”I actually had to scream for help” – abused women’s survival work before, during and after their shelter stay

In this interview study, we apply institutional ethnography and the ‘generous’ concept of work to analyse the survival work of ten women who have stayed in domestic violence shelters due to male partner violence. The analysis shows that survival work - the work the women do to gain access to protection and support - can take many forms. For instance, in order to access a shelter, women had to navigate the fragmented organisation of social services and articulate their experiences of violence to a range of different caseworkers. Once in a shelter, the women tried to manage and make sense of the safety rules they encountered. Moreover, they worked to increase their autonomy and freedom by trying to bridge the safety restrictions without jeopardizing the protection provided by the shelter. During the shelter stay, the women also worked to gain access to psychosocial support. The pursuit of support continued after leaving the shelter; with the purpose of establishing a new life in the municipality. This included the work to protect themselves from further violence.

Background: In Sweden, domestic violence shelters have served as a safe haven for abused women since the late 1970s when non-profit women's shelters were established for women escaping domestic violence. In those days, such sheltered accommodations received abused women without administrative decision. However, this changed when the protection and support of abused women became a municipal responsibility and domestic violence shelters were regulated by Swedish regulations and guidelines.  Presently, a shelter stay is granted by the social services subsequent to investigation and risk assessment. The actual implementation of the intervention is then referred to a women's shelter, or to a private or municipal shelter, which nowadays is regulated by the Social Services Act and its quality and safety requirements. Studies show that the status of women's shelters as social service providers has led to professionalisation of their activities. In addition, the number of private shelters has increased. Domestic violence shelters, in other words, are undergoing a process of institutionalisation and marketisation. Our knowledge of what this entails for abused women is, to date, limited. The aim of the study is to explore how abused women's experiences of and access to protection and support are taking shape within the institutional shelter system. 

Methods: This is a qualitative interview study involving ten women from various parts of Sweden who had been placed in shelters because of domestic violence. The analysis is based on Dorothy E. Smith's concept of work in her institutional ethnography approach, which encompasses women's physical, mental, emotional and linguistic activities. 

Findings: The women's activities to get access to protection and support before, during and after their stay in domestic violence shelters are referred to as survival work. Results show that the women navigated between different actors and officials before being placed in a shelter. For some women the survival work involved finding a guide to social services. For others, it involved navigating in the specialised and fragmented organisation of the social services, which was experienced as contradictory because different units made different assessments of their needs of protection. Once in a shelter, the women worked on making sense of the safety rules of the shelter, but also on autonomy and freedom, for the purpose of bridging the restrictions of safety rules without jeopardising the protection provided by the shelter. During the shelter stay, they also worked on getting access to psychosocial support, the organisation of which made it unattainable. The pursuit of support continued after leaving the shelter, but now involving access to counselling to cope with the effects of violence. In addition, survival work included protecting themselves from further violence and finding permanent housing without the help of the social services.  

Conclusions and implications: The result of the study demonstrates that the institutional shelter system fails to meet the needs of abused women. This insight can serve as a basis for making protection and support more accessible to women in domestic violence shelters. 

Sweden has had a considerably higher excess mortality among the elderly during the pandemic compared to the other Nordic countries. This failure to protect the elderly has highlighted the unreasonable working conditions in elderly care. Despite political commitments to ensure individually adapted care, the enormous socio-political challenge remains while the demands for care are expected to increase and care workers wish to leave their jobs in increasing numbers.

This presentation argues that the adverse situation can be understood in terms of organised insecurity, which is linked to the development towards temporary forms of employment in elderly care.

The trend towards new forms of employment has created uncertain terms of employment for care workers. Our studies show that also non-fixed term employment now involves working conditions characteristic of more precarious types of employment to solve insufficient staffing. As a result, organised insecurity is a central aspect of how work is perceived. The concept includes various employment forms, from being called in at short notice on an hourly basis to non-fixed employment with scheduled hours. Organised insecurity is thus understood as a process of more or less predictability, from organised security to organised insecurity with a range of socially excluding consequences in between.

The gap is widening between the policy discourse about ensuring a dignified elderly care and how this is organised in practice. The failure to reconcile political ambitions with decent working conditions affects not only the quality of care but also the care workers through the process of organised insecurity.

In the Western world mental health problems are increasing and in Sweden these problems are the most common reason for sick leave. Diagnoses of adjustment disorders and reactions to severe stress are increasing the fastest out of all mental health problems. The aim of this study is to contribute new insights into employees’ experiences and management of being on sick leave with a stress-related psychiatric diagnosis. The empirical material consisted of individual interviews with 26 employees who were on sick leave from at least part-time employment because of a stress-related diagnosis. The grounded theory method was used to analyse the results. In the generated model, we propose that sick-listed employees engage in enhancing credibility in relation to themselves and others, here attempting to come across as credible and, thus, avoiding disbelief and the negative attributions of being on sick leave with a psychiatric diagnosis. The interviewees shared the general concern that being perceived as either healthier or sicker than the case may be, as well as greater sensitivity to what others might think, which was manifested as being on guard and controlling their behaviour and emotional display. To return to work, the sick-listed employees tended to re-evaluate their previous performance at work and saw the illness as self-inflicted and as the result of not having been capable of drawing the line between work and leisure.

Rätten till heltid stöds av politiker och arbetsmarknadens parter för att undanröja det omfattande och ofrivilliga deltidsarbetet för äldreomsorgens personal. Arbetstidsmodeller med inslag av flexibel arbetstid möjliggör detta utan ökade kostnader för arbetsgivaren. För personalen innebär det att delar av såväl arbetstid som arbetsplats blir oförutsägbara. I studien analyseras följderna av denna omvandling ur arbetstagarperspektiv. Resultatet visar att priset för heltid är en organiserad osäkerhet med försämrade och oönskade arbetsvillkor.

Part-time work is more than twice as common among women than men in Sweden. New ways of organizing working hours to allow for more full-time jobs have been introduced for care workers in elderly care, which means unscheduled working hours based on the needs of the workplace. The aim of the study is to analyze how the organization of the unscheduled working hours affect employees' daily lives and their possibility to provide care. The Classic Grounded Theory method was used in a secondary analysis of interviews with employees and managers in Swedish municipal elderly care. The implementation of unscheduled working hours plunged employees into a situation of managing organized insecurity. This main concern for the care workers involved a cyclic process of first having to be available for work because of economic and social obligations to the employer and the co-workers, despite sacrifices in the private sphere. Then, they had to be adaptable in relation to unknown clients and co-workers and to the employer, which means reduced possibilities to provide good care. Full-time jobs were thus created through requiring permanent staff to be flexible, which in effect meant eroded working conditions with high demands on employee adaptability. Solving the part-time problem in elderly care by introducing unscheduled working hours may in effect be counter-productive.

Background

Study results concerning associations between body mass index (BMI) and psychological distress are conflicting. The purpose of this study was to describe the shape of the association between BMI and psychological distress in a large sample of Swedish adults.

Methods

Data was measured with the General Health Questionnaire-12 (GHQ-12), in 68,311 adults aged 18–74. Self-reported data was derived from a merger of the 2000, 2004 and 2008 Life and Health (Liv och Hälsa) questionnaires focusing general health and living conditions. Logistic regression analysis was used to describe the association between BMI and psychological distress when controlled for age and gender in combination.

Results

Women reported an overall higher psychological distress than men. A significant pattern of decreasing psychological distress with increasing age emerged among women in all BMI categories. Trends of this same pattern showed for men. Small or no differences were seen in psychological distress between those in normal weight, overweight, and obesity I categories (among women: 20.4 %, 18.4 %, 20.5 %; among men: 12.8 %, 11.2 %, 12.9 %). For both genders, any notable increase in psychological distress appeared first in the obesity II category (among women: 27.2 %. Among men: 17.8 %).

Conclusions

Our results raise questions concerning cultural norms regarding body norms. Does aging increase norm resistance while youth increases norm sensitivity, especially among women? The finding that psychological distress indifference between normal weight and overweight also included the obesity I category should be a point of departure in a search for important cut-off points in the BMI/ psychological distress association.

Results

Women reported an overall higher psychological distress than men. A significant pattern of decreasing psychological distress with increasing age emerged among women in all BMI categories. Trends of this same pattern showed for men. Small or no differences were seen in psychological distress between those in normal weight, overweight, and obesity I categories. For both genders, any notable increase in psychological distress appeared first in the obesity II category.

Conclusions

Our results raise questions concerning cultural norms regarding body norms. Does aging increase norm resistance while youth increases norm sensitivity, especially among women? The finding that psychological distress indifference between normal weight and overweight also included the obesity I category should be a point of departure in a search for important cut-off points in the BMI/ psychological distress association.