Reclaiming Liberty: From Crisis to Empowerment

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Into this crisis of progressive politics and liberal democracy come social liberals. Internationalism is under attack and British society continues to have vast inequalities of wealth and power. Social liberals have the ability to revive progressive politics, but in-order to do so we must change the political narrative and reclaim our biggest and most radical ideas.

We must reclaim the principles of liberty and ownership from market fundamentalists and so-called neoliberals, who have often misused them to further inequality and powerlessness. Social liberals should advance liberty and ownership in a narrative of economic empowerment in-order to redistribute wealth and power across our society. At a time when the political marketplace is crowded, individual economic empowerment is the unique selling point of social liberalism. We must actively work to create a viable progressive alternative to the failed market fundamentalist orthodoxy. To reshape our political economy, the political and economic inequalities at the heart of it must be addressed.

All liberals exist to advance the freedom of the individual. Liberty is related to individual autonomy; the ability that people have to act and think on their own initiative, free from external restraint. However, freedom from government authoritarianism isn't enough; freedom has a social dimension. If someone is unemployed, hungry, homeless, suffering from discrimination or unable to get access to healthcare and education, then they cannot truly be free.

The chains of poverty can weigh just as heavily as the chains of an authoritarian state. By tackling economic inequalities, social liberals ensure that the least well-off can take advantage of the opportunities they are presented with and live a more fulfilling life. People need control over their everyday lives, not to protect them from globalisation, but to make globalisation work for them. Liberals have spent almost two centuries arguing for the democratisation of our politics, now we must bring the same energy to argue for the democratisation of our economy.

If economic empowerment is to be achieved then social liberals must support the principle of expanding profit and power sharing within the workplace. Liberals have long supported employee owned and run cooperatives ever since the days of John Stuart Mill. The cooperative sector has shown to be very resilient in the recent economic crisis. While it might not be practical to turn big transnational businesses into cooperatives, it would be possible to do this with small businesses.

Smaller listed companies should have the ability to become cooperatives, if their employees wish them to. If the power imbalance within our present economy is to be truly addressed then there needs to be a government initiative to put worker representatives on company boards. This would inject some real democracy into the structure of our economy: The centrality of these occupations to welfare is not only related to the quantity of care receivers and the broad range of services provided, but also to the professional iden- tities and qualifications of the social and health professionals and care workers.

The professional qualifications of the social and health care workers correspond to the political and ethical standards of the Nordic welfare model. Furthermore, people in these occupations have identified themselves professionally with that model. Therefore the present recruitment crisis in Denmark is an important part of the crisis of welfare services. Learning in care The following three chapters, constituting the Danish section of this book, are examples of research into care as work and working life from the perspective of practice and the subjectiv- ity of the care worker.

This has been part of qualitative learn- ing research into changes in the welfare-creating sectors and occupations that has been carried out at Roskilde University over the last 15 years. A horizon of expectations is created from experience. The artic- ulation and activation of this horizon enables specific steps in learning. However, the possibilities for such articulation and activation are dependent on the historical and cultural context and the specific learning space occupied by the work- er.

The learning space is actively created through a process of framing. The learning concept has its roots in the concept of subjective and collective horizons of experiences and learning Ziehe that suggest differ- ent forms of learning, understanding and action. The three chapters aim at creating knowledge about the practices and practitioners in care from a psycho-societal per- spective in order to analyse the impediments to and possibili- ties of learning and becoming active agents of change in care.

Chapter One by Betina Dybbroe focuses on processes of oc- cupational identification and learning in nursing and points out how these are framed through a process involving politi- cal, social and structural factors. Placing the spotlight on the experiences of three nurses, Dybbroe argues that paradoxes in work in the health sector create paradoxes of learning that dismantle learning spaces within work. In Chapter Two Anne Liveng analyses everyday interactions in elderly care from the perspective of social and health care helpers.

The analysis demonstrates that subjective meaning in care is a prerequisite for not only quality in care, but also the willingness and the ability of care workers to stay in care work.

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Liveng shows how impediments to creating meaning and strong occupational identifications in work are related to hierarchical structures framing care work. Through the per- spective of experiential learning and practice-based knowl- edge, Krogh Hansen probes into the possibilities of learning in care work, arguing that such possibilities are presently unused and downplayed.

Thus Krogh Hansen illuminates how the occupational groups might become agents of change in care through the organisation of the everyday practice of elderly care as a learning environment seen from a lifelong learning perspective. RUC Statistics from https: The theme of crisis of learning and professional knowledge concerns all four countries, as the ideology of New Public Management in its different versions has been universally implemented. All of the Nordic countries therefore experience aspects of dequalification of the work force in the professional and semi-professional groups.

The dequalification process has several implications, concern- ing the jobs themselves, the shortage of qualified social- and health care workers as well as the failing recruitment strategies. The key consequence in focus here is the short supply of qual- ity learning environments in the workplaces. The recruitment crisis in the Nordic countries is also linked to the creation of a health economy and dequalification of work. Recruitment fail- ure is not an instrumental problem, but a symptom of more profound problems, such as the conditions society offers to the social and health care occupations, as well as a symptom of changes over time in the economic market.

Here I explore the crisis empirically through subjective and intersubjective experiences and dynamics, relating these to the contextual and structural factors that actively contrib- ute to the framing of education and learning in care. Before exploring the learning crisis, I shortly discuss the long-term crisis in recruitment facing the Danish care occupa- tions that has taken a turn during the last few years.

The number of graduates from the new so- cial and health care educations established in increased until the late s, but a rapid decline began in the year see table 1, see also Dybbroe , Christiansen All care educations have lost in popularity among the young peo- ple, if compared with other educations for the young under 25, and recently this decline has accelerated. This decline in intake coincided with renewed investments in enlarging the workforce in order to keep up with the public demand for elderly care and in an effort to expand hospital treatment Pedersen m.

Consequently, the slight decrease in the number of graduates had a severe impact, with the number of non-qualified em- ployees in elderly care increasing rapidly. In recent years, however, the number of dropouts in care educations has been increasing drastically: The percentage of dropouts from nursing education has been particularly high: While there are several background factors that in part explain the high level of dropouts, the numbers remain very high if compared with other fields.

The overwhelming majority of dropouts happen during the clinical and institutional practice periods. This is a recent development and one that especially stresses the need to examine the learning possibilities and professional devel- opment in the workplaces. There is further a notable decline in applicants with nurs- ing as their first priority. The de- clining interest coincides with the decrease in the volume of applicants. However, the most important problem is the job dropout among the newly educated. The large proportion of dropouts in this stage is a shared problem in nursing and social and health care.

Only a half of the newly educated social and health care as- sistants and helpers take jobs in this sector after graduation Pedersen m. The recruitment crisis is aggravated by three factors: The second factor is related to the current expansion of econ- omy, giving rise to a stronger competition for the young peo- ple.

Presently, all professional occupations providing welfare services are losing applicants. The third factor is demograph- ic and welfare-political, i. A recent prospective estimation of the needed manpower, not taking changes in the demands and tasks for future work force into account, stated that, by , the number of new health professionals needed is 9. An additional large number of new social- and health care workers are needed FTF b.

A further concern is that it is becoming exceedingly difficult to meet the need for qualified professionals. A growing number of qualified professionals are leaving the sector. At the same time, an increasing number of young people lack the basic qualifications needed even to be able to gain access to the social and health care educations.

The decreasing interest in these ed- ucations and the high number of workers and students leaving the sector is not, however, politically addressed FTF b. The key neglect in education policies is the lack of attention to the conditions for working practice and the life strategies of the young generations. Like the other Nordic countries, Denmark has made a sizable investment in the development of qualifications for care work.

The occupational groups in these sectors mainly consist of three categories: This discourse detaches care work from education, professions and formal qualifications. The political focus is on attracting new labour-market groups to the jobs in social and health care sectors. The current political discourse is narrowly framed by a labour market perspective and builds on a low ranking of jobs and educations in the social and health care sectors. As a result, the attractiveness of these jobs is declining among the traditional target groups for recruitment, forcing policy mak- ers to direct recruitment to new, more peripheral and lower skill groups and the contents of the jobs have to be revised so as to fit lower skill groups Minister of Employment A number of rev- elations in the media of scandalous quality in the caring insti- tutions in — created public and political critique of the ethics and standards of staff in health care institutions.

Their strongest argument was against lowering of professional standards.

Investing in the professionals i. Contradictory to this the government has op- posed these claims, arguing for quality without further costs Minister of Employment Recent research supports the argument that there is a rela- tionship between conditions in care work and the willingness and ability of care workers to stay in these jobs e. The research indicates that conditions, structures and framing in social and health care work, not the jobs and the work itself, are becoming exceedingly unattractive. At present, care workers do not have adequate possi- bilities, in the form of qualifications, learning possibilities, professional authority and working conditions, to properly perform the tasks that are expected of them.

Research further indicates that public sector organisations are not able to or- ganise learning possibilities for their employees Gustavsson From this perspective, the recruitment of workers with lower qualifications than earlier has the potential only to ac- celerate the crisis. But how are the inadequate possibilities for learning affect- ing knowledge, reflection and learning in the everyday life of care work? How are the professional identities of care work- ers changing due to changes in conditions and possibilities?

And how do care workers today create meaning and the desire to stay on in the welfare-providing sector and in care work? In the next section, I move on from the discussion about policy developments at the macro level to consider the developments in care work from the per- spective of the people providing care. This provides insight into the ways subjective horizons of experiences and learning are composed and how these, in their turn, are related to the ev- eryday life of care and nursing as well as other practices of life. Learning to be professional The life history of the care worker, including her experienc- es and knowledge, form her subjective context for learning.

New demands, challenges and circumstances must fit in, be rejected, or change her knowing and life historical orienta- tion. Her experiences may be included or excluded in the culture, the organisation, the knowledge base of the actual work process. This will also include shaping common or generalised experiences and expectations: Learning in the work place thus always has both an individual and a collective side. In the following, I present analysis of life-historical inter- views with three nurses. When Birthe became a nurse in the s nursing was in a rapid process of professionalization, helping nurses to acquire a strong position on the labour market.

For Birthe, adaptation to nursing practice and to the nursing community became intertwined with the building of a personal professional identity. The professional discourse of the time was full of tensions and contradictions, claiming a high level of professionalism both at the level of skills and in terms of moral and ethics and in the nursing school that Birthe attended both sides were emphasised. Teaching bound theory together with practice so that theoretical themes were linked to specific areas of nurs- ing work. Teachers in the nursing school had a mentor role for students, and apprentice-based learning played a big role.

The relation between teachers and students was close and oc- cupational identification was built up as something similar to educational identity. The object of learning and work was the same, and work was introduced to students as a learning en- vironment with no borders to school. She did not experience that transition as especially challenging or threatening. We were in the ward and we were one or two days in school, and what we learned in the classrooms, i.

The latter were to be acquired by listening to the pa- tients, implying a practice of locating patients whose condi- tion would illustrate the theme the students worked on in the classroom. It is a part of her pro- fessional thinking that practice always has to be adequate to the task and the need. She reacts against the contradictions in work, i. She finds it a big challenge to include patients, and will not accept asking patients how they feel, without time to do anything with the answer.

Therefore her biography is full of examples of workplaces she has criticised and left, and things she has tried to change in everyday practice.

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There is no education at the moment. At the same time there is a lot of dashing for something else, discon- nected to learning and development. The rest of the interview conveys that she links this experience to changes in the work- place of more tasks and more complexity, larger work areas and self-financing units, as well as more hierarchical manage- ment. These new organisational and economic measures are framing work, and getting the care workers to move too fast, while at the same time they experience standing still in their own development.

From a learning perspective, Birthe and her colleagues are presently not part of a reflecting community, and their ex- periences of the changing situation are individualised and not shared. As a learner, Birthe is highly dependent on an enabling learning environment and when she is faced with a lack of expectations to maintain high quality she is at a loss, unable to keep the new experiences inside her horizon of experiences.

Her own high standards and experience of making words into action are slowly pushed away from her perspective on everyday work. Neither the organisa- tion, nor the care worker collective are able to secure her the experience of providing good care. Birthe expresses her fear that nurses in hospitals currently work under a too heavy time pressure.

This fear contributes to the forming of her horizon for expectations of the future. She fears that work will be- come undignified. The space and time for learning are disap- pearing for her. She was interviewed in Nanna was building her professional identity at a time of big transformations in social and health care work, and at a time of increasingly severe recruitment crisis. She remains among the two thirds of nurses who did not dropout during education or during the transition to work.

She even wants to continue to work. Nanna is engaged both in her work and in her family and life outside of work. She interacts dynami- cally with her work, the patients, colleagues and the organisa- tion and takes part in the transformation of the health sector, not just being reactive, but proactive. Commonly in life-historical interviews, informants use phrases that suggest identification with some of the impor- tant professional roles in nursing.

In a previous study, we identified four common narrator positions expressing nurs- ing roles: Rather than positioning herself in this way, Nanna po- sitions herself against such images: Nanna confounds here two Danish proverbs: In other words, she is coarse and hurts people, but she is also close to people and they like her very much.

The linguistic mix-up ex- presses her experiential mix-up. She creates a transformative learning space at work by bringing in her societal experiences as a young woman and by drawing from the changed gender socialisation of her generation. Nanna is building a work role and a professional identity in an innovative and transforma- tive way, without taking any professional identity for granted or as a preconception.

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Nanna has three strong narratives of fighting against the hierarchy. The longest of these accounts is a story about protesting against management and organis- ing a strike, the other two stories are about resisting male doc- tors. In these situations, Nanna articulated her expectation of being recognised as a party in symmetrical relations at the workplace, but she was met with offences. One situation was an open professional argument that took place after a doctor had strongly corrected Nanna in front of a patient who they had been working with.

He had simply put me in a situation which was deeply disgrace- ful… where I confront him with it and say to him: Experimental prac- tices take place in order to create a new balance between the desirable and non-desirable sides of a challenge that threat- ens subjectivity. Acting in a new way requires that one finds inner energy to do so. This sort of practice and experience can transform professional identity, and seems to have done so for Nanna.

The story is thus one of her turning points, a sig- nificant experience of transformative learning, which has in- fluenced her practice and her professional identity. However there are other aspects of working life in which Nanna does not find it so easy to act in order to restore imbalances. She is confused as to how she should understand the importance of her professional work, when following a strike against bad working conditions, the management forced the employed back to work.

The many positions and rationalities active in the workplace are present as voices in the inner dialogue taking place in Nannas narrative. Work is positioned as a thing it, and this, but it is also a we, as working identity. Nanna even expresses a threatened professional identification through the discrepancy between you and it, as she is giving voice to the management.

With the work that has high value for her personally, or with the low value her work is given in terms of salary? Or should she identify with the views of her pa- tients? For Nanna it is necessary to work with patients, but in her view the management, the politicians and the public do not share the responsibility. Taking responsibility for the patients in a professional way may mean doing work of high value, in ad- equate conditions and frames, but it may also imply working with a concept of necessity, that is not professional and has low value. This type of paradox actively frames the learning space and shows how difficult it is to learn under such condi- tions.

It upsets professional identification. Such clashes are made even more severe by the fact that the potential for learning is currently ne- glected. Assuming gender as well as professional symmetry, young nurses expect to have equal opportunities and rights. Furthermore, they expect opportunities for personal develop- ment and space for being, at the same time, an individual and a care worker.

Young care workers are met by contradictory demands for socialisation, in work and outside work The imbalance be- tween these incompatible demands from the working culture and institutional context does not encourage the nurses or care workers to learn and create transformation.

Ditte did her basic occupational education in the s and has since taken two specialist edu- cations in nursing and a number of long continued education courses, in all, amounting to seven years of professional nurs- ing education. She is innovative in her approach to nursing and in learning and identifies with specialist as well as general tasks in nursing. She is an example of the young, well-educat- ed nurses who are focused on developing nursing profession- ally in practice and not as research.

However, she draws on the existing professional knowledge base: I will say as ordinary nurse, it demands, it really demands, that somebody sits down and keeps up with recent development, and reads the new PhD thesis. I have learnt [so much] about general care in the medical ward, and had all my anatomy revised by being here for two years. Workplace learning is of professional interest to Ditte, both in terms of teaching and tutoring colleagues and students in the workplace, and in relation to her own development as a prac- tically professional nurse.

In her view, professionalism is cre- ated through practice.

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It is here transformative and expansive learning takes place. In her job she has had the opportunity to become responsible for workplace education and learning in a larger area of the institution. Ditte talks about how to recruit nurses to the medical unit where she currently works, and makes a contrast between her current work in general medicine, and the work she left in the anaesthetic ward: I used to be working both 16 and 24 hours, and I am not doing that again…so I am really happy about just having 8 hours, because although things may be tough here, then I do have, then it does have an end.

And in that way I think you could recruit more, because in some ways, then it is, the way it goes on [in my old ward is like] a production unit, then it is production, production, production. There is no development of how you receive a patient, and who and what do we do with the anxious, and what we do with those that cannot have the mask.

I mean there is nothing, there is production, production, produc- tion, and I think there could be some students you could attract to a medical unit, if they knew, that this is what it is about, and you will not be hunted down, when you get off work. But in another part of the interview Ditte tells us about her present work in the medical unit: People have to work 16 hours. In both places working hours ex- ceed the eight-hour working day.

Neither of the units provides time for development. But Ditte does not discuss the similar- ity of her two workplaces, instead she stresses the differences between them. The contrast she creates in the narrative allows her to express that her experience of work is actually con- tradictory. Her present working situation is seen in two per- spectives: The new work becomes the realisation of what quality in nursing is really all about to Ditte.

But from another perspective, her old work and her new work are the same. She speaks in a language that reflects the Taylorisation of her work, where hospital nursing work is divided into small units, and divisions of labour following this dequalifies work and detaches it from professional judge- ment. From the second perspective she talks about her work in the language of a hard-working labourer who can identify only weakly with the contents of work and is more concerned with the conditions she works in.

This contradiction gives rise to ambivalence in relation to work and a learning dilemma for Ditte. On the other hand work is almost dis- gusting it is unbelievable what we send home and very diffi- cult to identify with. Similar to Nanna, Dittes learning dilem- mas are directly related to changes in working conditions and linked to the many double-sided messages of the health sys- tem. To be engaged in learning and creating learning possibili- ties for others in this situation is very difficult. What should the students and young graduates be suggested to adapt to or learn in relation to?

In order to encourage transformative and expansive learning the given situation must be counteract- ed. Which students will follow that road? As already pointed out by Thunborg the health services have always cre- ated learning dilemmas. The use of some qualifications has not been allowed and some are not affirmed when the situ- ation in a ward changes, or when patients or technologies change. Care workers encounter situations where they think they know how something should be done, but are not al- lowed or encouraged to do it. They can also face the dilemma of not knowing how to do something but being asked to do it i.

Ditte regrets that many young nurses resign during their transition to work, finding clinical practice difficult. Another element in the disillusionment of young nurses is that the more theoretical standards in nursing, upheld by the new graduates, are not recognised in the workplace.

According to Ditte who is responsible for educating and tutoring young nurses in her institution, many of them focus on nursing management after the initial disappointment with clinical practice. Thus they do not try to master the practice of clini- cal nursing. From a learning perspective, this can be seen as a defence mechanism against the ambivalences that the con- tradictions in work create.

Ditte is an example of how dilem- mas in learning can result in the pushing back of experienc- es, in this case of the changing and worsened conditions in work. By emphasising the good conditions in her present workplace, Ditte can maintain a certain tolerance towards the very ambivalent experience of work as learning space. Subjective and shared experience of dequalification This chapter has shown that if we are to understand the crisis of learning and professional knowledge in care in Denmark, it is relevant to reflect on the horizon of experiences and learn- ing Ziehe This reflection involves an inquiry into how we understand this horizon as being present in the learning space that the social- and health care work constitutes for care workers.

The horizon of learning is always present as the publicly articulated and established goals of learning and, in the case of work this could be the existing demand for com- petencies when introducing new technology, new procedures in a specific work etc. The horizon of learning is, however, also created through the individual experiences and the com- monalities in these in a specific working culture. A working culture encompasses the themes identified as professional themes in a specific workplace. The shaping of the individual learning horizon is related to the predominant professional experiences and paradigms that the care worker encounters in the workplace.

The dominant horizon both limits and facilitates expe- riences and learning. And at the same time the learning space can be framed so as to enable or constrain learning, which defines the scope for learning, particularly for transformative learning. There are a multitude of potential horizons for the trans- formation of work and workplace knowledge, meaning that there is not just one transformative space inside the work- place, but several separated spaces of transformation.

The learning space can be understood in relation to the lived experiences of a life. Recognising the complexity of a life as a basis for experience means attention both to the width of the lived experience and to the lifelong perspective of the individual. In a life-historical perspective, the learn- ing of care workers extends across physical space, administra- tive sectors and social spheres Becker-Schmidt Care workers carry their shared experiences of the working process and their individual life-historical experiences into the work they perform.

Unavoidably, they establish spaces of learning and transformation that extend across borders between work and life outside, and between past and present. An example of this is the way Nanna transforms the gendered role and the identity of the nurse by breaking with those called for by the workplace structure, taking her life as a young woman in present day society into the work place. Other examples are provided by the way all three, Birthe, Nanna and Ditte reflect their relation to working with patients in professional as well as personal way.

Here they take in their life-historical expe- riences as citizen and as people although this is not what is called for inside the professional frame. By employing their life histories as a context, professionals are thus able to estab- lish other than professionally construed horizons for learning and transformation of work. While the life-history perspective makes visible the great potential for renewal and development that is brought to care work by the care workers themselves, it is evident that the crisis in learning and professional knowledge smothers rath- er than supports the establishment and preservation of such horizons for learning that would accommodate the experienc- es of the social and health care workers.

The three professionals, whose stories form the empirical founda- tion for this chapter, have remained within nursing, but their stories provide insights into a dangerous landscape of con- tradictions and double-sided messages. The analysis of these stories further suggests that nurses are constantly forced to juxtapose their strong professional ambitions with the harsh reality of the workplace. Less-engaged nurses do not avoid these paradoxes and contradictions. Rather, their strategies may be much more defensive, such as withdrawal from clini- cal practice.

The lack of engagement may also lead to adap- tation to the austere conditions of the workplace and, in this way, contributing to the weakening of professional knowl- edge and identification. My analysis has shown that there is a contradiction be- tween the ways that the care workers conceive, create and enact their tasks and quality standards and the ways these are framed by the present organisation of social- and health care work. Currently, these contradictions are becoming so fun- damental that they exclude experiences and knowledge from practice and deconstruct space and time for learning.

The lack of space for learning in the workplace creates stressful ambiva- lences in the professionals, impeding learning. The second an- alytical point I have raised is that the deterioration of learning possibilities implies that occupational identities are threat- ened and weakened. This development has great relevance for the future of care, as it has an impact on how profession- als identify with their work and the workplace. Furthermore, it is likely that the loss of learning possibilities is reflected in the growing number of dropouts from care work.

Notes 1 The figure for is taken from a newsletter from the Danish Union of Nurses, and they indicate that the figures will be published shortly in a report from the Ministry of Education, as the analysis is still in progress. National Institute of Occupational Health. FOFU-Nyt 1—2 , p. Menneskearbejde- Tidsskrift for Arbejdsliv 1 , 67— Enabling and constraining a study of care work. Journal of Workplace Learning, 20 2 , 84— Revised version in H. Suhrkamp, Frankfurt am Main.

Center for Ligestillingsforskning ved Roskilde Universitetscenter. Concepts of learning in everyday life and formal education when work changes. Tidsskrift for Arbejdsliv 1 , 77— Prescod Ed , Zapping Through Wonderland. In some cases the actions involved are multifaceted. In other cases the complexity arises from the fact that the activities involve providing care to very ill, demented, or dying people. At other times the complexity is due to the fact that the care is provided to people who have a particular lifestyle characterised by psychological or social problems.

The work is demanding because the care workers are expected to handle the tasks efficiently and subject to a time schedule. They are also under contractual obligation to live up to certain standards. In addition, the care workers have a role as buffer between care recipients and the system e. Meijer , Thorsen Furthermore elderly care em- ployees are faced with the problem that, in comparison with other professional groups, it is relatively difficult for them to get compensation for work related injuries Dahl In spite of the physical and psychological stress loads the care workers are in general still pleased with their jobs.

The reason is that they experience it as a meaningful occupa- tion, where the human relations are a decisive factor, and because they wish to provide comfort to others for example Christensen ; EVA ; Szebehely At the same time they must take care of themselves and show responsibility and loyalty to colleagues who must work harder if they themselves do not go beyond the call of duty, or who might think that if you put in a lot of work, you force the pace and thereby undermine the rights achieved.

Christensen describes the position of diametrically op- posed demands as the two roles of the helper: However, the work is also experienced as meaningful. It provides care workers with development potential, through which they—the present generation of care workers—develop independence and identity.

In this chapter I shall contend that one should consider a care relation as a pedagogical possibility in the sense that it might contribute to personal development and quality of life for both parties in the care relationship. The focus is on the carer. In this way a pedagogical perspective on the care of the elderly is also an expression of the effort made with regard to the problems of recruiting and keeping a workforce in the sector.

Then I shall move on to consider the tensions inherent in care work from a pedagogical perspective. An important element in the research was to let small groups of care workers observe, comment, and discuss some filmed examples of care praxis. The groups were controlled as little as possible in order to see what was observed and commented on spontaneously, as well as which issues would cause discussion in the groups—and how.

A critical hermeneutical interpreta- tion of the material showed some essential, formative ideals, motives, conditions and possibilities in concrete and practical elder care. This provided me with the possibility to identify learning potentials located subjectively, individually, and col- lectively in care staff as part of their complex and conflictual work and living conditions.

Among some of the care workers who observed and com- mented on my films, there was for instance a spontaneous and heated discussion about the use of gloves when assisting with personal hygiene. The discussion began during a film se- quence where a social- and health care helper helps an elderly man in a shower.

The group of five female spectators focused their attention on the fact that the care worker was not wear- ing gloves. You get too close to me. Some of the women felt that one should always use gloves when assisting with personal hygiene. Others felt that gloves should only be applied in certain situations.

One of the women expressed this in the following way: Indirectly they were, however, clearly also voicing their own concerns regarding touch. I interpret this as an ex- pression of the fact that the women for various reasons repress and place a taboo on their own feelings and needs, which are strongly affected in the care work. At one point the discussion nevertheless touched upon the question of the significance of the gloves with regard to protecting the care workers against the intimate contact. This aspect of the situation was only sporadically voiced in explicit terms. However, the attentive listener would soon realise that the participants themselves inadvertently opened up a discussion of ambivalent emotions related to the encounter with the aging body.

All these issues are relevant material for learning pro- cesses in the field. The term occupational identity expresses my categorisation of a number of different statements and discussions which oc- curred among the observers in my research, when they were asked to talk about anything that came to mind, while they watched my films about care work. As it happened, one of the groups had a long discussion prompted by a take in the film, where a nurse refers to a social- and health care helper as a home help person. In this discussion the women voiced the concern that it is annoying, even hurtful, to be called a home help person, when one is trained as a social- and health care helper or assistant.

Furthermore they found it even more hurt- ful when nurses, who are acquainted with care training, do not use the right terms. The following excerpt from the dis- cussion shows some of the issues at stake: That would be just as offensive to me. Today we also do the nursing. However, this term is, like the women say, an outdated concept. It reminds them of the domestic help persons, who cleaned, and they wish to dis- tance themselves from this role.

Social- and health care help- ers and -assistants embrace the basic nursing aspect and this is an important element in their occupational identity. In the section above relating their discussion, I have only included a small extract of a debate, which touched on many subjects. It clearly indicated that stories about the lives of housemaids, domestic helpers, and home help persons, etc.

Due to the combination of historical distance and the topicality of the themes, the narratives are saturated with reflections and invitations, which endow the battles won, the issues under threat, and the battles worth fighting with transparency and actuality. Reading the excerpt above, it is evident that it is important to the women, that they, as opposed to the home help corps, embrace the nursing aspect.

These women do not react to the fact that their broad interdisciplinary competences are ren- dered invisible when they are labelled home help staff, a term in which issues related to social functions and health disap- pear. What actually matters to them is the fact that they have embraced the nursing aspect, which has higher status than other tasks. This raises the question whether it is advisable that it is a nursing orientation, which should attract the new generation of employees, or whether it were advisable that other aspects related to the care work get a better image? Above and beyond these issues there are questions related to traditions and structurally deter- mined definitions of which competences are allocated to vari- ous occupations, what tasks they are actually capable of per- forming, and which tasks they wish to perform.

As a final example of a theme, which developed during the discussions among the participants in my research, I shall mention the question of giving and receiving recognition. The need for recognition and problems associated with this need surfaced in the context of various values, ideals, reasons, and feelings related to injustices such as those expressed in the following discussion, which I referred to above: At the same time the question of recognition in- vites a critical stance with regard to the possibilities of achiev- ing recognition from colleagues and management.

This would be a precondition for avoiding a situation, where the indi- vidual care worker experiences a dependence on the recogni- tion dispensed by the care recipient, thereby unconsciously creating a state of dependence. This process expands the horizon, describing what and whom one can recognise, tolerate, and respect.

When care workers discuss for example problems of recog- nition of their professional competences and personal quali- fications a subject often touched upon by the participants in my research , it is an obvious pedagogical task to get them to associate their discussion with an investigation of how needs for recognition, and problems related to achieving recogni- tion, are related to personal issues, professional traditions, re- lations to colleagues, the conditions of the care work, and so- cietal relations in general.

The tensions of care work in a pedagogical perspective The examples mentioned above are concerned with physi- cality, encounters with age and death, occupational identity, the societal position of care work, and the need for personal and professional recognition. Secondly there is a psychodynamic dimension, since conscious as well as unconscious drives are affected.

Thirdly there is an existential dimension, since the care touches on questions related to fear of death, dependency, and meaning of life cf. The women are thus split between on the one hand experiences gained in a life history of good care performance, and on the other hand those aspects, which give status and support the efforts to bring professionalism into the care paradigm.

My research has also shown that there is a great struggle to deal with the psychodynamics and existential challenges as- sociated with care relations, i. This problem is reinforced through expec- tations that the care worker, as woman and professional per- son does not harbour negative feelings towards these issues, and that she without any problems can control and ignore her own emotions and needs.

By this term I mean that both parties in the relation come to ignore, repress, and distort perhaps the most important issue in their relationship, namely the experience of deterioration, bodily decay, dependency, and death, and that this happens at the cost of the possibilities of applying the relation to clar- ify existential questions and personal development.

In other words, my contention is that both parties in the relation are let down, because problems and emotions are individualised, tabooed, negated, and levelled out in such ways that the care personnel is afforded very limited possibilities of personal ex- pression via dialogical presence and recognition. The important questions, which are a good point of departure for learning and personal development in care education and work, will often concern relations which involve anxiety, conflict, taboos, and ambiva- lence.

Such learning processes are obviously difficult to organ- ise. However, perhaps these themes offer an ideal opportunity to learn more about oneself and each other. According to Honneth b the learning associated with such themes occurs through the articulation of impulses to take action. This requires anxiety free settings. This means that one should give care personnel the possibility to express and process the feelings and needs, which guide their actions at work. I agree in principle, however, I do not think that one can completely circumvent anxiety. As already mentioned, we are not transparent to ourselves.

For this reason each and every one of us is an inexhaustible source of anxiety. Instead of attempting to create anxiety free learning environments, one should attempt to create environments, which can con- tain anxiety, i. Such processes should, however, not develop into therapy as such. Anxiety free articulation of impulses for ac- tion is a pedagogical ideal, and a point of orientation for sig- nificant learning processes.

It is, however, not a project that could be honoured completely. A concrete plan of action could involve the establishment of learning situations, based on the understanding that progression and regression are two sides of the same coin. In my view it is a fundamental assumption that any care relation involves invaluable potentials for learning that pro- vides insight and change. These potentials can unfold, when care personnel are encouraged to show interest and openness to the challenges created by the shared interface.

This pre- supposes that those responsible in the fields of education, as well as in the daily practice, understand and support the fact that learning in a relation is a reciprocal process. This means that if the care in any way honours ideals such as equality and humanity, the care work changes both parties in the rela- tion Dybbroe By doing so, one takes into consideration the motives that inspire care workers and encourage them to remain in the field. The learning potentials to which I am referring here are embedded in the nature of the care relation, i.

The meeting provides both parties with an op- portunity to learn something new about themselves and the other. Learning processes with the potential to create change should provide increased insight into subjective as well as in- dividual relations and into the historically constructed care conditions. The learning processes should as part of the in- sight liberate disciplined and disciplining psychic energy. Insight into the complexity of care, as well as liberation of psychic energy, presuppose that you, or anyone directly or in- directly implicated in the possibilities of learning, accept that the subjective meanings of concrete experiences from every day life, including emotional ambivalences, are very impor- tant sources for relevant learning for care workers.

One has to accept that the learning processes should afford the care work- ers the opportunity to gain insight and create change in their own occupational lives. If the learning does not also target the care workers themselves, their quality of life, their experi- ences, their emotional and physical relations, there will be a risk that the learning translates to instrumental actions and empty or distorting rhetoric.

The latter statement is intended to con- vey the fact that the competences, which the care workers at- tain, should be a part of the care relations in such a way that the recipients of care also become a part of this learning, i. Lifelong exemplary learning In order to further emphasise the special demands of care work and the particular needs and learning potentials associ- ated with the occupation, I shall proceed with a discussion of the diametrically opposed logics, which become part of the orientation of the care personnel.

One is an ideologi- cal logic, where the care for the elderly is normatively con- stituted as an ethical, humanistic, and pedagogical project. This logic, which can be found in political slogans and in the educational programmes, expresses wishes and expectations that the care workers reflectively apply themselves, offering nurture and care, including social and pedagogical actions.

The other logic is a rational, service minded logic, which de- mands an efficient solution to a societal problem, presented in such a way that the recipients are perceived as consumers, and where the relation between system and consumer is con- tractual. And while the ideological logic upgrades care as paid work, the rational, service oriented logic downgrades care as paid work, which of course influences the possibilities of re- cruitment of workers who wish to remain in the occupation.

The third logic I have chosen to call subjective ascription of meaning. With the term subjec- tive ascription of meaning I mean partly that the individual caregiver subjectively interprets any situation, relation, and experience, and partly that any caregiver uses her so-called practical common sense and her feelings in every concrete sit- uation. When she subsequently explains her actions, she constructs—with the help of the two other systems of logic—some practical, professional rationales, which completely justify her actions.

This does not, however, reduce the world to a subjective construction. Concerning the subjective ascription of meaning in a learn- ing perspective, one could say that it expresses the condition that every subject on the basis of a personal perspective of signification, which constructs emotional patterns and sty- listic preferences basic assumptions , interprets objects and the meaning of events. The personal perspective of mean- ing is founded during childhood socialisation and changes through processes of learning continually throughout life in interactions with the societal conditions Mezirow In an overall perspective the three systems of logic can sub- stantiate and legitimate the system at large in such a way that its immediate representation is relatively logical and harmonious.

It is, however, hard work for the care workers to get the various demands posed by these systems of logic to add up. For this reason care workers must be en- couraged to understand the contexts shared between political, personal, psychodynamic, and existential aspects of care work. They should develop what I shall later refer to as a sociologi- cal mode of thinking, and they should be supported in their efforts to address the modern paid care occupation—precisely as a paid work challenged by diametrically opposed logical sys- tems and demands—but also as a prospect of self-development, and as a widely respected opportunity to unfold the need to have a meaningful relationship with other people.

On the contrary, the holistic concept is the totality of the societal production and reproduction process- es, which should be seen in their historical dimensions. This part is the empirical, social fact relevant to the learners. This relevance is not limited to the learners as individuals. It also concerns the occupational groups of care workers as wider col- lectivities and the society in general.

Learning should hence take its point of departure in so- cially experienced facts the parts , which concern the learn- ers as subjects embedded in societal relations the whole. This consists in transgressing the usual scientific professional di- visions, thereby becoming aware of structural connections, and changing a non-political conception of social relations to a political understanding.

Through this sociological mode of thought, learning which otherwise might seem chaotic, can become motivating and build potential for change. Negt emphasises that one should not confuse or equate ex- emplary learning with case methods in the teaching. He does, however, suggest that in exemplary learning one should work with cases from occupational life.

This may later make it easier to control what has been learned. Alternatively I shall see it as a possibility to maintain that there should be a connection and a social reality in the case that insights and suggestions do not dissociate themselves from concrete reality in discon- nected or idealistic ways.

Negt talks about exemplary cases. The issue is not necessarily that someone formulates a case, but that something is described in a thematic way. For a detailed discussion of the theoretical approach and its foundation, see Hansen Inspired by Negt, I have formulated criteria, which define an exemplary theme as a theme that: The problems show that the learning processes must engage with quotidian life and its subjective meanings.

However, to prevent the process from becoming therapeutic, and in order not to reinforce the present tendency to cumbersome indi- viduality, subjectivity, and intimacy Ziehe , it is essential that the learning goes beyond the individual and his or her subjective emotions and experiences. Conclusion There are many explanations to the crises in the care work sector in the Nordic countries: The situation calls for change.

This chapter has raised the argument that a tenable strategy in recruiting and keeping care workers within elderly care must encompass perspectives for the organisation of the care work. The care organisation should offer the care workers more adequate support with re- gard to coping with the various demands and stress loads, in- cluding the buffer role, in which they invariably find them- selves. In short, the care work must have intrinsic relevant and desirable possibilities for lifelong learning and personal development.

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This is necessary in order to help the present care workers to deal with the work, and to provide care work with an appealing image that will attract young people of today. As a rule this age group only applies for and remains in a job if it is experienced as meaningful, widely respected, and providing opportunities for personal development. Care work is complex and fraught with stress loads, and care personnel must perform a balancing act between diamet- rically opposed roles and systems of logic. I have shown in this chapter, however, that care work offers quite significant, yet unexplored, potentials for learning.

In addition there is the demand that learning based on experience must go beyond the individual with a view to understanding his or her own situation in a societal context. I have, however, suggested that one finds material for the themes of learning by increasing the awareness of direct and indirect statements about everyday life made by students or trained care workers.

It goes for all exemplary learning processes that these in one way or other must embrace the interaction between the subjective, the individual cognitive and emotional , and the structural. Either way exemplary themes in care training and in care practice will always be concerned with the question of psychosocial forces, which motivate as well as create problems in the relations between caregiver and care recipient. In other words, it is about engaging the care personnel actively and al- lowing it to influence the development of a practice that they feel like being part of.

Note 1 The care involved in the relation between the carer and the recipient of care for the elderly will in some way always involve pedagogical tasks and deal with learning and development. Whether or not the care situa- tion is regarded as a charitable relationship, as part of medical treatment and nurture, or as a contractual service obligation, a caregiver must be able to mediate, motivate, and involve as well as support the care recipient in the building and maintenance of a number of important competences.

In this view pedagogy are perceived as a tool to enable another human being to perform or understand a certain issue. This view of the role of pedagogy offers a fruitful agenda for both research and development of care work, but in this chapter I do not focus on these pedagogical aspects of care work, as I wish to address the potential of the pedagogical perspective for enhancing quality care. Psychosocial job environment, job satisfaction, gender and other diversities in care workforce, and quality of care services.

Social Kritik—Tidsskrift for social Analyse og Debat 94, 56— De unge og skolen under den anden modernisering. In all three hierarchies care work is ranked low. This kind of ori- entation towards the relations of care is an important motiva- tion for women who are being trained for the basic positions in the social and health sector. Care orientation, recognised by research as a central element in the motivation of the employ- ees in the field, seems to be under great pressure, existing in spite of political and organisational intentions Nabe-Nielsen

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