Timsrundor innebär en strukturerad regelbunden tillsyn av patienter och kan utföras för att upptäcka om patienters tillstånd försämras och för att förebygga trycksår, fall, smärta eller undernäring och för att patienterna inte ska behöva ringa på klockan för att få hjälp med till exempel toalettbesök. Akutsjukvården är i dag hårt belastad med ett ökat patientflöde. En hög arbetsbelastning kan medföra att sjuksköterskor inte alltid kan tillgodose patienternas omvårdnadsbehov. För att sjuksköterskor bättre ska kunna tillgodose patienters behov och upptäcka eventuella försämringar av patienters tillstånd, samt förebygga att skador uppstår kan timsrundor eventuellt vara ett arbetssätt. Syftet var att beskriva sjuksköterskors erfarenheter och upplevelser av timsrundor ur patientsäkerhetsperspektiv inom akutsjukvård. En litteraturstudie valdes som metod för att besvara studiens syfte. Databassökningen genomfördes i PubMed och CINAHL. Litteraturstudien är en sammanställning av resultaten i 18 inkluderade artiklar, publicerade mellan 2007 – 2017, med ett undantag för artikeln från 2006. Av artiklarna var åtta kvalitativa, tre var kvantitativa och sju var mixade studier. Resultatet sammanfattades i fyra kategorier; förbättrad kommunikation, ökad vårdkvalitet, minskning av vårdskador och timsrundor ökar tryggheten. Litteraturöversikten visar att delaktighet, noggrann implementering och att all personal, inklusive cheferna, arbetade mot samma mål var viktiga faktorer för att nå framgång med timsrundor. Flera av studierna visade att både patienter och sjuksköterskor upplevde att omvårdnaden förbättrades ur ett patientsäkerhetsperspektiv vid införandet av timsrundor, dock upplevde sjuksköterskor ofta tidsbrist samt att dokumentationen av timsrundorna kunde vara betungande. Flertalet av resultatartiklarna tyder på ökad patientsäkerhet med timsrundor genom att bland annat fall minskade eftersom ringklockan och patientens tillhörigheter placerades närmare patienten. Det framgick att patientnöjdheten ökade med timsrundor och att ringningar minskade. Slutsatsen som kan dras av denna litteraturöversikt är att timsrundor är ett nytt outforskat begrepp inom sjukvården i Sverige. Studien visar att timsrundor kan vara ett stöd i att förbättra patientsäkerheten. För att timsrundor ska fungera krävs en noggrann implementering där personal och ledning bör arbeta mot samma mål. Mer forskning inom ämnet timsrundor är önskvärt för att uppnå ökad validitet.

Discipline‐based medical curricula face the challenges of promoting horizontal (across course) and vertical (across years) integration, as well as providing opportunities for students to build the skills needed to become “residents‐as‐teachers”. To address these issues, we developed an Integrated Grand Rounds (IGR) series in which cases are co‐presented to M1/M2 students by clinical and basic science faculty. Sub‐topics relevant to the case are expanded upon by means of live patient interviews and small group sessions led by M3/M4 students. IGR effectiveness is measured by comparison of pre‐/post‐test scores and student attitude questionnaires. Overall, student post‐test scores improved by 23% and >; 95% of all students felt that this activity was an effective way to both integrate information across courses and highlight clinical applications of basic science material. Additionally, all M3/M4 students polled felt that the IGR provided a valuable opportunity to review important basic science concepts and practice clinical teaching skills. The IGR series has proven to be a highly successful tool for cross‐course and longitudinal integration and is enthusiastically supported by both faculty and students. Notably, the IGR provides an efficient and cost‐effective vehicle to expand interdisciplinary connections and enhance integration. As a result, we are in the process of expanding its use in our curriculum.

The starting point of the present thesis is nurses’ reported experiences of disagreements with physicians for pushing life sustaining treatment too far. The overall aim was to describe and compare nurses’ and physicians’ perspectives on the boundaries for life-sustaining treatment and to evaluate whether ethics rounds could promote mutual understanding and stimulate ethical reflection. A mixed methods design with qualitative and quantitative data was used, including interviews and questionnaires. The health professionals’ experiences/perceptions were based on known patients foremost from general wards, but also intensive care units, at four Swedish hospitals. The first two studies treated the perspective on boundaries for life-sustaining treatment and the last two evaluated philosopher- ethicist led ethics rounds. Analysis of data was performed using a phenomenological approach and content analysis as well as comparative and descriptive non-parametric statistics. In the first study, the essence of the physicians’ decision-making process to limit life-sustaining treatment for ICU patients, was a process of principally medical considerations in discussions with other physicians. In the second study, there were more similarities than differences between nurses’ and physicians’ opinions regarding the 714 patients studied. The physicians considered limited treatment as often as the nurses did. The ethics rounds studies generated mixed experiences/perceptions. It seemed that more progress was made toward the goal of promoting mutual understanding than toward the goal of stimulating ethical reflection. Above all, the rounds seemed to meet the need for a forum for crossing over professional boundaries. The most salient finding was the insight to enhance team collaboration, that the interprofessional dialogue was sure to continue. Predominating new insights after rounds were interpreted as corresponding to a hermeneutic approach. One of nurses’ negative experiences of the ethics rounds was associated with the lack of solutions. Based on the present findings, one suggestion for improvement of the model of ethics rounds is made with regard to achieving a balance between ethical analyses, conflict resolution and problem solving. In conclusion, the present thesis provides strong evidence that differences in opinions regarding boundaries for life-sustaining treatment are not associated with professional status. The findings support the notion of a collaborative team approach to end-of-life decision-making for patients with diminished decisionmaking capacity. There is an indication that stimulation of ethical reflection in relation to known patients may foremost yield psychosocial insights. This could imply that social conflicts may overshadow ethical analysis or that ethical conflicts and social conflicts are impossible to distinguish.

The Affordable Care Act of 2010 increased the number of patients seen in a northeast, urban trauma emergency department by 34%. This created a problem as it occurred simultaneously with a nursing shortage. Consequently, patient satisfaction scores fell below the national average benchmark. The rate patients left the emergency department without being seen was 2.6% higher than the national average and patient fall rates increased by 20%. A review of the literature to search for solutions led to the support of an hourly rounding project and an educational workshop promoting proactive nurse behaviors as a way to address the quality and safety gap. The goal of this scholarly project was to develop this evidence based, theory supported project and to conduct a formative and summative evaluation by an expert review panel in order to achieve consensus before implementation. An executive team was formed and led through the process of development of a detailed hourly rounding protocol and workshop, which will be implemented at the facility at a later time. A 10 member expert panel was formed. The panel members consented to participate in an explanatory session, to review all project materials, and to complete an anonymous 20 question survey tool. The panel also consented to review any changes made to materials as part of a summative evaluation. Descriptive analysis of the formative data demonstrated a 90% overall agreement that the workshop was comprehensive and covered key concepts within 5 categories. Minor requested revisions were made in response to formative results. The summmative review demonstrated 100% consensus on the revisions. This project will bring about social change by engaging nurses in proactively caring for patients in a safe and efficient manner.

There is a national movement to create improvements in patient safety and outcomes due to evolutionary changes in the healthcare. Many health care organizations are using the framework of a culture of safety in order to create a reliable and stable work environment that emphasizes safety and improves patient outcomes. Patient throughput, defined as the active management of the supply of patient beds (rooms for occupation) to the demand of patients to beds and the length of time it takes for this action to occur, has been identified as one of the areas in need of improvement. This study considered if the use of an interdisciplinary team to execute patient rounds improves patient throughput, helping to expedite the patient discharge process while decreasing needless readmissions to the health care organization. A quantitative longitudinal retrospective data analysis of time stamps obtained from the electronic health record was examined to determine what impact interdisciplinary rounds had on patient throughput. It was determined that a discrepancy existed between the actual planning of a patient's discharge and the execution of the discharge, which contributed to unwanted readmissions to the health care organization. A secondary factor affecting the readmission rate was excluding the patient as a member of the interdisciplinary team. The social significance of the research is how health care organizations engage patients, empowering patients to actively participate in their own care including them in the decision-making process that affects patient care and improves outcomes.

<p>Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities.</p><p>Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study.</p><p>The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies.</p><p>Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented.</p><p>Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented.</p><p>The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved.</p><p>There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.</p>

Ongoing structural and financial changes in the health care sector have resulted in increased risks for ethical dilemmas and moral distress. It is purported that increased ethical competence will help staff manage ethical dilemmas and hence decrease moral distress. To enhance ethical competence several approaches may be used – theoretical education, and methods focusing on reflection and decision-making abilities. Ethics rounds are a widespread systematic method hypothesized to improve ethical competence, nurture a reflective climate, and help in ethical decision-making. Despite its popularity, its effects on moral distress have hitherto never been evaluated in a controlled study. The purpose of this thesis was to evaluate the impact of an intervention, including ethics rounds; the hypothesis being that the intervention would decrease perceived moral distress. An additional aim was exploring the concept of moral distress in various health care establishments, including pharmacies. Focus groups were conducted to explore the concept of moral distress. To evaluate the intervention a scale assessing staff-perceived moral distress was designed, validated, and implemented. Results showed that moral distress is evident in diverse health care settings. Some factors associated with this were lack of resources, conflicts of interest, and rules that are incompatible with practice. An expanded definition of moral distress was presented. The training program was much appreciated by participants. However, no significant effects on perceived moral distress were found. Reasons could be that the intervention was too short or otherwise ineffective, there is no association between ethical competence and moral distress, the assessment scale was not sensitive enough, or management was not sufficiently involved. There is a need to further refine the various aspects of ethical dilemmas in clinical settings, and to evaluate the most efficient means to enhance skills for dealing with ethical dilemmas, for the benefit of staff, patients, institutions, and society.

In this thesis research, we investigate the usability of hand-held display (Tablet PC) and wearable head-mounted display (Google Glass) interfaces and their effect on doctor-patient interaction during clinical ward round in the hospital. We looked at existing literature to identify existing research about our topic. Using a User Centered Interaction Design process we developed a prototype hybrid system that used both a hand-held and head-mounted display. An evaluation of this prototype with a hand-held system and a paper based interface was performed in a simulated patient room with 20 doctors and 5 patients. The participants were observed, surveyed, and interviewed about their experiences. Generally, the patients had a high satisfaction rate and felt the interfaces were not causing the doctors to lose focus on them. The doctors found the hand-held display by itself and existing paper-based interface to be the most usable and least distracting interfaces for accessing patient information during clinical ward rounds.

The path to a career in nursing begins on the first day of nursing training and is not completed until the nurses have worked one year in their profession. During the training period, the student nurses have training elements in two different activitysystems: the higher education institution and the healthcare sector. The aim of this study is to examine and highlight the relationship between the different parts of the training as well as how the relationship is manifested during the newly qualified nurses’ initial period in the profession. The research’s overall question is what makes the newly qualified nurses’ learning and knowledge development easier or harder in relation to the different parts of the nursing training. Interviews have been used to create data which have been analysed based on activity theory, a social theory of learning and different ways of describing knowledge. The research findings show that the activity systems have different knowledge cultures, learning processes and patterns of action. The study participants describe the differences in terms of being in ‘different worlds’. The newly qualified nurses do not always have the practical skills that are sought after and, therefore, cannot always act as independent subjects, but become marginalized non-participants who observe the course of events. Supervision and the rounds are the two most demanding duties during the first year in the profession, since these duties have been practiced to a limited extent during the nurse training placement. The supervisory function appears different to newly qualified male and female nurses. The women in the study feel that it is problematic to be a supervisor for older experienced assistant nurses, in that the assistant nurses do not accept them as supervisors. The men do not indicate this as being a problem, rather emphasizing that the assistant nurses support them in the supervisory function. During the rounds, the nurses must inform the doctor of the state of the patients’ health and care needs. The participants feel that it is difficult to live up to the doctors’ demands ahead of the rounds. In summary, my findings show that the different knowledge cultures in the higher education institution and the healthcare sector make the newly qualified nurses’ learning and knowledge development more difficult. During the first year in the profession, the newly qualified nurses learn to be nurses, and they talk about themselves as nurses in a totally different way than at the start of that year. The changed way of talking about themselves indicates that they have recreated their identity from student nurses to nurses.

Järntorget bygg AB arbetar med nyproduktion av framförallt bostäder. Liksom alla andra arbetsplatser i Sverige berörs en byggarbetsplats av Arbetsmiljölagen med dess förordning och författningar. I dessa paragrafer som alla finns för att göra arbetsmiljön så säker som möjligt finns krav på att en Arbetsmiljöplan skall upprättas, vilket är den individuella strategi som tillämpas på varje byggarbetsplats för att uppnå god arbetsmiljö. Dessutom finns på byggarbetsplatser ett ordnings- och skyddsreglerdokument vilket är det dokument som varje ny hantverkare skall ta del av vid ankomst för att känna till arbetsplatsen bestämmelser.  Genom att ta del av gamla skyddsrondsprotokoll, delta på skyddsronder och genomföra intervjuer på Järntorgets i dagsläget tre aktuella byggarbetsplatser kan det konstateras att överträdelser mot såväl Arbetsmiljölagen som mot den egna Arbetsmiljöplanen och ordnings- och skyddsregler sker. Näst intill dagligen förekommer det att hjälm och västkrav samt städning åsidosätts.  Fallskyddsanordningarna är inte alla gånger tillräckligt säkra och gasoltuber förvaras felaktigt. På skyddsronderna är engagemanget i säkerheten bristfällig och väldigt få underentreprenörer involverade. Trots dessa brister fungerar dock arbetsplatserna bra och inga större skador eller tillbud har blivit anmälda. Dock kan det i framtiden bli ännu bättre om Järntorget expanderar sitt säkerhetsarbete redan idag, innan olyckan är framme. / Järntorget bygg AB works with new construction, primarily residential. Like all other workplaces in Sweden a construction site must follow the Work Environment Act with its regulations and statutes. These paragraphs, which exist to make the work environment as safe as possible, have a requirement that a work environment plan must be established. The plan is the individual strategy applied to any construction site in order to achieve good working environment. In addition there is an Order and Security Document on construction sites, which is a document that each new artisan has to read and sign on arrival to be familiar with the workplace requirements. After reading the old safety inspection records, participating in safety inspections and conducting interviews at Järntorget`s three current construction sites, it is clear that there are violations against the Work Environment Act as well as against Järntorget`s own Work Environment Plan and Order and Security Rules. Almost daily the use of helmets and vests or cleaning obligations is neglected. Fall protection devices are not always sufficiently secure and LPG cylinders are stored improperly. On the safety rounds the commitment to safety is faulty and very few subcontractors are involved. Despite these shortcomings the different construction sites work well and no major injuries or incidents have been reported. However, it would be an asset for Järntorget to expand their security work before an accident occurs.