses towards the EBN. Subsequently, a qualitative study in which five focus groups were conducted from a phenomenological perspective, was performed. Conclusion The attitude of PHC nurses towards the EBN is very positive but they don’t feel supported by the organization, it would be important that institutions should do a more professional and less politicized management to facilitate the use and implementation of EBN. Bibliography Brown, C.E., Wickline, M.A., Ecoff, L., Glaser, D., 2008. Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing 65 (2), 371-381. Fineout-Overholt, E., Williamson, K.M., Gallagher-Ford, L., Melnyk, B.M., Stillwell, S.B., 2011. Evidence-Based Practice, Step By Step: Following the Evidence: Planning for Sustainable Change. AJN The American Journal of Nursing 111 (1), 54. Thompson, D.S., Estabrooks, C.A., Scott-Findlay, S., Moore, K., Wallin, L., 2007. Interventions aimed at increasing research use in nursing: a systematic review. Implementation Science 2 (1), 15. Pericàs, J., González, S., De Pedro, J., Morales, J. M., & Bennasar, M. (2014). Perception of Spanish primary healthcare nurses about evidence-based clinical practice: a qualitative study. International Nursing Review, 61(1), 90-98. doi: 10.1111/inr.12075
González-Méndez, Wanda Wilma. "Alcohol Use Disorder and Withdrawal Syndrome in Correctional Facilities: An Evidence-Based Clinical Practice Guideline to Prevent Alcohol-Related Adverse Events." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4444.
Повний текст джерелаSugden, Eleanor, Elise Baker, Natalie Munro, A. Lynn Williams, and false Carol Trivette M. "Service Delivery and Intervention Intensity for Phonology-Based Speech Sound Disorders." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/4595.
Повний текст джерелаEriksson, Jakob, and Adelin Mara. "Faktorer relaterade till genomförande av uppföljningsintervjuer med ASI – klientprofil och organisation." Thesis, Hälsohögskolan, Högskolan i Jönköping, HHJ, Avd. för beteendevetenskap och socialt arbete, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-23733.
Повний текст джерелаAddiction Severity Index (ASI) is thought to be used both for client work at the individual level and for research at a group level. This study examines the extent to which the ASI Follow-up is carried out, and the individual and organizational factors influencing the usage. The study is quantitative, i.e. presents statistical analyzes. Data were collected in two ways. Access to ASI data was made possible by an anonymous file from the database ASI-Net and included data from eleven municipalities in Jönköping County. ASI data consisted of 1,964 interviews from ASI Basic and ASI Follow-up and was needed for the investigation of individual factors. Data regarding organizational factors was collected through web surveys to managers in Individual and Family Care (IFO) in the same eleven municipalities. The result shows that the percentage of follow-up interviews is increasing every year and that there are large differences between municipalities in the usage of the percentage of follow-up interviews. The analysis of individual factors suggest that the elderly, with higher education and a profession are interviewed to a greater extent. Clients with serious problems and in need of help with alcohol also undergo follow-up interviews more frequently, while more problems with drugs and legal problems tend to be followed-up to a lesser degree. The analysis of organizational factors could not in a meaningful way be tested for significance since the population for the web survey was small, however, correlation was discovered between the percentage of follow-up interviews for each municipality and organizational factors of population in municipalities and employee turnover. Organizational factors show the contrary as expected that small municipalities follow up to higher degree, and that factors such as staff turnover, training and case quantity does not explain the existing differences. The study's conclusions are that the percentage of ASI Follow-up is continuously increasing. Although the ASI follow-up is increasing, it is a long way until the even half of all cases with ASI Basic are re-interviewed. To increase the motivation to carry out follow-up interviews, it may be important for the social workers to get back more in the form of summaries and analyzes at the group level.
Sugden, Eleanor, Elise Baker, Natalie Munro, and A. Lynn Williams. "Involvement of Parents in Intervention for Childhood Speech Sound Disorders: A Review of the Evidence." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1996.
Повний текст джерелаJohn, Suja Merin. "Assessing Knowledge of Evidence-BasedPractice among Nurses." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2090.
Повний текст джерелаWilkerson, Wendy L. "Effects of an Online Training in the Ziggurat Model on the Autism Knowledge of School-Based Speech-Language Pathologists (SLPs)." UKnowledge, 2015. http://uknowledge.uky.edu/rehabsci_etds/29.
Повний текст джерелаAlexander-Goreá, Trenika. "Development of a Guideline for Hospice Staff, Patients, and Families on Appropriate Opioid Use." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4496.
Повний текст джерелаLauri, Marcus. "Narratives of governing : rationalization, responsibility and resistance in social work." Doctoral thesis, Umeå universitet, Statsvetenskapliga institutionen, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-119783.
Повний текст джерелаSverige har ett internationellt rykte för att ha en omfattande och kvinnovänlig välfärd. Även om riktigheten i en sådan uppfattning sedan länge ifrågasatts har på senare år, likt i många andra Europeiska länder, det svenska välfärdssystemet genomgått en omfattande förändring i avseende på dess räckvidd, men också dess organisering och styrning. Fokus för denna studie är just denna organisering och styrning, och mer specifikt, hur detta påverkar ett av välfärdens kanske mest centrala område: socialt arbete. Genom att intervjua socialarbetare undersöks i denna studie uttryck för och konsekvenser av en sådan förändring, bland annat genom att undersöka hur könsbundna föreställningar och förväntningar är sammanflätade med det sociala arbetets organisering och styrning. I studien konstateras att socialarbetare erfar att deras arbete genomgått omfattande förändringar, vilket kopplas ihop med både organiseringen och styrningen av det sociala arbetet. Detta uttrycks både i de ideal som kringgärdar arbetet men också i dominerande arbetssätt. En sådan förändring är införandet av omfattande dokumentationsprocedurer av socialarbetarens arbete och kontakt med klienter, vilket medför att kontakten med klienterna blir ytligare. Dokumentationsprocedurerna utgör också en sorts kontroll av både klienterna och socialarbetarna själva. En annan förändring som konstateras är att nya organisationsmodeller och en förändrad ledarskapskultur skapar förväntningar på socialarbetarna att vara lojala med organisationen och ledningen snarare än klienterna. Bland annat utrycks detta genom förväntningar att inte protestera och skapa dålig stämning på arbetsplatsen, men också genom uttalade krav att spendera så lite resurser som möjligt på klienterna; korta behandlingstider, öppenvårdsalternativ och orimligt hårda krav för att få ekonomiskt bistånd. Detta legitimeras genom sammanväxningen av flera olika ideal; budgetmedvetenhet, att klienter inte mår bra av långa institutionsvistelser, men också att klienterna ska tillåtas eller bör tvingas att klara att sig själva. Ett av studiens huvudresultat är att den nuvarande organiseringen och styrningen av socialt arbete skapar avstånd och likgiltighet. Genom flera sammankopplade ideal och arbetssätt styrs dagens socialarbetare till att bry sig mindre om de klienter de möter. På så sätt undermineras förutsättningarna för framväxten av en djup relation mellan socialarbetare och klient; 1) Idealet och kravet att socialarbetare ska arbeta utifrån evidens, det vill säga metoder och förhållningssätt som i speciellt utformade utvärderingsmodeller visat sig ha effekt, gör att väl strukturerade och rigida metoder ges företräde. Denna instrumentalisering underminerar ett flexibelt, relationsorienterat och helhetsfokuserat sätt att arbeta. Dessutom gör evidensidealets fokus på enskilda individer och avgränsade utvärderingstider att mer samhällsinriktat kritiskt och långsiktigt inriktat arbete undermineras. 2) Ett rationalitetsideal, tätt sammanbundet med föreställningar om professionalitet och maskulinitet, värderar objektivitet och förmågan att frikoppla socialarbetarens egna känslor från sitt arbete. Detta maskuliniserade professionsideal innebär att empati och solidaritet med klienten undergrävs. 3) Omfattande krav på olika former av dokumentation av det sociala arbetet gör att tiden som socialarbetaren har till sitt förfogande för att besöka och att ha möten med klienten blir knapp. 4) Ett allmänt samhällsideal kring individuellt ansvar och en särskild arbetsmetod (motiverande samtal) som många socialarbetare förväntas lära sig, framhäver klientens eget ansvar för och vilja till förändring. Detta legitimerar ett avståndstagande från klientens behov av hjälp och stöd enligt logiken ”du måste klara detta själv”. 5) En vanligt förekommande uppdelning av socialarbetarnas arbetsuppgifter i en så kallad beställar-utförarmodell gör att vissa socialsekreterare arbetar med hjälp och stöd, medan andra arbetar med bedömningar av klienters behov. De senare, som också har inflytande över resurstilldelning, blir med en sådan organisering av arbetet alltmer frikopplade från den stödjande och hjälpande verksamheten och kontakten med klienten. 6) Standardiserade digitala bedömningsinstrument, skapade för att på ett likvärdigt sätt bedöma klienters behov och dokumentera det sociala arbetet, reglerar och instrumentaliserar kontakten med klienter. 7) Tunga arbetsbördor, individualiserat ansvar och stress, bidrar ytterligare till att skapa avstånd och likgiltighet eftersom det för vissa utgör ett sätt att genomleva en ohållbar arbetssituation. En allmän åtstramning av socialtjänstens resurstilldelning förstås som en viktig orsak till behovet av att skapa ovan distansmekanismer. Men distansen hänger också ihop med en tendens till ett återupplivande av en tidigare dominerande förståelse av marginalisering och sociala problem; där människors nöd ses som ett utslag av dålig karaktär och ett resultat av dåliga individuella val. De förändringar av det sociala arbetets premisser som beskrivits ovan gör att socialarbetarna alltmer görs främmande inför sitt arbete – de alieneras. Detta främmandegörande uttrycks genom att inte kunna identifiera sig med arbetet självt, sina kollegor eller med sig själv. Ett sådant främmandegörande underminerar, eller fragmentiserar, både relationen till klienten, men också en känsla av gemenskap med andra socialarbetare. En gemenskap som kan utgöra ett ”vi” och ligga till grund för att ställa krav, protestera och göra motstånd mot avhumaniserande ideal och reformer. På så vis är främmandegörandet inte bara en konsekvens av dagens organisering och styrning, utan också något som fyller en viktig funktion för en sådan styrning och organisering, och genomförandet av en allmän åtstramning i socialpolitiken. Samtidigt som dagens organisering och styrning av socialt arbete är främmandegörande, slår vissa socialarbetare knut på sig själva och arbetar extra hårt för att täcka upp för systemets brister och krympande resurser, för att trots det svåra läget ändå försöka ge det stöd som de upplever att klienten behöver. Ett sådant historiskt förankrat femininiserat omsorgsideal, dvs känslor av ansvar och empati inför behövande och en ilska inför oförrätter, utgör därmed på samma gång grund för en fördjupad exploatering av socialarbetarna, och ett vardagligt motstånd mot rådande system. I ett läge när flera upplever att kollegialiteten som grund för motstånd på arbetsplatserna underminerats, utgör ett sådant omsorgsideal samtidigt också grunden för organiserat motstånd utanför arbetsplatsen, bortom chefernas insyn, kontroll och härskartekniker. Medan nuvarande styrningssystem underminerar ett visst sorts motstånd, uppstår samtidigt grunden för nya.
Van, Zyl Francois Nicolaas. "Going beyond evidence based and common factors approaches: a social constructionist model of therapeutic factors." Thesis, 2015. http://hdl.handle.net/10500/20014.
Повний текст джерелаThe inception of psychology as a practicing profession in 1938 brought with it a continuing scientific struggle geared towards cementing its place as a value-adding health service in the form of psychotherapy. Concepts such as Empirically Supported Treatments (ESTs), Evidence Based Treatments (EBTs) and Evidence Based Practice in Psychology (EBPP) arose out of research attempts to scientifically prove the efficacy of psychological treatment versus psychiatric medications or versus no treatment. This focus on evidence in psychotherapy partly stems from, but also influences public policy in the form of practice and training mandates as well as government and insurance funding policies for psychotherapy. At present ESTs, EBTs and EBPP are the source of polarisation among psychologists who argue for either sides of this controversy, raising questions on a practical/policy level as well as an epistemological level. This thesis differentiates between ESTs, EBTs and EBPP as well as the Common Factors approach and continues to critically investigate the advantages, practical/policy implications and epistemological critiques against these approaches. Some of the identified shortfalls resulting from unwarranted epistemological (empirical) assumptions are addressed by proposing a social constructionist model of therapeutic factors based on social constructionist- and eco-systemic theories. The proposed model allows therapists to employ EBT’s in conjunction with various other (excluded) approaches that are available in their arsenal of treatments. Clinical case studies are used to illustrate the model’s practical operation in therapeutic contexts.
Psychology
Ph.D. (Psychology)