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Sandman, Lars
Alternative names
Publications (10 of 102) Show all publications
Jonasson, L.-L., Sandman, L. & Bremer, A. (2019). Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training. Journal of Healthcare Leadership, 11(63-74)
Open this publication in new window or tab >>Managers’ experiences of ethical problems in municipal elderly care: a qualitative study of written reflections as part of leadership training
2019 (English)In: Journal of Healthcare Leadership, Vol. 11, no 63-74Article in journal (Refereed) Published
Abstract [en]

Background: Managers in elderly care have a complex ethical responsibility to address the needs and preferences of older persons while balancing the conflicting interests and requirements of relatives’ demands and nursing staff’s work environment. In addition, managers must consider laws, guidelines, and organizational conditions that can cause ethical problems and dilemmas that need to be resolved. However, few studies have focused on the role of health care managers in the context of how they relate to and deal with ethical conflicts. Therefore, the aim of this study was to describe ethical problems experienced by managers in elderly care.

Methods: We used a descriptive, interpretative design to analyze textual data from two examinations in leadership courses for managers in elderly care. A simple random selection of 100 out of 345 written exams was made to obtain a manageable amount of data. The data consisted of approximately 300 pages of single-spaced written text. Thematic analysis was used to evaluate the data.

Results: The results show that managers perceive the central ethical conflicts relate to the older persons’ autonomy and values versus their needs and the values of the staff. Additionally, ethical dilemmas arise in relation to the relatives’ perspective of their loved one’s needs and preferences. Legislations, guidelines, and a lack of resources create difficulties when managers perceive these factors as conflicting with the care needs of older persons.

Conclusion: Managers in elderly care experience ethical conflicts that arise as unavoidable and perennial values conflicts, poorly substantiated values, and problematic organizational conditions. Structured approaches for identifying, reflecting on, and assessing ethical problems in the organization should therefore be implemented

Keywords
manager, ethical responsibility, municipal, older person, thematic analysis
National Category
Other Medical Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-15232 (URN)10.2147/JHL.S199167 (DOI)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2019-06-20Bibliographically approved
Sandman, L. & Gustavsson, E. (2016). Beyond the Black Box Approach to Ethics!: Comment on "Expanded HTA Enhancing Fairness and Legitimacy". International Journal of Health Policy and Management, 5(6), 393-394
Open this publication in new window or tab >>Beyond the Black Box Approach to Ethics!: Comment on "Expanded HTA Enhancing Fairness and Legitimacy"
2016 (English)In: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939, Vol. 5, no 6, p. 393-394Article in journal, Editorial material (Refereed) Published
Abstract [en]

In the editorial published in this journal, Daniels and colleagues argue that his and Sabin's accountability for reasonableness (A4R) framework should be used to handle ethical issues in the health technology assessment (HTA)-process, especially concerning fairness. In contrast to this suggestion, it is argued that such an approach risks suffering from the irrrelevance or insufficiency they warn against. This is for a number of reasons: lack of comprehensiveness, lack of guidance for how to assess ethical issues within the "black box" of A4R as to issues covered, competence and legitimate arguments and finally seemingly accepting consensus as the final verdict on ethical issues. We argue that the HTA community is already in a position to move beyond this black box approach.

Keywords
Health Technology Assessment (HTA), Accountability for Reasonableness (A4R), Ethics, Ethical, Competence, Ethical Analysis
National Category
Philosophy, Ethics and Religion
Identifiers
urn:nbn:se:hb:diva-11346 (URN)10.15171/ijhpm.2016.43 (DOI)000379824500009 ()27285520 (PubMedID)2-s2.0-85002249037 (Scopus ID)
Available from: 2016-12-12 Created: 2016-12-12 Last updated: 2017-11-29Bibliographically approved
Bremer, A., Jonasson, L.-L. & Sandman, L. (2016). Chefers etiska värderingar. In: Lotta Dellve, Maria Wolmesjö (Ed.), Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar (pp. 43-56). Borås: Högskolan i Borås
Open this publication in new window or tab >>Chefers etiska värderingar
2016 (Swedish)In: Ledarskap i äldreomsorgen: Att leda integrerat värdeskapande i en röra av värden och förutsättningar / [ed] Lotta Dellve, Maria Wolmesjö, Borås: Högskolan i Borås, 2016, , p. 16p. 43-56Chapter in book (Other academic)
Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2016. p. 16
Series
Vetenskap för profession: rapport, ISSN 1654-6520 ; 35
Keywords
Etiska värderingar, chefer, äldreomsorg, etisk profil
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9552 (URN)978-91-88269-08-9 (ISBN)978-91-88269-09-6 (ISBN)
Available from: 2016-04-06 Created: 2016-04-06 Last updated: 2016-05-20Bibliographically approved
Sandman, L. & Bremer, A. (2016). Etik inom ambulanssjukvården (2ed.). In: Björn-Ove Suserud & Lars Lundberg (Ed.), Prehospital akutsjukvård: (pp. 26-39). Stockholm: Liber
Open this publication in new window or tab >>Etik inom ambulanssjukvården
2016 (Swedish)In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud & Lars Lundberg, Stockholm: Liber , 2016, 2, p. 26-39Chapter in book (Other academic)
Place, publisher, year, edition, pages
Stockholm: Liber, 2016 Edition: 2
Keywords
Etik, ambulanssjukvård, vårdetik, autonomi, integritet, rättvisa, etisk kompetens, etiska problem
National Category
Medical Ethics
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9329 (URN)978-91-47-11474-0 (ISBN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2016-11-25Bibliographically approved
Bremer, A., Kullén Engström, A., Fredman, M., Jonasson, L.-L., Jutengren, G., Karlsson, P.-Å. & Sandman, L. (2016). Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar. Borås: Högskolan i Borås
Open this publication in new window or tab >>Ledarskap i äldreomsorgen: att leda integrerat värdeskapande i en röra av värden och förutsättningar
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2016 (Swedish)Report (Refereed)
Abstract [sv]

Det övergripande syftet med denna rapport är att beskriva chefers etiska värderingar, dilemman och organisatoriska förutsättningar för att bedriva ett värdebaserat ledarskap i såväl kommunal som privat äldreomsorg.

Det empiriska materialet består av en omfattande enkätstudie till nästan 500 studerande inom ramen för den nationella ledarutbildningen för chefer inom äldreomsorgen vid Högskolan i Borås under perioden 2013 till 2015. Utbildningen gavs på uppdrag av Socialstyrelsen och omfattade 30 högskolepoäng med två års studier på kvartsfart. Samtliga studerande var yrkesverksamma som chefer och ledare inom kommunal eller privat äldreomsorg i södra Sverige. Metoder som använts i bearbetning och analys av materialet är deskriptiva, jämförande och analytiska med regressionsmodeller och SEM-analys.

Resultatet visar på att cheferna – oavsett utbildningsbakgrund, värderade följande etiska värden högst: att inte skada, respekt för individen och rätten till konfidentialitet. Värdedilemman i chefsarbetet är dock vanligt och sammanlänkat med andra utmaningar i arbetet, särskilt med utmaningar som rör hantering över organisationsnivåer (buffertproblem och containerproblem) och av olika ansvarsområden (logikkonflikter). Inom privat verksamhet skattade de medverkande cheferna värdekonflikter och andra utmaningar i lägre grad än chefer inom kommunal verksamhet.

De flesta chefer var nöjda med hur de kunde fullfölja sitt ansvar för utveckling av verksamheten avseende värdegrund, kvalitet, processer, dagligt arbete, brukarmedverkan, brukarsäkerhet och arbetsmiljö. De flesta skattade också att de arbetade i mycket hög grad med strukturering och utveckling av dessa frågor.

Stödresurser minskade upplevelsen av värdekonflikter, men det fanns skillnad i betydelsen relaterat till chefers grundprofession. Det organisatoriska stödet var också tydligare för chefer inom privat verksamhet. Organiserade stödresurser hade stor betydelse för hållbart integrerat och värdeskapande ledarskap samt för aktiva ledningsstrategier. Även sambandet mellan hållbart ledarskap och aktiva ledarstrategier modererades av grundprofession, där sambandet var moderat negativt för chefer med social grundutbildning. Det tycks således finnas ett utbildningsbehov bland äldreomsorgens chefer och behov av ett utvecklat stöd från arbets- HÖGSKOLAN BORÅS HÖGSKOLAN BORÅS 15 givaren då det varierar avseende omfattning, inriktning och nivå mellan kommunal och privat verksamhet.

Sammanfattningsvis har chefer i äldreomsorgen många olika värden, på olika nivåer och utifrån olika perspektiv att förhålla sig till i sitt ledarskap. Att hantera och utveckla förståelse för dessa är utmanande i chefskapet och värdedilemman är vanliga. Majoriteten av cheferna i denna studie beskriver dock generellt en aktiv och god hantering och organisering av dessa. Konstateras att en integrerad förståelse och hantering, samt goda organisatoriska stödresurser tycks bidra till mer hållbart och värdeskapande ledarskap.

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2016. p. 138
Series
Vetenskap för profession: rapport, ISSN 1654-6520 ; 35
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hb:diva-9333 (URN)978-91-88269-08-9 (ISBN)978-91-88269-09-6 (ISBN)
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2018-01-04Bibliographically approved
Sjostrand, M., Karlsson, P., Sandman, L., Helgesson, G., Eriksson, S. & Juth, N. (2015). Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists. BMC Medical Ethics, 16, Article ID 34.
Open this publication in new window or tab >>Conceptions of decision-making capacity in psychiatry: interviews with Swedish psychiatrists
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2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 34Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8357 (URN)10.1186/s12910-015-0026-8 (DOI)000359415200001 ()25990948 (PubMedID)2-s2.0-84934873646 (Scopus ID)
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2018-12-07Bibliographically approved
Munthe, C., Nykänen, P. & Sandman, L. (2015). Delat beslutsfattande och evidensbaserad praktik inom socialtjänsten: mål, begrepp och etik för utformning och implementering. Göteborg: Göteborgs universitet
Open this publication in new window or tab >>Delat beslutsfattande och evidensbaserad praktik inom socialtjänsten: mål, begrepp och etik för utformning och implementering
2015 (Swedish)Report (Other academic)
Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2015. p. 48
Series
Philosophical communications., ISSN 1652-0459 ; 62
Keywords
etik, värderingar, mål, delat beslutsfattande, medbestämmande, inkludering, evidensbaserad praktik, socialtjänsten, social omsorg, psykiatri
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8364 (URN)
Note

Rapport beställd av Socialstyrelsens enhet för kunskapsstyrning, 2014.

Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2016-01-07Bibliographically approved
Sandman, L., Molander, U. & Benkel, I. (2015). Developing organisational ethics in palliative care: a three level approach.. Nursing Ethics, 24(2), 138-150, Article ID 0969733015595542.
Open this publication in new window or tab >>Developing organisational ethics in palliative care: a three level approach.
2015 (English)In: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 24, no 2, p. 138-150, article id 0969733015595542Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8369 (URN)10.1177/0969733015595542 (DOI)000397917600003 ()26275966 (PubMedID)2-s2.0-85018759725 (Scopus ID)
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2018-12-07Bibliographically approved
Sjöstrand, M., Sandman, L., Karlsson, P., Helgesson, G., Eriksson, S. & Juth, N. (2015). Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists. BMC Medical Ethics, 16, Article ID 37.
Open this publication in new window or tab >>Ethical deliberations about involuntary treatment: interviews with Swedish psychiatrists
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2015 (English)In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 16, article id 37Article in journal (Refereed) Published
Abstract [en]

Background: Involuntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating toinvoluntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.

Methods: In-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences ofand views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. Theinterviews were analysed using a descriptive qualitative approach.

Results: The answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when andwhy it was justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros ofordering compulsory treatment were discussed, with particular emphasis on the consequences of providingtreatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factorsaffecting decisions for or against involuntary treatment were also discussed. These included issues about theSwedish Mental Care Act, healthcare organisation and the care environment.

Conclusions: Involuntary treatment was generally seen as an unwanted exception to standard care. The respondents’judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was alsoargued that the law leaves room for individual judgments when making decisions about involuntary treatment. Muchof the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to thetherapeutic alliance was weighed against the assumed good consequences of ensuring that patients received neededtreatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care weretypically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding theissue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. Itwas moreover argued that organisational factors sometimes led to decisions about compulsory treatment that couldhave been avoided, given a more patient-oriented healthcare organisation.

Keywords
Psychiatry, Bioethics, Personal autonomy, Paternalism, Coercion, Involuntary commitment
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-8356 (URN)10.1186/s12910-015-0029-5 (DOI)000359415500002 ()26016885 (PubMedID)2-s2.0-84930409244 (Scopus ID)
Available from: 2016-01-07 Created: 2016-01-07 Last updated: 2018-12-07Bibliographically approved
Bremer, A., Jonasson, L.-L. & Sandman, L. (2015). Ethical values among managers in elderly care. Paper presented at the Dilemmas for Human Services 2015: Organizing, Designing and Managing. In: : . Paper presented at 18th International Research Conference in Växjö, Växjö Sweden, September 10 – 11, 2015..
Open this publication in new window or tab >>Ethical values among managers in elderly care. Paper presented at the Dilemmas for Human Services 2015: Organizing, Designing and Managing
2015 (English)Conference paper, Oral presentation only (Refereed)
National Category
Health Sciences
Identifiers
urn:nbn:se:hb:diva-12440 (URN)
Conference
18th International Research Conference in Växjö, Växjö Sweden, September 10 – 11, 2015.
Available from: 2017-07-25 Created: 2017-07-25 Last updated: 2018-04-28Bibliographically approved
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