"Home Health Care Worker." : Current discourses at the political and practical levels.

Detta är en uppsats där normer och värderingar om vårdbiträdet i hemtjänst undersöks genom kritisk diskursanalys. Datamaterial omfattar SOU-rapporten I den äldres tjänst. Äldreassistenten – ett framtidsyrke samt två fokusgruppsintervjuer med omsorgspersonal från en hemtjänstenhet. Diskursanalysen utförs i förhållande till och i samspel med sekundärlitteraturen. Utöver den språkliga analysen tas även kulturella och sociala dimensioner med i studien. För att ringa in rådande diskurser studeras centrala termer och formuleringar genom att undersöka hur ofta och upprepat de förekommer, samt vilken inkludering och exkludering som görs. I spänningsfältet som uppträder mellan den statliga diskursen och den praktiknära diskursen framträder stridigheter om de brister som äldreomsorgen tillskrivs. På politisk statlig nivå framträder en normerande bild av vårdbiträdet som den bristande länken i lagarbetet kring den äldre. På praktiknära nivå framhålls en förklaringsmodell där organisering och ledning är centrala bristkomponenter. Praktiker-diskursens faktorer bemötande och lön konkurrerar med de överordnade faktorerna som återges i SOU-diskursen; utbildning och validering. This study is a discourse analytical study of norms and values in the Swedish public home health care sector. The discourse is studied at two different levels in Swedish society: the political and the practical. Information is collected through focus-group interviews at the practical level and at the political level from a report in the Swedish Government Official Reports Series (SOU 2008:126), appointed by the Ministry of Health and Social Affairs. Government-sponsored publications and reports are used as a basis for executive and legislative decision-making in the parliament and the government. The governmental study is an important template for the formation and maintenance of norms and valuations. Elder care workers constitute Sweden's largest labor force and a majority of them are employed by municipalities. The SOU report motivates competence-reform in light of pending waves of retirements within the elder care work force, increased demand for elder care, and decreasing high-school enrollment in care and service programs. The discourse analysis is executed in relation to and in concert with the secondary literature. The theoretical and methodological perspective in this study takes its starting point in Fairclough's critical discourse analytical theory and method. This provides dialectic of structures and practices, where discourse has an influence on and is influenced by social structures. In Fairclough's view, discourse practices are an important form of social practice that contributes to the forming of identities and relationships. The study investigates discursive practices in the report in order to uncover their role in the perpetuation of an unequal balance of power, so called ideological effects. The study reveals contradictions within the SOU report and discordance between the report and home health care workers. Despite a societal eagerness to professionalize the home health aide, the political discourse relegates the aide to the bottom of the care hierarchy, by excluding issues such as compensation and subordinating questions concerning the organization and management. Discourses and action-space for workers in the home health care environment can be investigated in light of current deficiencies in top-down guidance and limited opportunities for peer-group meetings, especially since an increasing number of home health care workers have Swedish as a second language. Interactive research with both workers and management could be investigated and developed with pedagogical tools as a part of process of reform. Because Swedish society places such a high value on government reports, it is of continuing importance to scrutinize through critical-discourse analysis the entity of governmental research