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Oplevelsen af Moralsk stress har været forværret, især under COVID-19 i sundhedsarenaer i Danmark. De 7 sygeplejersker der har været med til et interview i dette projekt har oplevet moralsk stress i forbindelse med etisk beslutningstagning. Dette medfører følelsen af at miste sygeplejerskens identitet. Ligeledes er essensen af omsorg blevet fremmedgjort, på grund af at der er enorm stor mangel på sygeplejerske i alle Danmarks Sundhedsinstitutioner. Moralsk stress er derfor uundgåeligt, dog kan dette mindskes ved at have en bedre normering på arbejdet. Ydermere, er moralsk stress og social acceleration sammenhængende. Der efterhånden blevet præsenteret i sygepleje verden, som kan føre os til at hjælpe og forstå problemstillinger, der indebærer moral og etik, som opstår indenfor sygepleje og sygeplejepraksis område.

Bakgrund: Det er velkendt at en række kroniske tilstande kan medføre nedsat evne til at varetage gøremål i hverdagen relateret til egenomsorg og huslige gøremål, også kaldet almindelig daglig levevis (ADL), og der er behov for at udvikle og evaluere interventionsprogrammer, der adresserer sådanne problemer. Med afsæt i Britiske Medicinske Forskningsråds vejledning (MRC guiden) for udvikling og evaluering af komplekse interventioner, blev den første version af det ergoterapeutiske program (ABLE 1.0) udviklet med det formål at forbedre ADL-evnen blandt personer med kroniske tilstande. ABLE inkorporerer viden baseret på eksisterende evidens, klinisk ekspertise hos ergoterapeuter og klienters erfaringer og behov. ABLE er et 8-ugers, struktureret og individualiseret forløb, som leveres i klientens hjem som en del af kommunal rehabiliteringspraksis. Forløbet består af 5-8 sessioner, og består af vurdering af ADL-evne, målsætning, intervention baseret på en kompensatorisk tilgang og afsluttes med revurdering af ADL evne. Desuden er programmet udviklet til at kunne anvendes på tværs af alder, køn og diagnoser, dvs. generisk. Et feasibility studie viste, at ABLE 1.0 var gennemførbar med hensyn til indhold og levering, med mindre justeringer af interventionsmanualen og procedurer for rekruttering. Det blev derfor anbefalet at gennemføre et pilot studie før planlægning og gennemførelse af evalueringsstudier. Formålet med denne afhandling var derfor at evaluere de resterende feasibility-aspekter forud for et randomiseret kontrolleret forsøg (RCT), inklusive revidering af ABLE 1.0, og at gennemføre effekt og proces evaluering af ABLE 2.0.Metoder: MRC guiden blev anvendt som ramme. Revidering af ABLE 1.0 omfattede gennemførelse af en kognitiv debriefing med deltagelse af fem ergoterapeuter, med henblik på at identificere uklarheder i ABLE manualens opbygning og indhold, som potentielt kunne føre til forvirring eller misforståelser. Derudover omfattede det inkorporering af opdaterede versioner af teoretiske modeller i programmet.Pilot studiet var designet som et randomiseret kontrolleret studie med to parallelle grupper. Planen var at inkludere 20 personer med én eller flere kroniske tilstande, som oplevede problemer med udførelse af ADL opgaver, i perioden fra december 2019 til april 2020. Følgende progressionskriterier blev anvendt for at vurdere gennemførbarheden at et RCT studie: (i) rekruttering (50 % opfyldte inklusionskriterierne) og fastholdelse (80 %), (ii) randomisering (80 % accepterede randomisering og proceduren blev udført som planlagt), (iii) gennemførbarhed og accept i praksis (100 % fulgte manualen), (iv) resultatmålinger (80 % af deltagerne leverede relevante og fuldt besvarede spørgeskemaer) og (v) sædvanlig ergoterapi (udtræk af nødvendig information fra klientjournaler var vellykket).Den efterfølgende effektevaluering havde et RCT design med blindede testere og forskere. Hjemmeboende klienter med kroniske tilstande og ADL problemer blev randomiseret og allokeret til ABLE 2.0 eller sædvanlig ergoterapi. Data blev indsamlet ved baseline (uge 0), efter endt intervention (uge 10) og ved followup (uge 26). Co-primære outcomes var selvrapporteret ADL evne, målt med ADL-Interviewet (ADL-I Udførelse) og observeret motorisk ADL evne målt med Assessment of Motor and Process Skills (AMPS) ved primært endpoint 10 uger efter baseline. Sekundære outcomes var selvrapporteret ADL evne, målt med ADL-I Udførelse, og observeret motorisk ADL evne, målt med AMPS, ved sekundære endpoint 26 uger efter baseline; og selvrapporteret tilfredshed med ADL evne, målt med ADL-I Tilfredshed, og observeret procesmæssig ADL evne, målt med AMPS, ved primært og sekundært endpoint. Eksplorative outcomes var aktivitetsbalance målt med Occupational Balance Questionnaire (OBQ11), oplevede forandringer målt med Client-Weighted-Problems Questionnaire (CWP-Q) og generelt helbred målt med det første spørgsmål i the MOS 36- item Short Form Survey Instrument (SF36-SF1) ved primært og sekundært endpoint. Alle outcomes blev analyseret i Intention-To-Treat analyser efterfulgt af sensitivitetsanalyser i form af Per-Protocol analyser ved hjælp af analyser af kovarians (ANCOVA) over tid mellem grupper som repeated measures. ADL-I Udførelse ved baseline blev brugt som kovariat.Procesevalueringen var designet som en realistisk evaluering. Ved hjælp af en programteori blev hypoteser om hvordan kontekstuelle faktorer og mekanismer i interventionsprogrammet kunne lede til bestemte outcomes, i såkaldte CMO konfigurationer, beskrevet. Procesevalueringen var baseret på kvalitative data fra interview med 8 klienter, som havde modtaget ABLE 2.0, og de tre ergoterapeuter, der havde leveret det. Desuden blev der indsamlet kvantitative data ved hjælp af registreringsskemaer, som blev udfyldt af de klienter der modtog programmet og de tre ergoterapeuter der leverede det. Resultater: Baseret på data fra kognitiv debriefing og opdateret teori blev manualen revideret, hvilket resulterede i ABLE 2.0. På grund af Covid-19 pandemien blev pilot studiet afbrudt i marts 2020, hvilket resulterede i et begrænset datasæt, som dog blev vurderet til at være tilstrækkeligt til at besvare studiets spørgsmål: (i) 18 ud af 37 som opfyldte inklusionskriterierne (48,6 %) blev rekrutteret; alle inkluderede (n = 6) forblev i programmet (100 %); (ii) 18 accepterede randomisering (100 %), og proceduren var effektiv; (iii) ABLE blev leveret som beskrevet i manualen (100%); (iv) 92,3-100 % af deltagerne gav relevante og fuldstændige svar i to af tre spørgeskemaer; og (v) information om sædvanlig ergoterapi var tilgængelig i syv ud af ni aspekter.I effektevalueringens ITT analyser af primære outcomes fandt vi ingen statistisk signifikante eller klinisk relevante forskelle mellem grupper i gennemsnitlige forandringer i selvrapporteret (ADL-I Udførelse) (-0.16; 95 % CI: -0.38 to 0.06) eller observeret (AMPS) (-0.1; 95 % CI: -0.3 to 0.1) ADL evne fra baseline til uge 10. Ved sekundært endpoint 26 uger efter baseline, fandt vi en statistisk signifikant og klinisk relevant forskel i motorisk ADL evne (AMPS) (LS mean change = -0.3; 95% CI = -0.5 to -0.1) mellem grupperne. Dette fund blev bekræftet i sensitivitetsanalysen (LS mean change = -0.4; 95% CI = -0.7 to -0.1).Procesevalueringen bekræftede overordnet set programteorien og tilføjede informationer om centrale mekanismer associeret med de positive resultater af ABLE 2.0: Aktiv involvering af klienten i problemløsningsprocessen, en velfungerende samarbejdsrelation, gensidig tillid og vejledning i en aktivitetsbaseret proces med brug af kompenserende tiltag. En række kontekstuelle faktorer, herunder understøttende ledelse, visitationsprocedurer der understøttede problemløsningsprocessen, levering i klientens hjem, ergoterapeuter med gode færdigheder, og klienter, der følte sig klar til forandringer, kunne aktivere mekanismerne.Konklusioner: På baggrund af studiernes resultater kan det konkluderes, at ABLE 2.0 havde effekt i forhold til at opnå forbedringer i observeret motorisk ADL evne, det vil sige nedsat anstrengelse i form af klodsethed, fysisk udmattelse og træthed, blandt personer med kroniske tilstande. De opnåede langsigtede effekter på den observerede motoriske ADL evne tilskrives den systematiske tilgang til problemløsningsprocessen, at interventionen leveres i hjemmet og brugen af kompenserende tiltag. Slutteligt, fordi klienternes observerede ADL evne ved baseline var den eneste identificerede forskel mellem de klienter, der opnåede forbedret ADL evne og de der ikke gjorde, og ABLE 2.0 således var effektiv på tværs af køn, alder og diagnoser, understøtter resultaterne ideen om et generisk program. Konklusionerne danner grundlag for at anbefale iværksættelse af forskningsaktiviteter, der sigter mod implementering af ABLE interventionsprogrammet i kommunal rehabiliteringspraksis. Background: Problems related to performance of activities of daily living (ADL) tasks is associated with chronic conditions stressing a need to develop and evaluate intervention programmes addressing such problems. Guided by the United Kingdom Medical Research Council’s (MRC) guidance on how to develop and evaluate complex interventions, the first version of the occupational therapy program (ABLE 1.0) was developed, aiming at enhancing ADL ability among persons with chronic conditions. ABLE incorporates knowledge based on existing evidence, clinical expertise of occupational therapists, and clients’ experiences and needs. ABLE is a structured eight-week, generic, homebased, adaptational program, including five to eight individualised sessions, developed to be delivered in the client’s home as part of community-based rehabilitation services. Following development of the programme, a feasibility study was conducted, showing that ABLE 1.0 was feasible in terms of content and delivery with minor adjustments to the intervention manual and recruitment procedures. Hence, pilot testing of the remaining uncertainties was recommended before proceeding to the evaluation phase. The aim of this doctoral thesis was to evaluate the remaining feasibility aspects prior to a randomised controlled trial (RCT), including minor revision of ABLE 1.0, and to conduct effectiveness and process evaluation of ABLE 2.0.Methods: The MRC framework for developing and evaluating complex interventions was applied. Revision of ABLE 1.0 included conduction of a cognitive debriefing including n=5 occupational therapists to identify any aspect of the ABLE manual leading to confusion or misunderstanding. Further, relevant updates of theoretical models incorporated in ABLE 1.0 were implemented.The pilot study was designed as a two-armed parallel RCT, planning a recruitment strategy including 20 persons with one or more chronic conditions and experiencing problems performing ADL tasks. The pilot study period was scheduled from December 2019 to April 2020. The following progression criteria were used to determine if a future full-scale RCT was feasible: (i) recruitment (50% met the eligibility criteria) and retention (80%), (ii) randomisation (80% accepted randomisation, procedure was executed as planned), (iii) adherence to programme (100% followed the treatment protocol), (iv) outcome measurements (80% of the participants delivered relevantly and fully answered questionnaires), and (v) usual occupational therapy (extraction of needed information was successful).The subsequent effectiveness evaluation was designed as a RCT with blinded assessors and investigators. Home-dwelling persons with chronic conditions experiencing ADL task performance problems were randomly allocated to ABLE 2.0 or usual occupational therapy. Data were collected at baseline (week 0), post intervention (week 10) and at follow-up (week 26). Coprimary outcomes were self-reported ADL ability (ADL-Interview (ADL-I) performance) and observed ADL motor ability (Assessment of Motor and Process Skills (AMPS)) at primary endpoint (week 10). Secondary outcomes were self-reported ADL ability (ADL-I performance), observed ADL motor ability (AMPS) at secondary endpoint (week 26) and perceived satisfaction with ADL ability (ADL-I satisfaction); and observed ADL process ability (AMPS) at primary and secondary endpoint. Explorative outcomes were occupational balance (Occupational Balance Questionnaire); perceived change (Client Weighted Problems Questionnaire) and general health (first question of the MOS 36-item Short Form Survey Instrument) at primary and secondary endpoint. All outcomes were analysed using the principles of Intention-To-Treat (ITT) analyses followed by sensitivity analyses in terms of Per Protocol (PP) analyses, applying analysis of covariance (ANCOVA) with time by programme as repeated measures. ADL-I at baseline was included as covariate. In the process evaluation a realist evaluation approach was applied. A programme theory (ABLE 2.0 initial programme theory) was constructed expressing how contexts (C) and mechanisms (M) in the intervention programme were hypothesised to lead to certain outcomes (O), in so-called CMO configurations. The process evaluation was based on qualitative interview data from a sub-group of clients (n=8) and the occupational therapists delivering the programme (n=3), supplied by quantitative data from registration forms, filled in by clients receiving (n=38) and OTs delivering (n=3) ABLE 2.0.Results: Based on data from the cognitive debriefing and updated theory the manual was revised resulting in ABLE 2.0. Due to the Covid-19 pandemic the pilot study was interrupted in March 2020, resulting in limited but sufficient data to answer most of the study questions. (i) Eighteen of 37 eligible persons (48.6%) were recruited; of those treated (n = 6), all remained in the programme (100%); (ii) 18 accepted randomisation (100%), and procedure was effective; (iii) ABLE was delivered with adherence (100%); (iv) 92.3–100% of the participants gave relevant and complete answers in two of three questionnaires; and (v) the needed information on usual occupational therapy was extractable in seven of nine aspects.In the effectiveness evaluation ITT analysis of primary outcomes identified no statistically significant nor clinically relevant difference between group mean changes on self-reported, i.e. ADL-I performance (-0.16; 95 % CI: - 0.38 to 0.06) and observed ADL ability, i.e. AMPS ADL motor ability (-0.1; 95 % CI: -0.3 to 0.1) from baseline to week 10. However, at the secondary endpoint (week 26) a statistically significant and clinically relevant difference was found in AMPS ADL motor ability (LS mean change = -0.3; 95% CI = -0.5 to -0.1) between groups. This was confirmed in the sensitivity analysis (LS mean change = -0.4; 95% CI = -0.7 to -0.1).The process evaluation overall confirmed the initial programme theory, adding information on core mechanisms associated with the positive effects of the ABLE 2.0. These included active involvement of the client in the problem-solving process, a collaborative working relationship, mutual confidence, and a consultative occupation-based process using adaptational strategies. Several contextual factors were required to activate the desired mechanisms in terms of supportive management, referral procedures encouraging the problem-solving process, delivery in the client’s home, skilled OTs, and clients feeling ready for making changes.Conclusions: Based on the results it was concluded that the ABLE 2.0 was effective in improving observed ADL motor ability, reflecting a decreased level of effort in terms of clumsiness, physical effort, and fatigue among persons with chronic conditions. Sustainability of the improvements in ADL motor ability was obtained based on delivering the individualised systematic problem-solving process in the home of the client and by using adaptational strategies. Finally, because baseline ADL ability was identified as the only area were persons who benefitted differed from those who did not, and the ABLE 2.0 otherwise was effective across age, gender and diagnoses, the idea of developing a generic programme was supported. Based on the conclusions it is recommended to proceed to planning of research activities aiming at implementing the ABLE intervention programme in clinical communitybased rehabilitation settings.

This study investigates whether the so-called Covid-19 critical movement continues itsactivity after the end of the restrictions in Denmark, and if so, what the activity is anexpression of.Methodologically this study takes a phenomenologically inspired, qualitativeapproach. The study is based on digital and physical observations, and four semistructuredinterviews with members from the movement.The theoretical frame of this study is based on New Social Movement Theory byRonald Inglehart, coupled with perspectives from the research conducted by sociologistsAnders Ejrnæs and Silas Harrebye. Moreover, the study uses theories about populism byErnesto Laclau combined with Jan Werner Müllers concepts regarding antielitism andantipluralism.We conclude that the Covid-19 critical movement continues to exist, but in a new form.However, in the current state, the movement shows more system critical tendencies.Therefore the Covid-19 epidemic has functioned as a catalyst for the present broadendcritique. This critique concerns different topics which are not seemingly correlated, but endsup being connected in an equivalent chain that relates all topics to system critique and a ‘fightfor freedom’. Furthermore, the movement is built upon distinct ‘freedom values’ due to theinfluence of strong post materialistic values. The movement is also influenced by populisttendencies such as antagonism, antielitism and antipluralism. Some of the critique which isexpressed by the movement can be seen as a sign of democratic satisfaction. However, someof the critiques also indicate a democratic dissatisfaction.

This paper explores and analyses the impact that the COVID-19 pandemicexerted on the well-being of workers in a Danish company - Hobbii. As a means ofachieving the specified end, we took an interpretivist approach towards thequalitative data we collected through employing semi-structured interviews amongthe current and former workers of Hobbii’s distribution centre, which revolved aroundinvestigating their group affective tones during various phases of the pandemic. Ourfindings showed a crucial and significant change, with the group affective tone ofworkers shifting from very positive to very negative in a blink of an eye, right uponthe emergence of the virus in Denmark. This phenomenon was moreover reinforcedin time by the economic boom that the company experienced due to COVID-19,which initiated substantial alterations of the corporate politics. The warehousetherefore metamorphosed unrecognisably.

This project investigates the research question: What standards does the H&M Group use to report sustainability in the years 2019, 2020, and 2022 and how do they signal sustainability in the context of the COVID-19 pandemic? The goal is to compare the standards used in the H&M Group’s sustainability reporting and analyse the content of these reports throughout the pandemic. In this project, the conceptualization of sustainability reporting, corporate social responsibility, and the fast fashion industry is outlined. Furthermore, the triple bottom line introduced by J. Elkington (1994) is used as a framework for sustainability, and the signalling theory by B.L. Connelly (2011) is explained to understand how an organisation can communicate sustainability. The methods used to investigate the problem are as follows: a case study written by B. Flyvbjerg (2006) is used to collect data and qualitative content analysis is made use of to analyse the data. Besides that, the encoding framework proposed by Amaya et al. (2021) is also used to help with designing the project’s structure.The results show that the project’s goal was achieved successfully with the comparison of the standards used by the H&M Group in the company’s sustainability reporting and various signals to communicate sustainability were recognised. The COVID-19 pandemic had little effect on the structure of the reports investigated but it had an impact on transparency.

Since being chosen as the head coach of the Danish national football team, Kasper Hjulmand has become a prominent public figure, and been a central character in several major events. He led the team to their biggest success in many years by reaching the semi-final of the European Championship, dealt with the sudden heart attack of star player Christian Eriksen during a match and gathered the attention of an entire nation during the mentally straining COVID-19 pandemic. All this eventually led to him being chosen as “leader of the year”, as the first recipient who’s not in a traditional business role.This research conducts a discourse analysis of interviews with Hjulmand in conjunction with the use of leadership theories, to identify some traits and themes regarding what kind of leader he is. This understanding leads the analysis to an investigation of the narrative surrounding him as a leader, how it is created, and what role he himself can play in it. Existing studies have been made regarding achieving success in sports and leadership, and others regarding how a narrative is created. The findings of this study take this knowledge further, by determining how a public leader, like Hjulmand, influences the narrative surrounding them and achieves a deeper understanding of how a well-functioning social atmosphere is a precursor for the success of sports teams.

AbstractThe outbreak of the Covid-19 virus in the beginning of the year 2020 quickly escalated into a global pandemic. Protests started to surface all around the world, as governments and authorities resorted to imposing drastic measures to curb the spread of the virus, that would profoundly affect the lives of many people. This project seeks to explore the experiences undergone by a group of participants from different parts of Europe, who exhibited some resistance to the measures enforced by the authorities to uncover their grievances, feelings, and the power imbalances they experienced and that could predispose them to resort to collective protest movements. The study suggests that there has been a lack of research done throughout Northern and Southern Europe, that focuses on the protestors’ experiences of the pandemic to determine the reasons that could engender them to resist decisions imposed by the authorities to combat the pandemic. This paper could potentially contribute new understandings of the human motivations that underlie counter-conducts at a time of rising polarities brought by a disruptive event like a global pandemic. Interpretative Phenomenological Analysis is used as a method to make sense of the personal and social world of the participants interviewed on this socially sensitive topic. Elements of social movement theories and pertaining to the social psychology of protest that focus on feelings, grievance analysis, perceived injustices, were used to extract meaning from their understandings and perceptions and throw light on how these could lead to the emergence of protest movements. A theory of analytics of counter-conducts, is used to point at namely forms of knowledge relied upon by the participants and fields of visibility of the protests.The grievances expressed by the participants were a strong distrust in the authorities founded on knowledge sources that are varied, ranging from accounts from the mainstream media to alternative sources to statements of professional doctors. These are accompanied by strong feelings of outrage towards this ‘enterprise of divide and conquer’, that employed harmful measures, even more lethal than the pandemic itself, that also translated in economic collapse and surge of mental health issues and death in some instances. Those constitute common beliefs of these participants who were spread across Europe, that could make them susceptible to partake in large scale protests. There is also a fear of extinction for humanity and fear of being controlled by the authorities that is very dominant, underlying a general concern for other fellow human beings.