Suchergebnisse

AbstractFrontline workers bring different forms of knowledge to bear on decisions and actions. Even so, knowledge has so far received limited attention in the street-level literature. This article develops a nuanced understanding of what constitutes knowledge in frontline work and shows how different forms of knowledge are mobilized on the ground. Taking a practice-based and abductive approach, the article draws on qualitative data from a multi-sited organizational ethnography in three Danish child welfare agencies as well as insights from a broad range of literature to build a conceptual framework for studying knowledge mobilization in frontline work. The framework delineates three interdependent forms of knowledge—knowledge-that, knowledge-how, and knowledge-by-acquaintance—that are all essential in frontline work. Knowledge-that is explicit and includes research evidence. Knowledge-how is rooted in experience and acquired through practice. Knowledge-by-acquaintance is rooted in encounters and denotes frontline workers' "sense" of a case or situation. The empirical work shows how each form of knowledge is mobilized in practice. The findings yield important insights into the dynamics of knowledge mobilization at the frontlines, including the detrimental effects of rapid turnover, the conditions for realizing ideals such as evidence-based practice and data-driven decision-making, and the potential implications of digitalization and algorithmization.

AbstractDeliberation is a widely recognized but understudied aspect of frontline decision-making. This study contributes to theory development by exploring deliberative practices in frontline organizations and their implications for decision-making. Drawing on a multi-sited ethnographic study in three Danish child welfare agencies, the analysis clarifies the multiple purposes of deliberation in everyday practice and shows how deliberation is enabled and structured by formalized and informal deliberative organizational routines. Findings show that deliberation may influence individual decision-making or amount to collective decision-making. Depending on how deliberative organizational routines are enacted, deliberation may serve to enhance professional judgment, ensure appropriate justification for decisions, and alleviate uncertainty and emotional strain. Yet, while deliberation represents a productive form of collective coping, deliberative routines may also obscure transparency and reify dysfunctional group dynamics. A conceptual framework is developed to support further research into the purposes, practices, and implications of deliberation across diverse street-level contexts.

AbstractThis article shows how a new normative standard for public professionalism has evolved from the introduction of evidence-based practice in Danish child protective services. The concept of 'theorization' from institutional theory is discussed and applied as the main analytical lens to explore how new ideas are introduced, interpreted, and negotiated in the organizational field. Based on a cross-level ethnographic case study, the study traces the process of theorization and shows how actors are informed by local translations and theorizations as they challenge, negotiate and develop collective understandings in the field. Theorization is therefore conceptualized as a continuous multidirectional process of recursive intertwinement between field-level and organizational developments, which may or may not entail institutional change. The study also contributes to our understanding of changing forms of professionalism by proposing the concept 'explicit professionalism' as a way of capturing the new normative standard for public professional work that has evolved from the process of theorizing evidence-based practice. Explicit professionalism is both a descriptive concept and a normative ideal and, it is suggested, an important dimension of new forms of organizational and organizing professionalism, which can aid our understanding of related developments in different professional fields.

Physical activity in leisure-time is recommended by authorities as healthy while physical activity at work is often considered to be harmful to your health. In Denmark the term 'nedslidning' is used to describe the gradual physical deterioration due to exposures in the work environment. This article presents a review of the literature about physical work and health, and the historical and present use of the term 'nedslidning' is described. Instead of using the not vey specific term 'nedslidning', the article suggests that the process of deterioration is seen as part of the musculoskeletal ageing process. The reader is presented to a 'life course perspective' on the aging process and to a 'life course perspective' on the relationship between the physical activity in work life and the following physical function in midlife. The paper concludes with a recommendation of the use of these perspectives in future occupational research and in daily life, where professionals are working with the relationship between work environment and health.

Anne Marie Bülow-Møller undervisar i engelska vid den fackspråkliga fakulteten vid Handelshögskolan i Köpenhamn. Hon har doktorsexamen med inriktning på linguistic criticism från University of East Anglia (UK). 1989 publicerade hon The Textlinguistic Omnibus, en pedagogiskt inriktad översikt över textlingvistisk metod. Här presenterar hon ett urval pedagogiskt relevanta textlingvistiska kategorier.

Street-level workers are notoriously difficult to manage. Over the years, scholars have highlighted the importance of social dynamics and informal and collective leadership in street-level contexts. Yet, the question of how formal managers can support street-level workers' performance and well-being remains underexplored. Building on insights from the street-level and generic leadership literatures, the authors seek to delineate a role for formal managers that takes seriously the particularities of the street-level context. The authors develop a concept of street-level leadership that is underpinned by a relational approach and focused on activating street-level workers' professional knowledge and building supportive communities, with the purpose of supporting professional uses of discretion, conscientious prioritizations, and the ability to handle moral dilemmas and emotional strain. Empirical examples illustrate street-level leadership in practice. Future research should explore the proposed mechanisms and effects of street-level leadership, including important HRM outcomes such as job satisfaction, retention, and burnout.

Despite the centrality of bureaucracy to both the theory and the realities of street-level bureaucracy, street-level scholars have rarely engaged with the concept of bureaucracy as such. We argue that Weber's perspective on bureaucracy represents an indispensable source that may help us align the theoretical foundation of street-level scholarship with its empirical findings and bring attention to aspects of street-level work that are often overlooked. Drawing on a value-based reading of Weber, we propose an ethics of office-approach that allows us to see frontline workers' discretionary practices as an integrated aspect of their bureaucratic ethos, which enables them to handle complex demands and multiple obligations. The ethics of office-approach further recognizes that their actual possibilities for doing so are related to their training and expertise within specific life orders characterized by different purposes and ethical codes. The approach therefore calls for contextual sensitivity. To develop our argument, and demonstrate the analytical range and usefulness of the ethics of office-approach, we present three case examples based on ethnographic studies of midwifery care, child protection, and citizen services.

AbstractPractice-based studies have demonstrated how institutional logics function as repertoires of cultural resources that actors may use strategically for professional (re-)positioning. This article focuses on the concept of hijacking based on a qualitative study of the implementation of a randomized controlled trial (RCT) in specialized cancer palliation. Using the logics-as-resources perspective as theoretical framing, we describe the negotiations and hijacking of logics that followed the introduction of the RCT and the temporary reversal of home logics between professional subgroups in cancer treatment and care. The analysis shows how hijacking unfolds in a highly institutionalized and complex professional healthcare setting characterized by intra-institutional heterogeneity. We contribute to the literature by highlighting how hijacking is related to power differentials and identity work and may contribute to obscuring underlying conflicts, in this case between science and care logics. The article develops our understanding of hijacking as a theoretical concept and an empirical phenomenon.

Denne artikel beskriver de udfordringer, vi er stødt på i det indledende arbejde, i bestræ- belsen på at udvikle et nyt patient rapporteret outcome measure (PROM) for livskvalitet blandt patienter med multisygdom. De eksisterende livskvalitetsmål, der i dag anvendes, præsenteres sammen med en redegørelse for deres relation til dette projekt. Derefter in- troduceres projektets teoretiske ramme for en patientcentreret, behovsrelateret livskvalitet, The Needs-Based Model. Endelig diskuteres udfordringerne ved at definere begrebet livs- kvalitet, så det er kvantificerbart og kan bruges på populationsniveau i forskningsmæssige sammenhænge.






Tre af de indledende interviews i et pilotstudie er i denne sammenhæng udvalgt som ca- ses, fordi de på hver deres måde bidrager til at illustrere de tematiske udfordringer: adaptiv livskvalitet og temporalitet i multisygdom. Data fra disse interviews viser, at selvevaluerin- ger af livskvalitet kan ændres gennem forløbet af en sygdom, og at der i disse ændringer kan være tale om en iboende gradvis tilpasning til sygdommene. Interviewene tydeliggør herudover koblingen af temporalitet med multisygdom som en både progressiv og cyklisk faktor og den deraf afledte mulige fluktuation i livskvalitet.
Til sidst præsenteres de refleksioner og de valg, forfatterne har foretaget, for at tage højde for forskellige definitioner af multisygdom samt adaption og temporaliteten i multisygdom. Herunder begrænsningerne ved at anvende et øjebliksbillede af livskvalitet som et forsk- ningsmæssigt værktøj.

Antallet af mennesker, der lever med multisygdom, er gennem de seneste år steget markant, både som et resultat af en aldrende befolkning, men også på grund af en forbedret medicinsk behandling af, og tertiær forebyggelse hos, mennesker med kroniske sygdomme. Interessen i forskning om multisygdom har også været støt stigende de seneste år, men, trods denne interesse, er der fortsat ingen konsensus om, hvordan multisygdom skal defineres, og varia- tionen i, hvordan multisygdom bliver defineret og brugt i den videnskabelige litteratur, er stor. Med denne artikel vil vi diskutere konsekvenserne af heterogeniteten i definitionen af multisygdom. Vi tager udgangspunkt i en systematisk gennemgang af definitionen af mul- tisygdom, og diskuterer, om begrebet multisygdom giver mening og for hvem, og om vi med de eksisterende definitioner kan risikere at fokusere på andre patienter end dem, der har det største behov. Dette leder derefter over i en diskussion om, hvorvidt definitionsproblematikkerne skaber risiko for, at multisygdom i sig selv som begreb kan føre til overdiagnostik og dermed være til mere skade end gavn for patienterne.

Abstract
Ischemic heart disease (IHD) causes mortality and morbidity. High levels of occupational physical activity (OPA) increases IHD risk, and occupational lifting (OL) is suggested as a detrimental OPA exposure. This study investigated the association between accumulated OL throughout working life, and risk for IHD, and potential sex and hypertension differences. Data from Copenhagen Ageing and Midlife Biobank linked to register-based information on incident IHD during 9 years follow-up in the Danish National Patient Registry were included. The outcome was the odds of IHD from baseline (2009–2011) to end of follow-up (2018), among participants without IHD at baseline. Accumulated OL was assessed by linking occupational codes to a Job Exposure Matrix, creating a measure in ton-years (lifting 1,000 kg/day/year). Multivariable logistic regression tested associations between level of accumulated OL and IHD, among the 6,606 included individuals (68% men). During follow-up, 7.3% men and 3.6% women were hospitalized with IHD. Among all participants, the odds for IHD were 47% (OR 1.47, 95% CI 1.05–2.06) higher among those with ≥5 to <10 ton-years, 39% (OR 1.39, 95% CI 1.06–1.83) higher among those with ≥10 to <30 ton-years, and 62% (OR 1.62, 95% CI 1.18–2.22) higher among those with ≥30 ton-years, compared to no accumulated OL. However, these increased odds were in the same direction in the fully-adjusted model but statistically insignificant, ≥5 to <10 ton-years OR 1.28, 95% CI 0.88–1.88; ≥10 to <30 ton-years OR 1.20, 95% CI 0.85–1.69; and ≥30 ton-years OR 1.22, 95% CI 0.81–1.84. No statistically significant interactions, nor any associations, between OL and sex, or hypertension were seen.