Det övergripande syftet med denna avhandling är att belysa innebörder av att vara medarbetare, arbetsledare och närstående till en person som utvecklar utbrändhet och att beskriva tecken som föregår utbrändhet. Avhandlingen omfattar fyra delstudier baserade på kvalitativa data och med olika fokus. I delstudie I och II består data materialet av intervjuer med 15 medarbetare till personer som utvecklat utbrändhet, i delstudie III, intervjuer med 12 arbetsledare till personer som
utvecklat utbrändhet och i delstudie IV, intervjuer vid två tillfällen med 5 närstående till en person som utvecklat utbrändhet. I samtliga delstudier
genomfördes narrativa intervjuer och i delstudie I analyserades texten med hjälp av tematisk innehållsanalys. I delstudie II-IV tolkades texterna med fenomenologisk-hermeneutisk metod. Resultatet visar att medarbetarna retrospektivt beskriver olika tecken som föregår utbrändhet. De beskriver att deras arbetskamrater kämpar för att klara sig själva och att de visar självuppoffring. Medarbetarna beskriver också att deras arbetskamrater kämpar mot ouppnåeliga mål och att de distanserar och
isolerar sig. Mot slutet innan sjukskrivningen, beskriver medarbetarna också att de visar tecken på att bryta samman (I). Innebörder av att vara kvinnlig medarbetare till en person som drabbas av utbrändhet är att kämpa, å ena sidan för att förstå och hjälpa personen, å andra sidan handlar kampen om att klara sitt eget arbete.
Denna betungande situation innebär att medarbetarna fylls av motstridiga och frustrerande känslor och när den drabbade slutligen sjukskrivs, uppstår dåligt samvete och känslor av att ha misslyckats (II). Innebörder av att vara arbetsledare till medarbetare som drabbats av utbrändhet är en kamp för att hjälpa den
drabbade fortsätta arbeta. Som ansvarig för enheten, tvingas dock arbetsledarna att se till att arbetet på enheten blir utfört. Allt eftersom situationen fortgår, kläms arbetsledarna i en besvärlig situation där de inte kan hjälpa den drabbade och känslor av otillräcklighet visar sig. När den drabbade blir sjukskriven visar sig känslor av självanklagelser och när tiden är inne för rehabilitering kläms
arbetsledarna återigen mellan motstridiga krav i en som det verkar omöjlig situation (III). Innebörder av att vara närstående till en person som drabbats av utbrändhet är att sätta sitt liv åt sidan för att hjälpa denne. De närstående strävar att finnas till hands för den drabbade oavsett deras egna behov. De närstående ’räddar ansiktet’
på den drabbade för att skydda dem från stress. Allt eftersom situationen fortgår, bär de närstående ensamma en tung börda och de behandlas ibland med
respektlöshet av den drabbade, en situation som blottar de närståendes eget lidande. Närståendes strävan att finna återhämtning föder dåligt samvete, denna situation visar på ett stort behov av stöd till de närstående (IV). Helhetsförståelsen är att innebörder av att vara medarbetare, arbetsledare och närstående till en person som utvecklat utbrändhet är å ena sidan en komplicerad kamp att stödja personen å den andra sidan att axla ett en tung börda. De försöker att göra allt de kan för att hjälpa och stödja den drabbade personen (II-IV). Dessa försök ser dock inte ut att nå fram till den drabbade (I-IV). Medarbetarna uppfattar tecken på att något är fel (I), men de förstår inte vad det är som händer med den drabbade (II-IV).
Denna betungande situation är konfliktfylld och sliten mellan den komplicerade kampen att stödja och klara av denna betungande situation, uppstår
tillkortakommanden och dåligt samvete (II-IV). Helhetsförståelsen i delstudie I-IV diskuteras och reflekteras på med hjälp av teorier om socialt stöd och med hjälp av den danske filosofen Lögstrups tankar om det etiska kravet.
Sökord: burnout, medarbetare, arbetsledare, närstående, sjukvård, fenomenologisk hermeneutik, tematisk innehållsanalys, det etiska kravet, socialt stöd
ACKNOWLEDGEMENTS
This thesis would not have been completed without many different kinds of support from a lot of people. I would like to extend my warmest gratitude to:
All the participants in the studies for offering their time and sharing their experiences with me.
My co-supervisor who came to be my supervisor, Gunilla Strandberg, for sharing your genuine and extensive research knowledge and experiences and for stimulating me to think and reflect, over my own thoughts too. Thank you for your excellent supervision, which has guided me through these years. Thank you also for our exciting conversations over the years about all the difficulties we discovered during our research journey together. I know that we ought now to go our separate ways so that I can become independent as a researcher but I hope we will somehow continue to work together as a team.
The leader of the ‘Stress of conscience study’, and my supervisor who came to be my co-supervisor, Astrid Norberg, for the great honour and privilege working with you – one of the most famous and successful nursing researchers in the world. You have given me so many ideas and tried to share your wisdom with me, both in terms of structural scientific thinking and philosophical thoughts. You have been very supportive and encouraged me during these years.
My closest family, without your instrumental, emotional and appraisal support this thesis would not have been written. Thomas, my dearest husband, for often putting life on hold for many years in order to give me the opportunity to study. You are a wonderful person, my husband, my best friend and my beloved. Viktor and Julia, my wonderful children, for reminding me to take some rest, and that there is a world existing out there and for helping me living in the present. You have
overlooked my absent-mindedness, sometimes asking the same question five times over; you have had such patience! Thanks for our nice, jolly and much appreciated journeys abroad together during these years, they gave me the time necessary to recharge my batteries. Together with you, I feel the very best!
My parents Barbro and Ove, without your important different kinds of support this thesis would not have been completed. You have also at times put your lives on hold in order to help me and my family. It is incredible to have such parents who, without flinching, always stand by me, no matter the time of day or other
circumstances.
My co-workers at the Department of Nursing, Umeå University in Skellefteå, for always supporting me with happy acclamations during these years. Special thanks to my co-worker Margaretha Westerlind, for providing instrumental and emotional support, but also for being my warm-hearted friend.
My friends and co-workers in the project ‘Stress of conscience study’. Gabriella, we have ’used’ each other as ’containers’ over the years and it has been very important to me to have you by my side. Vera, I have perceived and received your warmth and care as a great support. Christina, Karin, Ann-Louise, Karin and Anna, thank you for all wise ideas and for the help and support I have received from you all.
The group of doctoral students in Skellefteå, which will now soon be broken up, some of the doctoral students now have a doctoral degree. Thank you to Olav, Karl-Anton, Margareta, Gabriella och Lena. You have been of great importance to me during these years.
My friends, for always standing by my side, no matter what the circumstances. For seeing to it that I have done other things than research during these years, for example having fun together, for inviting my family and me to dinner and for taking care of our dogs when needed. A special thanks to Marie, who by narrating your experiences about your life, gave me knowledge about stress-related ill-health.
Thank you for taking me with you on your journey to recuperation and for being my partner in conversations. You have taught me so much!
Our dogs Alice and Asta, for always staying by my side while I was writing thesis, especially Alice who now is a lady cocker spaniel in the autumn of her life. You two has lain at my feet and given me warmth, and insisted on having a break for relief and exercise - not only yours, but also mine. We have walked in the forest
irrespective of weather and wind, and I have enjoyed every minute of it! You two have contributed to keeping me healthier during these years.
Marika, my former supervisor and a very good friend, for the courage you gave me in the beginning of my nursing career. Your courage and engagement have guided me in my practice as a nurse. Gunilla, my former co-worker and a very good friend, for the warmth and wisdom you have given to me and for our conversations about the wonderful things in life but also the hard things. Thank you for also helping me to keep an eye on my health during these years, you know what I mean!
The personnel at Skeribi, our campus library in Skellefteå, for always trying to help me, whatever my demands, and for always being nice and kind to me.
Pat Shrimpton for tirelessly helping me to check my English writing and spelling, your help has been priceless! You have with the patience of a saint tried to tell me,
This work was supported by grants from the Swedish Research Council (grant no.
K2006-27X-20068-01-3), the Vardal Foundation for Healthcare Sciences Allergy Research (grant no. E2005011, Healthcare Ethics Project), Faculty of Medicine, Umeå University and the Department of Nursing, Umeå University.
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