I bakgrunden redogörs olika aspekter som berör kultur samt sjuksköterskos förhållning till patienters etnicitet. Patienters syn på vård skiljer sig åt beroende på kulturtillhörighet vilket påverkar mötet i vården. Sjuksköterskans ansvar är att ge vård samt behandla patienterna med respekt och värdighet oavsett etnicitet. Svårigheter kan finnas i att tillgodose detta i mötet med patienter då uppfattningen av sjukdomsorsak kan skilja sig ifrån sjuksköterskans. Svårigheter i kommunikationen samt i förståelsen för respektive kultur kan leda till missförstånd. Gränsen är hårfin gällande kulturell lyhördhet då patienten lätt kan särbehandlas eller diskrimineras. Syftet med examensarbetet är att beskriva sjuksköterskors upplevelser i möten med patienter med annan etnisk bakgrund än majoritetsbefolkningen. Metoden som användes var en systematisk litteraturstudie där vetenskapliga artiklar analyserats. Resultatet presenteras under fyra teman: Förståelse för genusperspektiv i vårdandet, Förståelse för olika uttrycksätt, Kunskap om sjukdomssyn samt Utbildningsbehov. Resultatet visar att sjuksköterskor önskar mer kunskap om kultur i sin utbildning, samt mer förståelse för skillnader i genusdynamiken då kulturella möten uppfattas som svåra vilket kan medföra ett uteblivet vårdande möte speciellt när kommunikationsbrister fanns. Sjuksköterskor behöver och önskar mer utbildning om kulturella aspekter för att känna större trygghet i mötet med patienter med en annan etnicitet än dem själva. / The background describes cultural aspects and how nurses relate to patients' ethnicity. Patients' view on health care varies depending on cultural background, which affects the encounter with health care. Nurse's responsibility is to provide care for and treat patients with respect and dignity regardless of ethnicity. During the encounter with patients difficulties may arise in meeting these needs when the understanding of what caused the disease may differ from the nurse. Difficulties in communication and in understanding each culture can lead to misunderstandings. There is a fine line to cultural sensitivity as the patient can easily be treated differently or discriminated against because of their ethnicity. The aim of the thesis is to describe nurse’s experience in encounters between patients with another ethnic background than the majority ethnic population. The method used was a systematic literature review where scientific articles were analyzed. The result is presented in four themes: Understanding the gender perspective in caring, understanding of different modes of expression, knowledge of insight to disease and Educational needs. The result shows that nurses desire more knowledge about culture in their training, and a broader understanding of differences in gender dynamics as cultural encounters were perceived as difficult resulting in a non-caring encounter especially when communication deficiencies were found. Nurses need and want more training about different cultures.

In my story there are daily conflicts that occur around the boy Peter. I focus on the role of the educator and the preschool, on the grey area children, on the interaction with parents and on "fighter relation". I have during my work tried to see this dilemma from differentperspectives. I question my role as a teacher and recently become a preschool teacher. Peter has no diagnosis, but I have decided to proceed from emotional disorders and language difficulties.

Cette étude traite des écueils de communication que rencontrent les apprenants de l’anglais langue étrangère dans l’enseignement secondaire en Tunisie, et à partir de ces constats, propose quelques recommandations susceptibles de les aider à surmonter ces obstacles.Il s’est avéré que ces difficultés de communication ont pour origine deux facteurs principaux: le manque d’exposition à l’anglais et l’inadéquation de certaines méthodes pédagogiques.En effet, l’anglais semble être enseigné tout simplement comme une matière scolaire. Les apprenants ne sont exposés à cette langue qu’en milieu institutionnel, et ce pendant seulement quelques heures par semaine.Il faut noter, par ailleurs, l’inadéquation de certaines méthodes pédagogiques: le recours à la langue maternelle dans l’enseignement de l’anglais en est un exemple. Ceci est une technique qui s’est révélée plus nuisible que bénéfique du fait qu’elle est souvent utilisée uniquement pour expliquer des termes lexicaux et des structures syntaxiques difficiles.Quant à l’approche communicative, elle n’a pas permis d’atteindre les objectifs d’apprentissage escomptés en raison de certaines contraintes sérieuses qui ont entravé sa mise en application.Le fait que cette approche mette l’accent sur le sens aux dépens de la forme et donne la priorité à l’expression orale au détriment de l’expression écrite d’une part, ainsi que les classes nombreuses et le manque ou l’indisponibilité de matériaux pédagogiques, d’autre part, sont d’autres éléments qui ne favorisent pas l’apprentissage.Outre ces facteurs, on remarque également l’absence quasi‐totale de cours théoriques sur les diverses compétences à acquérir avant que ne débute l’apprentissage de la langue étrangère.Donc, afin d’aider les apprenants à progresser dans leur apprentissage et de contribuer à l’amélioration de leur compétence communicative, il serait utile de créer un environnement anglophone au lycée même et dans la mesure du possible, à l’extérieur de l’institution. Il serait également pertinent d’adopter des approches diversifiées et attacher davantage d’importance aux leçons théoriques en parallèle avec l’enseignement pratique. / This study explores the whys and wherefores of the communication difficulties experienced by Tunisian secondary school learners of English as a foreign language, and aims at offering ways out of the issue.It has been demonstrated that the issue proceeds broadly from the woeful dearth of exposure to and practice of the language and certain inadequacies of the teaching methodology.English seems to be learned as a mere curricular discipline, in that students have only a few weekly sessions confined solely to a classroom setting.The inadequacies of the teaching methodology are manifest in a number of aspects. The use of the mother tongue in EFL classes has proved to generate more harm than good. In the very framework, it has also been revealed that Communicative Language Teaching (CLT) has not been at the level of the expected outcome. Two CLT principal principles, focus on meaning to the detriment of form, and prioritizing oral fluency over written proficiency, as well as certain constraints, mainly the severe lack of instructional materials and large classes have intervened with its successful implementation in EFL classes. An added factor related to teaching methodology is the quasi‐absence of theoretical teaching as a prerequisite for the success of specific learning activities.Accordingly, exposing learners profusely to English in various ways inside and outside the classroom, adopting an only‐English eclectic approach to teaching the language, and combining theoretical instruction with practical teaching can considerably contribute to surmounting the students’ learning difficulties, and hence to the achievement of their communicative competence.

Bakgrund: En av de största orsakerna till funktionsnedsättningar i världen är stroke. Stroke kan orsaka ett flertal komplikationer varav en av de vanligaste är svårigheter med kommunikation. Kommunikation är en viktig del i mötet mellan patient och vårdare och det är centralt för sjuksköterskan att ha kunskap om olika sätt att kommunicera med patienter som har kommunikationssvårigheter. Sjuksköterskan behöver ha kunskap om dessa kommunikationssvårigheter och patientens upplevelse av kommunikation under och efter vårdtiden för att kunna ge en god personcentrerad vård där patientens behov uppfylls.  Syfte: Syftet var att belysa patienters upplevelse av kommunikationssvårigheter till följd av stroke.  Metod: Denna icke-systematiska litteraturöversikt inkluderade 15 vetenskapliga artiklar, av dessa bestod 13 av kvalitativ ansats och två av en mixad metod. Med hjälp av olika kombinationer av sökord inhämtades samtliga artiklar från PubMed och CINAHL. Dessa har sedan utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet genomgått en kvalitetsgranskning. En integrerad dataanalys har använts för att analysera och sammanställa resultatet.  Resultat: Resultatet delades upp i två huvudkategorier; kommunikation i vården och kommunikation efter vårdtiden. Även fem underkategorier har identifierats; tillit och bemötande, självständighet och stöd, sociala aktiviteter och interaktion, hopp och känslor till följd av kommunikationssvårigheter. Resultatet visade både positiva och negativa upplevelser kring kommunikationssvårigheter. Ett mönster som upptäcktes var att negativa känslor var kopplat till den akuta fasen och att positiva känslor uppstod i ett senare skede.  Slutsats: Studien visar att sjuksköterskor behöver bemöta och stötta strokeöverlevare och använda sig av god kommunikation genom att prata direkt till patienten, låta personen tala till punkt, samt lyssna på patienten och anpassa informationen till patienten. Detta kommer stärka patientens tillit till vården, självständighet, sociala förmåga, känsla av hopp samt minska de negativa känslorna som uppstår efter en stroke. / Background: One of the major causes of disability in the world is stroke. Stroke can cause a number of complications, one of the most common of which is difficulties with communication. Communication is an important part of the meeting between patient and carer, and it is cnetral for the nurse to have knowledge of different ways of communicating with patients that have communication difficulties. The nurse needs to have knowledge of these communication barriers and the patients’ experience of communication during and after the period of care in order to provide good person-centred care where the patients' needs are met.  Aim: The aim of this study was to illuminate patients' experience of communication difficulties due to stroke.  Method: This non-systematic literature review included 15 scientific articles, of which 13 consisted  of a qualitative approach and two of a mixed method. Using different combinations of search terms, all articles were obtained from PubMed and CINAHL. These have then undergone a quality review based on Sophiahemmet University's assessment basis for scientific classification and quality. An integrated data analysis has been used to analyze and compile the results.  Results: The results were divided into two main categories; communication in care and communication after the care period. Five subcategories have also been identified; trust and treatment, independence and support, social activities and interaction, hope and feelings as a result of communication difficulties. The results showed both positive and negative experiences regarding communication difficulties. A pattern that was discovered was that negative emotions were linked to the acute phase and that positive emotions emerged at a later stage. Conclusion: The study shows that nurses need to meet and support stroke survivors and use good communication by talking directly to the patient, letting the person speak to the end, as well as listening to the patient and adapting the information to the patient. This will strengthen the patient's trust in care, independence, social ability, sense of hope and reduce the negative feelings that arise after a stroke.

Bakgrund: Många patienter som söker sjukvård i Sverige talar olika språk som kan begränsa deras förmåga till kommunikation med sjukvårdspersonal. Detta kan leda till att sjuksköterskor möter patienter med olika språk och kulturer som skiljer sig från deras egna. Brist på ett gemensamt språk mellan patienter och sjuksköterskor kan bli ett hinder för att möta patienters problem och behov samt kan göra det svårt för sjuksköterskornas dagliga arbete.   Syfte:Att beskriva sjuksköterskors upplevelser av vårdande kommunikation vid språkliga barriärer. Metod: En systematisk litteraturstudie med beskrivande syntes baserade på tolv kvalitativa vetenskapliga artiklar. Resultat:I studiernas analys framkom det att relation, förståelse och gemenskap mellan sjuksköterskor och patienter var viktigt. Sjuksköterskorna ansvarade för att skapa en god relation och ingjuta en upplevelse av hopp hos patienter. Samtidigt var respekt, förtroende och motivation egenskaper som visade patienterna att sjuksköterskorna genuint brydde sig om dem.Slutsats:Samspelet i kommunikation kan vara ömsesidigt exempelvis med hjälp av kroppsrörelser, ansiktsuttryck, lättförståelig information och att sjuksköterskorna är öppna och ger utrymme för patienter att berätta sina upplevelser. Vid språkliga barriärer kan exempelvis sjuksköterskornas positiva inställning, vilja att hjälpa, önskan att skapa relation och visa respekt påverka patienternas välmående och lindra lidandet. / Background:Many patients seeking medical care in Sweden speak different languages that can limit their ability to communicate with healthcare professionals. This can lead to nurses meeting patients with different languages and cultures that differ from their own. Lack of a common language between patients and nurses can be an obstacle to meeting patients ' problems and needs and can make it difficult for nurses daily work. Aim: To describe nurses´ experiences of caring communication in language barriers. Method: A systematic literature study with descriptive synthesis based on twelve qualitative scientific articles. Results: In the study's analysis it emerged that relationship, understanding and community between nurses and patients was important. The nurses were responsible for creating a good relationship and instilling a sense of hope in the patient. At the same time, respect, trust and motivation were characteristics that showed the patients that the nurses genuinely cared for them. Conclusion:The interaction in communication can be mutual for example by means of body movements, facial expressions, easy-to-understand information and that the nurses are open and give space for patients to tell their experiences. In the case of language barriers, for example, the nurses 'positive attitude, the willingness to help, the desire to create relationship and show respect can affect the patients' well-being and alleviate the suffering.

This study explores the whys and wherefores of the communication difficulties experienced by Tunisian secondary school learners of English as a foreign language, and aims at offering ways out of the issue.It has been demonstrated that the issue proceeds broadly from the woeful dearth of exposure to and practice of the language and certain inadequacies of the teaching methodology.English seems to be learned as a mere curricular discipline, in that students have only a few weekly sessions confined solely to a classroom setting.The inadequacies of the teaching methodology are manifest in a number of aspects. The use of the mother tongue in EFL classes has proved to generate more harm than good. In the very framework, it has also been revealed that Communicative Language Teaching (CLT) has not been at the level of the expected outcome. Two CLT principal principles, focus on meaning to the detriment of form, and prioritizing oral fluency over written proficiency, as well as certain constraints, mainly the severe lack of instructional materials and large classes have intervened with its successful implementation in EFL classes. An added factor related to teaching methodology is the quasi‐absence of theoretical teaching as a prerequisite for the success of specific learning activities.Accordingly, exposing learners profusely to English in various ways inside and outside the classroom, adopting an only‐English eclectic approach to teaching the language, and combining theoretical instruction with practical teaching can considerably contribute to surmounting the students' learning difficulties, and hence to the achievement of their communicative competence.

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Introduktion: Migrationen har ökat markant det senaste decenniet. Detta leder till svårigheter att tillämpa vård på lika villkor för patienter som inte har sitt modersmål i landet de befinner sig i. Detta kräver att en tredje part som är tolk blir involverad för att underlätta kommunikationen mellan vårdgivare och patient. Syftet: Att beskriva patienters upplevelser vid användning av tolk i kommunikation med hälso- och sjukvården. Metod: En allmän litteraturstudie baserad på vetenskapliga kvalitativa artiklar. Datainsamling genomförd i databaserna CINAHL och PubMed. Tolv utvalda artiklar har kvalitetsgranskats utifrån SBU:s kvalitetsgranskningsmall (2012).  Resultat: Patienters upplevelser av tolkanvändning inom hälso- och sjukvården var varierande. Resultatanalysen redogörs i fem kategorier; Jämlik vård, oro för missförstånd och bristande tillit, informella tolkar, professionalism hos tolken, tillfredsställelse med telefontolk/videotolk respektive fysisk närvaro. Slutsats: Tillgången till auktoriserade tolkar upplevdes avgörande för att få en jämlik vård. Däremot upplevde deltagarna att det uppstod brist på auktoriserade tolkar samt information om tillgången till auktoriserade tolkar. Patienterna beskrev positiva såväl som negativa aspekter av tolkanvändning. Den negativa upplevelsen gentemot den auktoriserad tolken beskrevs som att det förekom dialektskillnader som ledde till missförstånd, bristande tillit över tolkens översättningsförmåga samt tolkens sätt att vara objektiv och neutral i sitt uppdrag. Detta resulterade i att patienterna valde att använda informella tolkar bland annat familjemedlemmar som saknade medicinska språkkunskaper. Vilket i sin tur ledde till svårigheter att uppnå patientdelaktighet och personcentrerad vård.   Nyckelord Tolk, patienters upplevelser, migranter, kommunikationssvårigheter, hälso- och sjukvård. / Introduction: Migration has increased significantly in recent decades. This leads to difficulties in applying care on equal terms to patients who don’t have their mother tongue in the country in which they are located, which requires the involvement of a third party who is an interpreter to facilitate communication between healthcare professionals and patients. Aim: the purpose is to investigate patients' experiences of using an interpreter in communication in health care.   Method: A general literature study based on scientific qualitative articles. Data collection was performed in the databases CINAHL and PubMed. Twelve selected quality articles were reviewed based on the SBU quality review template (2012).     Results: Patients' experiences of interpreter use in health care vary. The results analysis is presented in five categories; Equal care, Concerns about misunderstandings and lack of trust, non-formal interpreters, professionalism of the interpreter, Satisfaction with telephone interpreter / video interpreter and physical presence.   Conclusion: The availability of authorized interpreters was perceived as crucial in order to receive equal care. However, the participants felt that there was a shortage of authorized interpreters and information about the availability of authorized interpreters. Patients described positive as well as negative aspects of interpreting. The negative experience towards the authorized interpreter was described as that there were dialect differences that led to misunderstandings, lack of trust in the interpreter's translation ability and the interpreter's way of being objective and neutral in his assignment. This resulted in patients choosing to use informal interpreters, including family members who lacked medical language skills. Which in turn led to difficulties in achieving patient participation and person-centered care.   Keywords Interpreters, patients' experiences, migrants, communication difficulties, health care.

The purpose of this degree project was to find and investigate how global cooperation works in the construction industry. The goal of this work is to evaluate whether this type of solution remains profitable in the future and includes four perspectives consisting of communication, resource seeking, costs and quality. A final goal of this degree project was to present concrete conclusions that make it easier for companies which are interested in initiating a collaboration with a foreign company. The work is based on a literature study that describes previous research in the field as well as a case study that includes document analysis and interviews. The document analysis was carried out at the client to contribute knowledge about how a quality system is structured. Interviews have been conducted with four companies who are active in the design industry to obtain responses related to communication, quality, costs and resources. The interviews have been conducted with Skype and with one of the companies the interview was held on-site. All interviews have been recorded to reproduce the correct results. The result of this work shows the importance of a long-term relationship between the Swedish and the foreign company to make the collaboration successful. Before the cooperation starts it is important to keep in mind the differences in cultures, find people with required educational background and to search for a company that understands what is requested. If the collaboration intends to make a profit, the total cost of the project needs to be minded and not just the lower engineering costs. The results of this work also show that to find the required competence in Swedish projects, it can be successful to find that competence in a foreign country. The right quality is achieved by the foreign engineers based on the Swedish standards due to clear guidelines and system for overlooking. The technical quality has not been affected by language and communication difficulties, this because of well-structured communication methods including video meetings and patience to understand each other. Cooperation with foreign companies can be successful, the Swedish company must however be prepared for the consequences that may occur and understand that it can require more planning than initially was predicted. If the co-operation is planned in a long-term perspective and exchange of knowledge takes place on an ongoing basis, the cooperation will hopefully be efficient and successful over time.

Multiprofessionella team i rehabiliteringsverksamheter kräver att patienter kontinuerligt uttrycker sina önskningar och behov för att teammedlemmar ska kunna arbeta personcentrerat. För patienter med kommunikativa svårigheter kan det uppstå hinder i vårdsammanhang i form av minskad delaktighet gällande sin vård. För att effektivisera kommunikationen och motverka låg delaktighet behöver anpassningar göras. Anpassningar kan komma i form av alternativ och kompletterande kommunikation (AKK) eller andra strategier som underlättar ett samtal för båda samtalsparter. Föreliggande studie undersöker interaktionen mellan logopeder och patienter med kommunikativa svårigheter med respektive utan AKK under vårdbesök. Studien innefattar dessutom vårdpersonals samt patienters upplevelser avseende AKK och kommunikation.  Materialet bestod av videoinspelningar av två behandlingsbesök med två logopeder och två patienter som använder AKK. I samband med videoinspelningarna intervjuades även patienterna. Därtill inkluderades intervjuer med tio deltagare som representerade fem olika professioner. Det inhämtade videomaterialet analyserades med hjälp av multimodal interaktionsanalys och intervjuerna analyserades tematiskt. Resultatet som framkom i studien indikerade att interaktionen mellan vårdpersonal och patienter generellt förbättras vid AKK-användning. Däremot finns faktorer som påverkar effektiviteten av AKK-användningen, till exempel vad det är för omgivning, patientens motivation, frustration respektive insikt om kommunikationssvårigheterna samt vårdens bemötande och vilka anpassningar som tillämpas. Intervjuerna med vårdpersonalen visade att logopeden har en betydande roll inom teamet i relation till att öka kunskapen och medvetenheten avseende hur man samtalar med patienter med kommunikativa svårigheter. Videoinspelningarna och tillhörande patientintervjuer stöttade flera aspekter som framkom i vårdpersonalintervjuerna samtidigt som de bidrog med ytterligare perspektiv. Slutsatsen som dras i föreliggande studie är behovet av ökad kunskap avseende kommunikation och AKK, vilket kan leda vidare till ett tätare samarbete mellan teammedlemmar som arbetar med patienter med kommunikativa svårigheter. Slutligen är det av vikt att betona att kommunikativa svårigheter inte endast beror på en patients insjuknande, utan de blir mer påtagliga när goda förutsättningar i olika sammanhang inte finns. / Multiprofessional teams within rehabilitation clinics are dependent on patients verbalizing their needs and wishes in order for the team members to work with a person-centered approach. Patients with communication difficulties may experience reduced participation regarding their own healthcare. Therefore, it is important that adjustments are implemented to increase communication efficiency and the patient’s participation. The adjustments can be Augmentative and Alternative Communication (AAC) or other strategies that facilitate a conversation between the participants. The present study investigated interaction between speech and language pathologists (SLPs) and patients with communication difficulties with or without AAC during a medical appointment. The study also investigates experiences of healthcare professionals and patients regarding communication and AAC.  The data consisted of video recordings of two treatment visits between two SLPs and two patients that use AAC. The patients were interviewed after the visit. The data also consisted of interviews with ten participants that represented five different professions that regularly work with patients who use AAC. The video data was analyzed using multimodal interaction analysis and for analysis of the interviews with professionals, thematic analysis was employed. The findings indicated that the interaction between healthcare professionals and patients was improved when AAC was used. There were, however, factors that may affect the effectiveness of AAC, such as the type of environment, the patient’s motivation, frustration and an awareness of the communication difficulties, as well as healthcare providers’ attitudes and adjustments that are implemented. Analysis of the interview conducted with healthcare providers demonstrated the vital role of the SLP in a team in regard to improving knowledge and awareness of how to communicate with patients with communication difficulties. The video recordings with complementary patient interviews supported many aspects that emerged in the interviews with healthcare providers. Video analysis also contributed to additional perspectives.  Results of the present study imply that there is a need to improve the knowledge of communication and AAC in interprofessional teams, which could also lead to enhanced collaboration between team members. Lastly, it is of importance to highlight that communication difficulties are not solely due to a patient’s illness.  Communication difficulties become more pronounced when various contextual conditions are not favorable.