Bakgrund: Överrapportering av patienter inom slutenvården är ett vanligt förekommande moment för sjuksköterskor. Det finns strategier och faktorer som har betydelse för patientsäkerheten vid överrapportering av patienter mellan sjuksköterskor inom sluten hälso- och sjukvård. Genom att uppmärksamma strategier och faktorer som har betydelse för överrapportering av patienter inom slutenvården kan en säkrare patientvård bedrivas. Syfte: Att belysa strategier och faktorer som har betydelse för patientsäkerheten vid överrapportering av patient mellan sjuksköterskor inom sluten hälso- och sjukvård. Metod: Designen som använts var en litteraturöversikt. Litteraturöversikten grundade sig på 15 vetenskapliga artiklar som var av kvalitativ, kvantitativ eller mixad metod. Datainsamling har gjorts via PubMed och Cinahl. Resultat: Resultatet av inkluderade artiklar visade att strategier och faktorer hade betydelse för patientsäkerheten vid överrapportering. Strategier som var viktiga att belysa var "förberedelse inför rapport, frågor, bedside handover och rapporteringsmallar som Situation, Bakgrund, Aktuellt och Rekommendation (SBAR) och head to toe". Faktorer som beskrevs i resultatet var "rapportens innehåll, tidsbrist, teamsamarbete och attityder, miljö och teknik". Slutsats: Litteraturöversikten slutsats kom fram till att flera strategier hade en inverkan på överrapportering, dessa var "förberedelse inför rapport, frågor, bedside handover och rapporteringsmallar som SBAR och head to toe". Faktorer hade också en inverkan på överrapportering och dessa var "rapportens innehåll, tidsbrist, teamsamarbete och attityder, miljö och teknik." Dessa strategier och faktorer har positiv och negativ inverkan på sjuksköterskans arbete mot en säker vård och patientsäkerhet. / Background: Reporting of a patients within inpatient healthcare was a common occuring moment for nurses. By paying attention to strategies and factors of relevance for reporting of should it be possible with a more safe patient care. Aim: To illustrate strategies and factors of relevance patient safety when reporting of patients between nurses within inpatient healthcare. Method: The design used was literature review. The review was based on 15 scientific articles of qualitative, quantitative or mixed method. The data have been collected from PubMed and Cinhal. Result: The result showed that strategies and and factors was of importance for the patient safety when reporting of. Strategies important to focus on was "preparation before reporting of, questions, bedside handover and reporting forms as Situation, Background, Assessment and Recommendations (SBAR) and head to toe. Factors described in the result were " content of the report, lack of time, team cooperation and attitudes, environment and technique. Conclusion: The conclusion of the literature review was that a number of strategies have impact on reporting of. These strategies are "preparation before reporting of, questions, bedside handover and reporting forms as SBAR and head to toe". Even factors have an impact on reporting of. Theses are "reporting content, lack of time, team cooperation and attitudes, environment and technique. These strategies and factors have impact on the work nurses conduct to secure healthcare and patient safety.

Healthcare delivery within the military requires a multifaceted approach to achieve the desired outcomes of safe, effective, patient-centered, timely, efficient, and equitable health care. The prospect of maintaining a cycle of continuous process improvements within military clinical settings hinge on frontline leaders and middle-level managers who must be prepared to execute the mission and motivate, supervise, coach and mentor the staff. This project showcases a review of current literature translated into the development of an evidence-based Transformational Leadership Induction Program (TLIP) module that consisted of 4 subsections: the environment of care, clinical decision support systems, human resources management, and change management as well as resources for successful leadership within the organization. The training is designed to bridge the transition gap, facilitate role orientation and induction, and socialize frontline and middle-level managers during their role transition. The results of a need assessment survey, approved by the organization, were completed by 30 incumbents and resulted in 57% (17) providing feedback and role-specific contents that were integrated into the development of the TLIP module. The overall response to the survey was positive with 82% (14) of the respondents either agreeing or strongly agreeing with the items that they reviewed. The TLIP module provides a medium that translates current evidence into a succinct training platform capable of enhancing leadership transition and handoff. The TLIP module enables a culture of trust, enhances staff satisfaction, and fosters change management and succession planning within the military healthcare system.

Collaborative efforts between medical and behavioral health professionals is required to simultaneously treat individuals with medical and mental health disorders. However, there is lack of focus on the competencies and trainings needed by behavioral health clinicians (BHCs) transitioning to integrated primary care (IPC) settings. The purpose of this qualitative interpretive phenomenological study was to describe the lived experiences of BHCs who have transitioned from specialty outpatient behavioral healthcare settings to IPC settings. Semi-structured interview questions were used to collect data. Using interpretive phenomenological data analysis approach, themes and the shared meanings and experiences of 8 licensed BHCs were explored. Seven participants had graduate degrees and 1 participant had post-graduate degree. All participants had at least a year of experience working in IPC settings, worked full-time in North Carolina, and had over a year of experience in traditional behavioral healthcare settings. Results indicated that participants shared experiences in 5 themes: (a) clinical experience, (b) effective communication, (c) collaboration with primary care providers(PCPs), (d) continued education and trainings, and (e) care coordination. The outcome of this research will inform institutions, administrators, and credentialing boards to consider implementation of defined competencies for BHCs in community health centers that operate on IPC principles to ensure collaborative efforts between BHCs and PCPs in order to help provide effective holistic and affordable health care in a systems-based approach.

In this thesis, performances of some Mobile IP handoff schemes have been compared. The comparison has been based on simulation results. Simulation study has been carried out with a MIP model developed using OMNeT++ and available model frameworks. The literature on Mobile IP and several improvements including handoff management schemes have been surveyed. A MIP model has been constructed and then validated with the help of some scenarios in the literature, especially the one found in [7]. The model has been then used to investigate performances of FMIP. The study also included performance of FMIP under local traffic where mobile hosts communicate with each other in the same domain. Simulations are carried out under several scenarios involving UDP and TCP transfers. Mobile host speed and base station buffer size variables have been changed throughout the simulations. The result show that use of L2 triggers reduces handoff latency as both FMIP Post-Reg and Pre-Reg have better performance than HMIP without L2 triggers. The results also show that FMIP Post-Reg is a good candidate for future MIP infrastructures with its low latency handoff characteristics due to bidirectional tunneling between old and new points of attachment. Moreover, the results suggest that FMIP Post-Reg is also the best handoff scheme under local traffic where mobile hosts communicate among each other in the same foreign network.

Submitted by Mayara Nascimento (mayara.nascimento@ufba.br) on 2017-05-25T10:43:35Z No. of bitstreams: 1 openwimesh-mob-thesis.pdf: 2880119 bytes, checksum: 22b2ecda798a5886836af27bd7152027 (MD5) / Approved for entry into archive by Vanessa Reis (vanessa.jamile@ufba.br) on 2017-05-25T12:17:44Z (GMT) No. of bitstreams: 1 openwimesh-mob-thesis.pdf: 2880119 bytes, checksum: 22b2ecda798a5886836af27bd7152027 (MD5) / Made available in DSpace on 2017-05-25T12:17:45Z (GMT). No. of bitstreams: 1 openwimesh-mob-thesis.pdf: 2880119 bytes, checksum: 22b2ecda798a5886836af27bd7152027 (MD5) / As Redes em Malha Sem Fio (WMN, do inglês Wireless Mesh Networks) têm sido apontadas como solução vantajosa para provimento de infraestrutura sem fio, principalmente, quando comparadas com outras arquiteturas baseadas no padrão IEEE 802.11. Adicionalmente, o uso de dispositivos móveis tem crescido de tal maneira que redes Wi-Fi ubíquas e suporte a mobilidade transparente são requisitos cruciais para os provedores de rede. De modo a proporcionar uma boa experiência de mobilidade aos usuários, a rede sem fio deve prover handoff transparente aos clientes móveis, preservando as métricas de QoS e QoE em níveis aceitáveis para acomodar aplicações de tempo real e de multimídia interativa, cuja utilização torna-se cada vez mais popular. Não obstante, as estratégias de gerenciamento de mobilidade tradicionais, baseadas no padrão 802.11, incorrem em latência e degradação da QoS na rede, impactando negativamente o desempenho das aplicações. Desse modo, este trabalho propõe uma nova estratégia de handoff definido por software e baseado em monitoramento passivo da qualidade dos enlaces. Nessa estratégia, o processo de handoff é inteiramente controlado pela rede, o que permite mobilidade transparente aos usuários e não requer qualquer mudança nos dispositivos do cliente. Assim, as principais contribuições deste trabalho são: i) propor uma métrica de qualidade de enlaces Wi-Fi, a fim de identificar oportunidades de handoff , baseado em monitoramento passivo; ii) propor um algoritmo de gerenciamento de handoff composto pelas estratégias de decisão e execução do handoff , além da seleção de AP para o cliente móvel, os quais, em conjunto, melhoram a experiência de mobilidade e otimizam o uso dos recursos de rede; e iii) desenvolver um protótipo como prova de conceito dessas estratégias, através do framework OpenWiMesh. Foi realizada uma análise detalhada sobre o desempenho da proposta, comparando-a com uma estratégia baseada no protocolo B.A.T.M.A.N. e handoff controlado pelo cliente. Os resultados mostram que a proposta de gerenciamento de handoff melhorou em até 70% as métricas de QoE durante a mobilidade de clientes, ao passo que manteve métricas chave de QoS abaixo de limites de restrição para aplicações de tempo real.

Design systems have gained traction in the last few years. They have been primarily used by big tech companies to improve collaboration between designers and developers and to speed up the development process of their digital products. There is no formal definition of what a design system is and what it should entail as of the time of writing. It is believed that communication breakdown during the creation of design systems occurs because designers and developers do not understand each other’s fields of expertise. The purpose of this study is to explore common aspects that cause communication breakdown between developers and designers when creating a design system. The method of choice for this study is semi- structured interviews conducted with frontend/web developers, exploring their views and experiences. The results of this study indicate that there are both similarities and differences between peoples’ views on design systems and that the lack of understanding of a developer's field of work can be seen as an aspect that can cause a communication breakdown. Furthermore, the results imply that one of the factors which can contribute to a more successful understanding of the handoff for developers is the visualization of the design. The major limitations of this study are the lack of scientific literature on the topic of design systems as well as the limited number of participants.

Bakgrund: Överrapportering är en kommunikativ process där patientansvaret skiftar från givare till mottagare. Överrapportering uppfattas påverka patientsäkerhet och vårdkvalitet. Syfte: Syftet var att beskriva sjuksköterskors upplevelse av överrapportering från anestesisjuksköterskor i samband med patientöverföring från operationsavdelningen till den postoperativa avdelningen. Metod: En semistrukturerad intervjustudie (n=13) analyserades med hjälp av kvalitativ innehållsanalys enligt Graneheim och Lundman (2004). Resultat: Sjuksköterskornas upplevelser av överrapportering från anestesisjuksköterskor i samband med patientförflyttning från operationsavdelning till postoperativ avdelning genomsyrades av interaktion och rädsla för att missa saker. Förberedelser påverkar upplevelsen av rapporten. Sjuksköterskorna tillägnade sig information, vilket orsakade effekter. Slutsats: Sjuksköterskorna upplevelser av överrapportering genomsyrades av en medvetenhet om patientsäkerhet. / Background: The responsibility of the patient shifts from a sender to a receiver during handover, through a communicative process. Handover is perceived as crucial to patient safety and quality of care.  Objective: The aim of the study was to describe nurses’ perceptions of nurse anesthetists' handover when patients were transferred from the operating room to the postanesthesia unit.  Method: Semi-structured interviews (n=13) were analyzed using qualitative content analysis according to Graneheim and Lundman (2004).  Result: The postanestesia unit nurses’ experiences of handover from nurse anesthetists was influenced by interaction and fear of missing information. Preparation featured the impression of handover. The participants acquired information, which in turn caused effects.  Conclusion: The postanesthesia unit nurses’ experiences of handover was influenced by awareness of patient safety.

Bakgrund: För att sjukvården ska kunna upprätthålla patientsäkerheten krävs ett säkert sätt att överföra information mellan skifte av personal. För att kunna inkludera alla viktiga komponenter i en rapport krävs skicklighet i rapportering. Information som missas gör att patienter löper större risk att drabbas för vårdskador. Patienter som genomgår utsätts för sedering eller operativa ingrepp är redan sköra och löper större risk att drabbas av negativa konsekvenser. Syfte: Att undersöka innehållet i den muntliga överrapporteringen mellan anestesisjuksköterskor och postoperativ personal samt granskavad som kan påverka innehållet. Metod: En observationsstudie med kvalitativ och kvantitativ ansats utfördes på en intensivvårdsavdelning och en post-operativ avdelning. Resultat: Sammanställningen av 50 observationer visade att allergier, kirurgiska komplikationer, blodförlust och luftvägshantering var de mest frekventa punkterna som försummades. Innehållet jämfördes sedan med hur nöjda sjuksköterskorna som tog emot rapporten var gällandeinnehåll och struktur. Inga säkra slutsatser kunde dras av förhållandet mellan tid och innehåll, störningsmoment och innehåll, samt uppskattad nöjdhet med rapporten och innehåll. Vart rapporten sker har inverkan i hur stor utsträckning in-och utfarter samt operationsförband rapporteras. Störningsmoment har ingen inverkan på antal parametrar som tas upp. Konklusion: Resultatet visar att viktig information missas i olika utsträckning. Utifrån resultatet på studien dras slutsatsen att det behövs fortsatt forskning för att ge möjligheten att optimera och strukturera rapporterna så innehåll inte missas. / Background: If the health care is to maintain the patient security, a safe way to transfer information between staff changes is required. To be able to include all the important components in the report requires great skill. Information that is missed will expose the patient to a greater risk of care damage. Patients that undergo surgery or anaesthesia are already fragile and are at a greater risk of voluminous consequences. Objective: To examine the content of the oral report between the anaesthesia nurse and post-operative nurse, and what causes that could possibly affect the contents of the report. Method: An observation study with qualitative and quantitative method approach was adopted. The setting for the study was an intensive critical care unit and a post anaesthesia unit. Result: The findings in the 50 observations shows that allergies, surgical complications, blood loss and airway management were the most neglected points in the report. The amount of time the observations took were examined along with the content, structure and how satisfied the nurses that received the report were afterwards. No certain conclusions could be shown in the relationship between time and amount of content in the report. Neither was there a relationship between amounts of distraction and decreasing of content. These findings were compared with estimated satisfaction from the nurses that received the report. Where the report is held has impact on how much information about venous access, tubes and bandages is transferred. Disturbance had no effect on the amount of information being reported. Conclusion: The result shows that important information is missed to a certain degree. The study results show that there is still a need for more research to be able to find a way to optimize the oral report and the information transfer.

The Use of a Standardized System of Communication to Change the Perception of Handoff Communication in a Psychiatric Setting by Alicia Renee' Plunkett MSN, Walden University 2007 MSHA, University of St. Francis, 2005 BSN, University of Memphis, 1995 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University December 2014 The Joint Commission's review of sentinel events indicated that communication errors were the cause of over 65% of the sentinel events occurring in healthcare. The nursing profession has the responsibility of providing 24-hour care in an acute care setting and nurses are thus the primary participants in the handoff communication process. The purpose of this project was to assess the nursing staff's perception of handoff and to create a process for handoff communication. The most common framework for correcting communication errors in the literature is the Situation, Background, Assessment, and Recommendation framework, which was used as a guide for developing a process and form for handoff in this facility. The "Clinical Handover Staff Survey" developed by O'Connell, MacDonald, and Kelly (2008) was modified for use in this study. This survey was distributed to nurses and mental health technicians in 2 acute care units within a standalone acute care psychiatric hospital (n = 140). The quantitative survey identified 3 common barriers to the process in this facility that included: (a) interruptions, (b) subjective terminology used to describe patients, and (c) the lack of confidence in the information presented. After the implementation of a new process and form, the staff members were resurveyed to measure their post implementation perceptions of the handoff process. In each of the 3 areas measured, the implementation of a new process and form allowed the facility to see changes in the staffs' perceptions of the handoff process. The changes seen in this facility further indicate the need for education, standardization, and a continued focus on improving and mastering the important task of handoff communication. Improving handoff communication prevents errors in patient care from occurring, therefore decreasing mortality and morbidity rates.

Kravet och efterfrågan på IT-system har ökat i en teknologiskt framåtskridande värld. Mjukvaruutvecklingsprojekt involverar olika roller och överlämningar av information och domänkunskap. Utmaningar uppstår då designers saknar teknisk kunskap och utvecklare saknar grafisk expertis. Överlämningsprocessen är oundviklig och kan leda till ineffektivitet och kommunikationsproblem om inte hanterad korrekt.  Syftet med studien är att undersöka överlämningsprocessen av information mellan designer och utvecklare samt hur kommunikationen förs mellan dessa roller. Det finns en påvisad problematik när information förs från designer till utvecklare, detta på grund av att utvecklaren har svårt att tolka designerns faktiska budskap.  Undersökningen har nyttjat två teoretiska ramverk som har utgjort grunden för studiens analys. De teoretiska ramverk som har använts i studien är Aktivitetsteori samt Kollaborativt informationssökande. Aktivitetsteorin analyserar individers eller gruppers sociokulturella historia och hur detta påverkar en aktivitet som i denna studies fall är överlämningsprocessen. Kollaborativt informationssökande används för att se hur individer skapar en sammanhängande betydelse av information i samarbetsmiljöer.  Studien identifierar framgångsfaktorer och utmaningar i kommunikationen i överlämningsprocessen mellan designer och utvecklare. Båda roller måste delta och skapa gemensam förankring av informationens betydelse och syfte. Att definiera projektets mål och kontext skapar en gemensam syn på informationsflödet. God kommunikation kan minska friktion och problem och är nödvändigt för ett framgångsrikt samarbete. / More individuals require IT systems, thus creating a higher demand for such systems. The development of software involves various roles and the sharing of information and knowledge. Difficulties arise when designers lack sufficient technological understanding and developers lack adequate design knowledge. In the absence of a proper handover process, communication issues can arise, leading to inefficiencies.  The objective of this study is to examine how designers and developers exchange information and communicate. One challenge lies in how developers comprehend designers' intentions. To address this, the study utilizes two concepts: Activity Theory and Collaborative Information Seeking. Activity Theory investigates how individuals' cultural background influences their actions, while Collaborative Information Seeking explores how individuals collaborate to comprehend information.  The study identifies success factors and challenges in the communication within the handover process between designers and developers. Both parties must actively participate and grasp the significance and purpose of the information being exchanged. Clearly defining goals and establishing the project's context helps everyone understand the flow of information. Good communication can minimize issues and enhance their collaborative efforts.