Students enrolled in the Swedish Compulsory School for Pupils with severe and multiple Intellectual Disabilities typically exhibit significant care needs stemming from their disabilities. Consequently, the educational approach is marked by a synergy of care and learning, fostering close collaboration among educators, guardians, and external experts, including rehabilitation services.  

Historically, the content of education for the students has primarily focused on the development of functional skills and ability training. In recent years, with the implementation of the swedish curriculum in 2011, learning and knowledge development have assumed a central role. Internationally, a similar shift from a focus on care to knowledge is occurring, affecting students with intellectual disabilities among others. Nevertheless, there is insufficient research on this field. 

The educational form has been criticized for being too care-oriented, as highlighted in a review by the Swedish Schools Inspectorate (2010), where knowledge orientation is presented as positive, while care is described as an indicator of low quality. Östlund (2013) argues that it is problematic to polarize care needs and learning, suggesting that these do not need to be opposing forces. Platine Ewe (2021) also points out the risk that educational relational competence may b,e overshadowed when the care relationship is allowed to dominate, consequently affecting students' learning. 

The purpose of the research is to contribute to an enhanced approach towards the students where caregiving and learning are closely intertwined. The research inquiries  are: 

• How are teaching and learning activities practically implemented for students with profound intellectual disabilities and physical impairments? 
• What factors influence instructional time for students? 

The theoretical foundation of the study is based on a salutogenic approach, centering around the Sense of Coherence (SOC) theory (Antonovsky, 1991), as the theoretical framework to interpret the results regarding teaching and learning activities.  

To identify and analyze external and internal factors influencing the instructional time, Berg's  theory of school governance (2003), using the free space model as its foundation, is applied.  

The study employs an ethnographic approach, as ethnographic methodology is particularly suitable when examining how something operates in its natural environment (Hammersley & Atkinson, 2007). Video observation and participant observation (Fange, 2017) has been used to collect the data. The study participants included school staff and students from grades 1 to 9, divided across five classes. 

The analysis of video documentation and field notes involved a thorough examination of collected data. Patterns, behaviors, and themes were identified and thematized to extract meaningful insights. 

The results indicate that there are several factors influencing students' instructional time. These factors can be categorized as external or internal influencing factors. The school bus consistently arriving late to school most mornings is an example of an external influencing factor documented in the study. Information exchange among school staff during ongoing lessons is an example of an internal influencing factor within the school's organization, documented on multiple occasions. By providing documentation of various factors that occur and illustrating how these factors reduce students' instructional time, the study aims to raise awareness of the current situation. The insights facilitated by the documentation can set the stage for school staff to enhance the practices. There are also numerous documented instances of teaching sessions characterized by both learning and care for the students. A common feature among these documented teaching sessions was that they were characterized by a high degree of a sense of coherence, where both content and execution were meaningful, comprehensible, and manageable for the students.These documented occurrences can serve as good examples of how caregiving and learning, according to the Sense of Coherence (SOC) theory, can be organized in practice. 

Participatory observation is a widely accepted method when the study applies an ethnographic approach. The method is described as one of the most central to social research and consists of two concurrent actions, namely interaction and observation. Combining interaction and observations in a balanced manner is necessary to collect credible data (Fange, 2017). Participatory observation can be described as a balancing act between participating and observing, where the balance shifts on different occasions. At times, there is a higher degree of participation, while at other times, there is a greater emphasis on observation. The situation determines what is suitable at any given moment (Alm, 2019). The purpose of participatory observation is to create a nuanced understanding of human actions and interactions in a specific context by participating in and observing a social setting over an extended period (Klingberg et al., 2021). In ethnographic research, it is essential to generate "thick descriptions," meaning not only describing concrete observations but also understanding the events in their specific context. To enable the collection of rich data while minimizing the risk of errors, video observation was chosen as the method. Advantages of video observation include the ability to gather large amounts of data over time, with the added benefit of being able to review sequences from the material multiple times afterward. For video observations to function as a favorable data collection method, it is crucial to know in advance what should be observed (Jacobsson & Skansholm, 2022)

External factors such as school transportation and the substitute pool lie outside the school's organizational structure but have a significant impact on its operations. In most observed morning lessons , students arrived late in the morning. affecting instructional time. In instances of staff shortages, the substitute pool didn't always have the capacity to provide substitutes, affecting the staff's ability to carry out planned activities during the school day. Even though external circumstances in the study seem to be part of the school's daily routine, the extent of their impact on students' education becomes a matter of how they are managed. Creating space for development, therefore, involves discovering and adopting strategies for how staff can effectively handle the aforementioned influencing factors. There are numerous documented instances of teaching sessions that embody both student learning and care. A prevalent aspect among these documented sessions is the high level of coherence, where both content and delivery are meaningful, understandable, and manageable for the students. These instances serve as valuable examples of how, in accordance with the Sense of Coherence (SOC) theory, the integration of caregiving and learning can be effectively implemented in practice.

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