Syfte: Syftet med denna studie var att undersöka sjuksköterskors upplevelser av bemötande, kommunikationen och omvårdnad kring patienter vars språk inte hanteras av sjuksköterskan. Metod: En deskriptiv intervjustudie genomfördes med sju sjuksköterskor på kirurgiska vårdavdelningar på ett universitetssjukhus för att kunna beskriva sjuksköterskors upplevelser som svarade på studiens syfte. Materialet analyserades deduktivt i enlighet med Graneheim& Lundmans kvalitativa innehållsanalys (2004). Resultat: Respondenterna upplevde att kommunikationssvårigheter beroende på språkliga skillnader ofta leder till problem efter första mötet med patienten, som information kring vården som bedrivs, utförande av omvårdnadsåtgärder och patientens möjlighet att delta i sin egen vård. Slutsats: Sjuksköterskor upplevde att omvårdnaden kring patienter som de ej delar språk med påverkas negativt, patientdelaktigheten och autonomin kränks och att en mer generös rutin kring tolkanvändning behövs. Det förekommer dock att en kreativ inställning påverkar förmågan att kommunicera positivt. / Purpose: To investigate nurses' experiences of how communication influence the nursepatient relationship, care and nursing with a patient whose languageisn’t handled by the nurse. Method: A descriptive interview study was performed on seven nurses in the surgical care units on a university hospital to describe nursesexperiences to answer the purpose of the study in detail. The material was analyzed deductively according to Graneheim&Lundmans qualitative content analysis (2004). Results: Respondents urged that communication difficulties due to language differences often lead to problems after the first meeting with the patient, as information on health care conducted, the performance of nursing interventions and patient the opportunity to participate in their own care. Conclusion: Nurses experienced that care about the patientsthey do not share the language with to be negatively affected, patient participation and autonomy was violated and that a more generous routine with interpreters is needed. There is however, that a creative approach affects the ability to communicate positively.

Annotation: The research of communication barriers, which appear at students of the secondary school, is the topic of my thesis. The work is divided into two parts - theoretical and practical. The theoretical part is devoted to communication, emphatically to educational communication, communication barriers and at the end also to communication apprehension, which can be one of the communication difficulties. The empirical part contents the conclusions of the research, which was provided at the school with the teachers and students, using the interview and the questionnare as the research methods.

O objetivo deste estudo é analisar as informações fornecidas por profissionais envolvidos durante a morte e como compreenderam as suas próprias ações no momento de comunicação da morte. É assim, visando esse objetivo acima citado, que este trabalho pretende responder à questão de quais foram as preocupações dos profissionais médicos, numa unidade de terapia intensiva, ao depararem-se com a comunicação de óbito aos familiares de pacientes internados. As informações foram obtidas através de pesquisa descritiva, de abordagem qualitativa, após entrevistas semiestruturadas conduzidas aos profissionais que forneceram a comunicação, durante o período de três meses no ano de 2013. A análise das entrevistas e de seus respectivos conteúdos proporcionou a divisão em duas categorias – Compreensão da Notícia e Limitação da Medicina/Proximidade da Morte. Ambas as categorias proporcionaram intensa análise e comparação com referências bibliográficas sobre como esses momentos eram encarados em diversos aspectos: médicos, psíquicos, filosóficos e até mesmo religiosos. Podemos, sob o aspecto subjetivo que é inerente a esta pesquisa, perceber que nos momentos finais da vida os pediatras selecionados neste trabalho preocuparam-se, principalmente, com o caminho no qual a comunicação encontrava o seu receptor e quais entendimentos os familiares obtinham através da informação que era fornecida. Também nota-se a preocupação dos médicos em estabelecer o limite terapêutico, e quando a proximidade da morte era maior que a possibilidade de interferência de potenciais intervenções terapêuticas. Os entrevistados demonstraram a necessidade de estabelecer o momento em que se deveria evitar a agregação de terapias fúteis e obstinadas, mantendo a família, em sua visão, com a maior informação possível desses limites. / We aimed with this study, to analyse how information was given by pediatrician to the families who underwent with a children who died in a Pediatric Intensive Care at Porto Alegre, Brazil, and how this pediatricians understood they’re own actions at the moment of the breaking bad news. Information was given through a descriptive research, with qualitative analysis, after semi-structured interviews conducted to the physicians who were breaking the bad news in the period of three months of 2013. Analysis of the interviews and respective contents allowed division in two main themes – Comprehension of the news and The edge between Medicine and proximity of death. Both categories allowed intense analysis and links with medical literature about how this moments are faced, through several aspects: medical, psychological, philosophical an even religious. We can, through this kind of analysis, sense that at the final moments of life, pediatricians selected were worried, mainly, with the potential distance between breaking bad news and comprehension of the parents. Also, in this study, we can notice, several times, during the interviews, concerning of the medical team to state when therapeutical limits were reached. Pediatricians at this study showed needs to maintain clear communication when these limits were set, and through a continuous process to inform the family. Interviewers showed importance in keep families connected with the ideas when new treatments were futile.

The thesis is aimed at the problems of communication barriers in patients with tracheotomy at intensive care units. Communication is the basis of nursing care and nursing process is based on partnership relation between a nurse and a patient. Everybody who wants to communicate sometimes faces problems, obstacles complicating his/her interpersonal communication. Recognition of these obstacles is the first step leading to their overcoming. Tracheostomy disqualifies the glottal function and patients are not able to communicate by means of speech. Such a situation is new for the patients and is also very stressing, which is why these patients have to be paid extra attention and these problems have to be dealt with. The aims of the work and the hypotheses were focused on the area of communication barriers, but also on adherence to the effective communication principles and alternative ways of communication. The goal was to find mutual dependence between the individual variables. Quantitative research extended by qualitative research was used for reaching the goals. An important relation was proven in hypothesis number two upon the results of statistic examination. The fact that the communication barriers perceived by a nurse depend on the character of the department where the nurse works was found. Some relation was also proven in hypothesis number eight, which examined dependence of alternative ways of communication on the character of the hospital department. No dependence relation was found in the other hypotheses. An analysis of results obtained from nurses and from patients showed us that nurses realize many more communication barriers in patients than patients themselves. A hypothesis expressing a relation between selection of an alternative communication method and the overall patient condition arose from the qualitative research.

O objetivo deste estudo é analisar as informações fornecidas por profissionais envolvidos durante a morte e como compreenderam as suas próprias ações no momento de comunicação da morte. É assim, visando esse objetivo acima citado, que este trabalho pretende responder à questão de quais foram as preocupações dos profissionais médicos, numa unidade de terapia intensiva, ao depararem-se com a comunicação de óbito aos familiares de pacientes internados. As informações foram obtidas através de pesquisa descritiva, de abordagem qualitativa, após entrevistas semiestruturadas conduzidas aos profissionais que forneceram a comunicação, durante o período de três meses no ano de 2013. A análise das entrevistas e de seus respectivos conteúdos proporcionou a divisão em duas categorias – Compreensão da Notícia e Limitação da Medicina/Proximidade da Morte. Ambas as categorias proporcionaram intensa análise e comparação com referências bibliográficas sobre como esses momentos eram encarados em diversos aspectos: médicos, psíquicos, filosóficos e até mesmo religiosos. Podemos, sob o aspecto subjetivo que é inerente a esta pesquisa, perceber que nos momentos finais da vida os pediatras selecionados neste trabalho preocuparam-se, principalmente, com o caminho no qual a comunicação encontrava o seu receptor e quais entendimentos os familiares obtinham através da informação que era fornecida. Também nota-se a preocupação dos médicos em estabelecer o limite terapêutico, e quando a proximidade da morte era maior que a possibilidade de interferência de potenciais intervenções terapêuticas. Os entrevistados demonstraram a necessidade de estabelecer o momento em que se deveria evitar a agregação de terapias fúteis e obstinadas, mantendo a família, em sua visão, com a maior informação possível desses limites. / We aimed with this study, to analyse how information was given by pediatrician to the families who underwent with a children who died in a Pediatric Intensive Care at Porto Alegre, Brazil, and how this pediatricians understood they’re own actions at the moment of the breaking bad news. Information was given through a descriptive research, with qualitative analysis, after semi-structured interviews conducted to the physicians who were breaking the bad news in the period of three months of 2013. Analysis of the interviews and respective contents allowed division in two main themes – Comprehension of the news and The edge between Medicine and proximity of death. Both categories allowed intense analysis and links with medical literature about how this moments are faced, through several aspects: medical, psychological, philosophical an even religious. We can, through this kind of analysis, sense that at the final moments of life, pediatricians selected were worried, mainly, with the potential distance between breaking bad news and comprehension of the parents. Also, in this study, we can notice, several times, during the interviews, concerning of the medical team to state when therapeutical limits were reached. Pediatricians at this study showed needs to maintain clear communication when these limits were set, and through a continuous process to inform the family. Interviewers showed importance in keep families connected with the ideas when new treatments were futile.

This thesis deals with the internal communication and with the tools to enhance its effectiveness. The main goal is to characterize the internal communication and communication tools, to implement a survey of the state of internal communication in a particular company and on the basis of the results to recommend appropriate measures to increase the efficiency of internal communication. The first part focuses on the clarification of important concepts relating to the topic of the thesis, such as: communication content, division of the communication, communication barriers, communication tools. The practical part deals with the results obtained by using a questionnaire, which was compiled for the analysis of internal communication in a particular company. From the analysis of the results of the questionnaire resulted deficiencies in the internal communication. Therefore, in the conclusion of the thesis, there are suggested measures to improve the effectiveness of communication within the company.

O objetivo deste estudo é analisar as informações fornecidas por profissionais envolvidos durante a morte e como compreenderam as suas próprias ações no momento de comunicação da morte. É assim, visando esse objetivo acima citado, que este trabalho pretende responder à questão de quais foram as preocupações dos profissionais médicos, numa unidade de terapia intensiva, ao depararem-se com a comunicação de óbito aos familiares de pacientes internados. As informações foram obtidas através de pesquisa descritiva, de abordagem qualitativa, após entrevistas semiestruturadas conduzidas aos profissionais que forneceram a comunicação, durante o período de três meses no ano de 2013. A análise das entrevistas e de seus respectivos conteúdos proporcionou a divisão em duas categorias – Compreensão da Notícia e Limitação da Medicina/Proximidade da Morte. Ambas as categorias proporcionaram intensa análise e comparação com referências bibliográficas sobre como esses momentos eram encarados em diversos aspectos: médicos, psíquicos, filosóficos e até mesmo religiosos. Podemos, sob o aspecto subjetivo que é inerente a esta pesquisa, perceber que nos momentos finais da vida os pediatras selecionados neste trabalho preocuparam-se, principalmente, com o caminho no qual a comunicação encontrava o seu receptor e quais entendimentos os familiares obtinham através da informação que era fornecida. Também nota-se a preocupação dos médicos em estabelecer o limite terapêutico, e quando a proximidade da morte era maior que a possibilidade de interferência de potenciais intervenções terapêuticas. Os entrevistados demonstraram a necessidade de estabelecer o momento em que se deveria evitar a agregação de terapias fúteis e obstinadas, mantendo a família, em sua visão, com a maior informação possível desses limites. / We aimed with this study, to analyse how information was given by pediatrician to the families who underwent with a children who died in a Pediatric Intensive Care at Porto Alegre, Brazil, and how this pediatricians understood they’re own actions at the moment of the breaking bad news. Information was given through a descriptive research, with qualitative analysis, after semi-structured interviews conducted to the physicians who were breaking the bad news in the period of three months of 2013. Analysis of the interviews and respective contents allowed division in two main themes – Comprehension of the news and The edge between Medicine and proximity of death. Both categories allowed intense analysis and links with medical literature about how this moments are faced, through several aspects: medical, psychological, philosophical an even religious. We can, through this kind of analysis, sense that at the final moments of life, pediatricians selected were worried, mainly, with the potential distance between breaking bad news and comprehension of the parents. Also, in this study, we can notice, several times, during the interviews, concerning of the medical team to state when therapeutical limits were reached. Pediatricians at this study showed needs to maintain clear communication when these limits were set, and through a continuous process to inform the family. Interviewers showed importance in keep families connected with the ideas when new treatments were futile.

The diploma thesis is focused on internal communication in a selected company. The first part of the thesis defines the concept of communication, its function and division. It characterizes internal communication and problem communication in company. This knowledge is further used in the practical part, which is supplemented by an introduction and description of the company. The analytical part examines employee satisfaction with internal communication. Based on the theoretical and analytical part of the work, real recommendations are proposed to improve the level of communication in selected company.

Bakgrund: Migration är vanligt förekommande i världen och en anledning till att människor behöver söka hälso- och sjukvård i ett nytt land. I mötet med vården kan det då uppstå svårigheter med kommunikationen gällande språkliga barriärer mellan patient och sjuksköterska. Språkbarriärer uppstår när sjuksköterska och patient inte talar samma språk. Kommunikationsbrister kan resultera i att patienten inte kan förmedla sina behov samt förstå given information angående sin vård. Det kan även leda till att sjuksköterskan inte kan tillhandahålla korrekt information och därmed riskeras den fullständiga omvårdnaden av patienten. Språkbarriärernas påverkan på omvårdnaden samt patienternas upplevelse behöver undersökas för en bättre kommunikation mellan patient och vårdpersonal.  Syfte: Att beskriva mötet mellan sjuksköterska och patient när det föreligger språkliga barriärer, avseende vad det hade för betydelse för omvårdnaden och patientens upplevelse. Metod: En beskrivande litteraturstudie av elva kvalitativa originalartiklar från databaserna PubMed och CINAHL. Resultat: Efter analys av samtliga artiklar identifierades två huvudkategorier; Språkbarriärers påverkan på omvårdnaden och Språkbarriärers påverkan på patientupplevelsen. Huvudkategorin som berörde påverkan på omvårdnaden delades in i fyra underkategorier: Bristande patientsäkerhet, Otillräcklig patientinformation, Behov av extra planering och koordination samt Risk för tidskrävande omvårdnad. Även huvudkategorin som berörde patientupplevelsen delades in i fyra underkategorier: Beroende av anhöriga för tolkning, Risk för otillräcklig delaktighet i vården, Risk för diskriminering samt Frustration relaterat till otillräcklig kommunikation. Slutsats: Språkbarriärer påverkade omvårdnaden negativt genom att det krävdes extra planering och tid av sjuksköterskan, kunde leda till brister i patientsäkerheten samt otillräcklig patientinformation. Patienternas upplevelse av de språkliga barriärerna var otillräcklig delaktighet i sin vård, frustration relaterat till otillräcklig kommunikation, diskriminering samt beroende av anhöriga för tolkning. Med ökad kunskap och förståelse för dessa problem kan sjuksköterskans förmåga i att erbjuda patienten en god transkulturell omvårdnad öka och upplevelsen av vården för patienten förbättras. / Background: Migration is common in the world and a reason why people need to seek health care in a new country. In the encounter with health care, difficulties with the communication may arise due to language barriers between patient and nurse. Language barriers arise when the nurse and patient do not speak the same language. Lack of communication can result in the patient not being able to convey their needs and understand the given information regarding their care. It can also lead to the nurse not being able to provide correct information and thus risking the complete care of the patient. The impact of language barriers on nursing care and patients' experiences needs to be investigated in order to improve the communication between patient and care staff. Aim: To describe the meeting between nurse and patient when there are language barriers, regarding what it meant for the nursing care and the patient's experience.  Method: A descriptive literature study of eleven qualitative original articles from the databases PubMed and CINAHL. Results: After analysis of all the articles, two main categories were identified: The impact of language barriers on nursing care and The impact of language barriers on the patient experience. The main category that concerned the impact on nursing care was divided into four subcategories: Lack of patient safety, Insufficient patient information, Need for extra planning and coordination and Risk of time-consuming nursing care. The main category that concerned the patient experience was also divided into four subcategories: Dependence on relatives for interpretation, Risk of insufficient participation in care, Risk of discrimination and Frustration related to insufficient communication. Conclusion: Language barriers negatively affected nursing care by requiring extra planning and time from the nurse, risking deficiencies in patient safety and insufficient patient information. Patients' experiences of the language barriers were insufficient participation in their care, frustration related to insufficient communication, discrimination and dependence on relatives for interpretation. With increased knowledge and understanding of these problems, the nurse's ability to offer the patient good transcultural care can increase and the experience of care for the patient can be improved.

Bakgrund: I och med att globaliseringen växer har det medfört en ökning av mångfalden i samhället. Allt fler interkulturella samtal sker som kräver ett fungerande samspel mellan utrikesfödda patienter och sjukvårdspersonal. Bristande kommunikation i form av språkbarriärer utgör en risk för vårdandet samt försvårar möjligheten för god vård. Syfte: Syftet var att beskriva utrikesfödda patienters upplevelser av språkbarriärer inom hälso- och sjukvård. Metod: En litteraturöversikt genomfördes baserad på elva vetenskapliga artiklar.Resultat: Resultat presenterar tre huvudkategorier. Dessa är Konsekvenser av språkbarriärer, Vikten av fungerande kommunikation och Tolk i vården. Sammanfattning: Litteraturöversikten har påvisat att språkbarriärer försvårade patient- och sjukvårdspersonalens vårdrelation. En konsekvens av detta var att informationsöverföringen brast och patienter lämnades ovetande om sin hälso- och sjukvårdssituation. Andra svårigheter som lyftes fram var korrelerat till känslomässiga, negativa ochkulturella element. Även tolkanvändning för att stödjakommunikationen benämndes vilket upplevdes både positivt ochnegativt. Att visa omtanke till patienter som inte kan detgemensamma språket är nyckeln till en god vård. Respekten ochförståelse för patienters olika kulturer är en central del för enpersoncentrerad omvårdnad. / Background: As globalization around the world grows, it has led to an increase in the diversity of society. More and more intercultural conversations are taking place that require a functioning interaction between foreign-born patients and healthcare professionals. Lack of communication in the form of language barriers compose a risk for patient care and makes the possibility of quality care more difficult. Aim: The purpose of this study was to describe foreign-born patients ́ experiences of language barriers in health care. Method: A literature review based on eleven scientific articles. Results: The result presents three main categories. These are consequence of language barriers, the importance of effective communication and interpreters in healthcare. Summary: The literature review has shown that language barriers made it difficult for patients and healthcare professionals to have a caring relationship. One consequence of this was that the transfer of information broke down and patients were left unaware of their healthcare situation. Other difficulties highlighted were correlated with emotional, negative and cultural elements. The use of interpreters to support communication was also mentioned, which was experienced both positively and negatively. Showing care to patients who do not know the common language is the key to good care. Respect and understanding of patients' different cultures is a central part of person-centered nursing.