Lydahl Doris, Davidsson Anna
Department of Philosophy, Linguistics and Theory of Science, Faculty of Humanities, University of Gothenburg, Gothenburg, Sweden.
Department of Sociology and Work Science, Faculty of Social Sciences, University of Gothenburg, Gothenburg, Sweden.
BMC Health Serv Res. 2024 Dec 6;24(1):1555. doi: 10.1186/s12913-024-12053-1.
In Swedish care for older adults, the use of welfare technology - for example, medicine-dispensing robots and GPS alarms - stimulates ongoing evaluations and negotiations. National policy documents, as well as previous research, indicate that these technologies are expected to improve the quality and efficiency of care but also involve potential or experienced challenges in providing high-quality care and the conditions for care workers - often portrayed as a conflict between political and caring organizational values. More research is thus needed on how the use of welfare technology is justified at central and municipal government levels as well as within care-providing organizations. This article aims to identify how the introduction and use of welfare technology is justified by employees and in policy documents pertaining to welfare technology in Swedish care for older people.
Qualitative interview data involving 37 individuals were collected in municipalities in southern Sweden. The interviewees were managers, administrative staff, and licensed practical nurses working in home care services or special housing for older adults, offering care 24/7. Policy documents and agreements of significance for Swedish welfare technology policy were analysed. The analysis focused on values promoted as significant for the provision of care and related to the use of welfare technology. Justifications and values were analysed as belonging to different 'worlds of worth', as either shared or conflicting, and contextually situated.
The documents reflect values regarding, for instance, efficiency, independence, good working conditions, optimised use of human resources, and time to tend to relationships. The employees justified the use of welfare technologies with reference to optimisation and efficiency, activation and participation, dignity and freedom, social relationships, and good working conditions. These values represent three different worlds of worth - the industrial world, the civic world, and the domestic world - and are situated in employees' everyday work practices.
Values presented by employees and in policy documents are shared rather than conflicting. However, employees emphasise values associated with the domestic world, downplaying industrial values. We argue that politicians and civil servants should consider the situated judgements made by employees and develop more bottom-up strategies. This requires an acknowledgement of the existing values hierarchy, where values of optimisation and efficiency are held in high esteem but to accommodate higher values rather than as end goals.
在瑞典的老年人护理中，福利技术的使用——例如，药品分发机器人和全球定位系统警报器——促使人们不断进行评估和协商。国家政策文件以及先前的研究表明，这些技术有望提高护理质量和效率，但在提供高质量护理以及护理人员的工作条件方面也存在潜在的或实际遇到的挑战——这通常被描述为政治和护理组织价值观之间的冲突。因此，需要更多关于福利技术在中央和地方政府层面以及护理提供组织内部如何被证明合理的研究。本文旨在确定瑞典老年人护理中员工以及与福利技术相关的政策文件是如何为福利技术的引入和使用提供正当理由的。
在瑞典南部的市政当局收集了涉及37人的定性访谈数据。受访者是在居家护理服务机构或老年人特殊住房中工作的经理、行政人员和有执照的执业护士，提供全天候护理。分析了对瑞典福利技术政策具有重要意义的政策文件和协议。分析重点关注那些被认为对护理提供具有重要意义且与福利技术使用相关的价值观。正当理由和价值观被分析为属于不同的“价值世界”，是共享的还是冲突的，以及在情境中的定位。
这些文件反映了关于效率、独立性、良好工作条件、人力资源的优化利用以及维护人际关系的时间等方面的价值观。员工们以优化和效率、积极性和参与度、尊严和自由、社会关系以及良好工作条件为由，为福利技术的使用提供了正当理由。这些价值观代表了三个不同的价值世界——工业世界、公民世界和家庭世界——并且存在于员工的日常工作实践中。
员工和政策文件中呈现的价值观是共享的而非冲突的。然而，员工强调与家庭世界相关的价值观，淡化工业价值观。我们认为，政治家和公务员应该考虑员工做出的情境判断，并制定更多自下而上的策略。这需要承认现有的价值观等级制度，其中优化和效率的价值观备受推崇，但应将其作为容纳更高价值观的手段而非最终目标。
