Bakgrund: Patientdelaktighet är ett koncept som myntades i vårdlitteraturen under 1960-talet. Detta är en betydande faktor i en av sjuksköterskans kärnkompetenser: personcentrerad vård. Ett arbetssätt som inom aktuell forskning har argumenteras eventuellt kunna främja detta är ronder vid sängkanten. En annan fördel som framkommit i tidigare forskning är den positiva effekten på det interprofessionella samarbetet. Det har dock framkommit en del hinder med denna typ av rond, och forskning inom ämnet är otillräcklig. Syfte: Syftet med denna studie var att undersöka patienters uppfattningar om ronder som utfördes vid sängkanten. Metod: En allmän litteraturöversikt användes som studiedesign. Översikten innefattade tio originalartiklar, RCT (randomiserade kontrollerade studier) och artiklar av kvasiexperimentell design. Sökningen genomfördes i databaserna Pubmed, CINAHL, Web of Science Core Collection, SveMed+ och Statens beredning för medicinsk och social utvärdering [SBU]. Valda artiklar kvalitétsgranskades med mallar som modifierades för detta arbete. Resultat: Patienterna rapporterade ett gott bemötande, en hög nivå av delaktighet i vården, ett gott samarbete mellan vårdpersonalen, kommunikationen som god, en god förståelse om sin hälsa och vården, god tilltro till vårdpersonalen och en hög generell tillfredsställelse. Slutsatser kunde inte dras gällande uppfattningen om avskildhet. Slutsats: Patienterna hade i regel positiva uppfattningar av ronder utförda vid sängkanten. Då vissa negativa uppfattningar dock rapporterats krävs ytterligare forskning för att implementering av bedside-ronder i vården skall vara etiskt och vetenskapligt motiverat. / Background: Patient participation is a relatively new concept established during the 1960s. This is an important component in nursing that plays a pivotal role in one of the nursing core competence descriptions: patient-centered care. It has been indicated by research that bedside rounds may have a positive effect in promoting patient centered care. Another benefit that has been introduced in previous research is a positive effect on interprofessional teamwork. Despite this there are some perceived barriers that have emerged regarding bedside-rounds, therefore research in this topic is insufficient. Aim: The purpose of this study was to explore patients perceptions of bedside rounds. Method: The study design used was a literature review, comprised of ten original articles. The articles included in this study were either randomized controlled trials or of a quasi experimental design. The search was conducted with the means of Pubmed, CINAHL, Web of Science Core Collection, SveMed+ and SBU (Swedish Agency for Health Technology Assessment and Assessment of Social Services). The articles included in the study were then reviewed for their quality using guides that were modified for this study. Result: The patients experienced a good reception from health personnel, a high level of involvement in care, good teamwork between the health personnel, good communication, a good understanding of their health, high levels of trust in the health personnel and a high general satisfaction. No conclusions could be drawn regarding experienced integrity. Conclusion: In general, the patients had a positive perception of bedside-rounds. Despite this some negative perceptions were also reported. This indicates that there is a need for further scientific and ethical research to provide sufficient proof that bedside-rounds should be implemented in healthcare.

Digitalisering är något som är allt mer utbrett i samhället, på arbetsplatser och i våra hem. Arbetsmiljöarbetet är idag delvis digitaliserat och hur arbetet genomförs kan se olika ut beroende på vilken typ av arbetsplats det gäller. Även processen kring en skyddsrond, vilken utförs för att bedöma risker i den fysiska arbetsmiljön, varierar mellan liknande arbetsplatser. Dokumentering utförs till stor del manuellt och data som samlas in går ej att överblicka på ett användbart sätt. Riskerna är att viktig information går förlorad och att digitalisering som redan är implementerad inte når sin fulla potential. Mer konkreta konsekvenser utgörs av att organisationer kan gå miste om förtjänster samt leda till bristande arbetsmiljöarbete. Studien genomfördes i form av en kartläggning där elva skyddsombud intervjuades. Data från intervjuerna analyserades sedan genom ett affinitetsdiagram. Analysen resulterade i teman som berörde krångliga processer, avsaknad av information, psykosocial arbetsmiljö och samarbete. Även att digitala verktyg kan skapa mer problem än de löser. Slutsatsen är att arbetsprocesserna kan bli mer tidseffektiva, data som samlas in kan bli mer korrekt och därmed utgöra ett tydligt beslutsunderlag som lättare kan visualiseras och integreras i en organisations verksamhet. Bättre tillgång till data i en organisation kan även leda till bättre förutsättningar för uppföljning av arbetsmiljöarbetet. Kring utmaningar dras slutsatsen om att befintliga arbetsprocesser inte får försvåras. / Digitalisation is widely spread in society, in our workplaces and in our homes. The work environment work is partially digitalized and how the work is carried out differs amongst work places. Even the process with the work environment inspection round, which is performed to assess risks in the physical work environment, is different amongst similar workplaces. The documentation is substantially carried out manually and the collected data lack a useful overview. The risks due to the latter is loss of information as well as that implemented digitalisation does not reach its full potential. In concrete, the consequences are constituted by missed earnings for companies and lacking work environment work. The study was conducted in the form of a survey where eleven work environment representatives were interviewed. The collected data were analyzed through an affinity diagram.The analysis resulted in themes that referred to complicated processes, lack of information, psychosocial work environment and collaboration. As well that digital tools can create more problems than they would solve. The conclusion is that work processes can be more time effective, collected data can be more correct and hence constitute a distinct decision basis that is more easily visualized and integrated into the operations of a company. Better access to data in an organization can also lead to better prerequisites for follow-up on work environment work. The conclusion regarding the challenges of digitalisation is that it should not make existing processes more difficult.

Bakgrund: Ambulansens uppdrag har utvecklats och numer bedrivs bland annat avancerad vård. Den äldre befolkningen ökar vilket även speglar ambulansuppdragen. Den äldre befolkningen kan vid sjukdom eller på grund av åldrande ha en nedsatt beslutsförmåga, vilket gör dessa bedömningar svårare. För att bemöta de äldre i ambulanssjukvården behöver den etiska kompetensen synliggöras. Ett sätt att belysa etiken och det etiska arbetsklimatet är genom etikronder. Syfte: Beskriva ambulanspersonalens erfarenheter av etikronder beträffande vård av äldre inom ambulanssjukvården.  Metod: Kvalitativ intervjustudie med induktiv ansats. Deltagare rekryterades utifrån de som deltagit i etikronder, den insamlade data analyserades med hjälp av Erlingsson och Brysiewicz (2017) kvalitativ innehållsanalys. Resultat: Resultatet resulterade i två teman; ”trygg och öppen atmosfär under etikronden”, vilken innehåller beskrivningar av olika aspekter av faktorer som bidrog till upplevelsen av etikronden, och ”etikrondens avtryck på både personlig och kollegial nivå”, vilken innehåller tankar, reflektioner och resultat som har kommit efter att ha deltagit i etikronder. Slutsats: Etikronder är en positiv upplevelse, med en moderator som lederdiskussionen framåt i ett öppet klimat synliggörs etiska dilemman. Detta hjälper ambulanspersonal att hantera etiska svårigheter och den etiska kompetensen förbättras, en ökad trygghet i bedömningar av patienter upplevs. Detta kan leda till att vården av de äldre patienterna blir mer anpassad och att den moraliska stressen minskar hos ambulanspersonal. För att fortsätta denna utveckling efterfrågas etikronder mer regelbundet och att alla på arbetsplatsen ska delta. / Introdution: The ambulance assignments has developed and now has the ability to provide advanced care. The increase in the elderly polpulation reflects in the ambulance missions. The elderly population may, in case of sickness or due to ageing, have a reduced decision-making abilit, which make these assessments more challenging. In order to approach the elderly in the prehospital care, the ethical competence needs to be made more visible, one way to highlight ethics and the ethical work climate is through etics rounds. Aim: To describe the ambulance personell experience of ethics rounds regarding the care of elderly in prehospital care. Method: Qualitative interview study with an inductive approach. Participants were recruited based on who had participated in ethics rounds, the collected data was analyzed using Erlingsson and Brysiewicz (2017) qualitative content analysis.Result: The result resulted in two themes; "safe and open atmosphere during the ethics round", which contains descriptions of various aspects of factors that contributed to the experience of the ethics round, and "the impact of the ethics round on both a personal and collegial level", which contains thoughts, reflections and outcomes that have come after participating in ethics rounds. Conclusion: Ethics rounds are a positive experience, with a facilitator who leads the discussions forward in an open climate and makes ethical dilemmas visible. This helps paramedics deal with ethical difficulties and the ethical competence is improved, and increased moral confidence in assessments of patients is experienced. The effect can lead to the care of the elderly patients becoming more adapted and reduced moral stress for ambulance personell. To continue this development, ethics rounds are requested more regularly and that everyone in the workplace should participate.

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Thesis (MPhil)--Stellenbosch University, 2011. / ENGLISH ABSTRACT: Background: The theoretical / cognitive component of ethics and professionalism teaching to undergraduate medical students at Stellenbosch University (SU) is well developed, but a concern exists about the need for teaching and assessment of clinical ethics and professionalism on ward rounds. Some teaching does take place during clinical rotations in the form of role modelling as part of the hidden curriculum. Opportunities should be created for explicit teaching of ethics and professionalism beyond the hidden curriculum. Assessment of the cognitive component of ethical and professionalism occurs, but assessment of clinical ethics and professionalism during clinical rotations remains a challenge. Methods: This was a non-experimental study and included three subgroups of undergraduate medical students in their clinical years as well as a random sample of educators involved in clinical training. Questionnaires were distributed to the students and educators. This was followed by focus group interviews among the students. Results: A majority of the students (88%) had indicated that they had experienced ethical and professional dilemmas while working in the wards or during ward rounds. The main dilemmas revolved around inadequate consent processes, lack of confidentiality and privacy, disrespect for patients, poor communication and students being expected to perform tasks they were not trained for. An average of 64% of students indicated that ethical and professional issues were not discussed during the clinical rotations in hospitals. Seventy-eight percent of students indicated that they did not feel free to discuss their own feelings or beliefs on ward rounds. All of the educators felt that there was a need for increased teaching and assessment of the medical students during their clinical rotations. Conclusions: Deliberate opportunities need to be created for teaching ethics and professionalism on clinical ward rounds. This could be a shared responsibility between the clinical departments with continuous input throughout the clinical years of study. Strong institutional support and commitment are necessary to make the teaching sustainable and successful. Structured opportunities need to be developed where students can discuss ethical and professional issues in a safe environment. Further research is needed for the development of an appropriate curriculum and assessment tools. / AFRIKAANSE OPSOMMING: Geen opsomming

Syftet med denna magisteruppsats varatt empiriskt studera och ökakunskapenom hur professioner lär inom vården. Den fokuserar pålärande som förändrat deltagande och förståelse i situerade aktiviteter. Mot bakgrunden av att samtal spelar en avgörande rollför lärande ocheffektivt interprofessionellt samarbete, har fyra ronder på en intensivvårdsavdelning studerats. Kommunikation anses ofta, inom hälso-och sjukvården,vara viktigförgod informationsöverföring. Den här studien fokuserar, förutom på detta, på kommunikation som en konstituerande, social aktivitet som bidrar till lärande genominteraktionellaprocesser. Den teoretiska och metodologiska hemvisten för denna studie ärden etnometodologiska traditionen där samtalsanalys (Conversation Analysis) har en framträdande roll för att analysera lärande i interaktion i vardagliga samtal.För att besvara studiens syfte och frågeställningar har empiriskt material från observationer, ljudinspelningar och dokument samlats in frånfyraintensivvårdsronder på ett sjukhus i Sverige. Analysernasfokus har varit mikroanalytisktdär uppmärksamheten riktats motatt fånga det lärande som uppstår i interaktion mellan ronddeltagarna.Resultatet visadehur professioner inom intensivvården lär i det vardagliga arbetet och hur de i interaktion skapaderelevant kunskap. Analysen visadehur deltagarna i teamet tillsammans skapadekategorier(topiker) och ett meningsfullt innehåll i dessa. Deltagarnasinbördes relationer framträdde genom attde uttrycktesina förväntningar på sin egen och andras kunskaper samtidigt sommotstånd och ifrågasättande kunde bidra till reflektion i teamen. / The aim of this master thesis is to empirically study and contribute to increased knowledge about how professionals learn in hospital settings. It focuses on learning as changing understanding in situated social activities. Four intensive care rounds are studied on the backdrop that conversations play a key role for effective interprofessional collaboration and learning. Communication is often listed as a key ingredient for effective interprofessional practice in health care but is often associated only with information transmission. This study discusses communication not only as information transmission but also as a constitutive, social action that allows us to understand learning as a process of collective sensemaking. The learning that takes place is studied through the theoretical and methodological framework of ethnometodology and Conversation Analysis (CA). Conversational Analysis enables to study learning in interaction. In order to answer the questions posed in the study, the study draws on observations, audio recordings and artefacts from four daily rounds on an intensive care ward in a university hospital in Sweden. The empirical analyse used CA methods, including detailed micro-analytic attention to the spoken interaction. The results show how intensive care professionals learn in their daily work and how they build relevant knowledge during interaction. The analysis is based on how topicalizations and collective meaningmaking produce contents of learning within the team. It also shows how the participants make relevant knowledge relations through their expectations of themselves and others. It also reveals how opposition and questioning can increase learning through reflection.

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This study aims at defining the development of the macro/meso level Swedish labourmarket regime during the last decade. This includes the effect of structural changesand what development tendencies exist. For this purpose three questions have beenformulated:1. How can the macro/meso level relations between the labour market organizations of the bargainingrounds since 1997 be described using the concepts exit, voice and loyalty as an interpretation oforganizational choices?2. How can the changing relations between the labour market organizations be explained?3. Based on this, how can the present labour market regime be defined?For this purpose the concept of labour market regimes is used. The interactionbetween actors in this is interpreted through a cooperative game theory coupled withthe concepts exit, voice, loyalty. Exit means the actors leaving the system,corresponding to the negotiation game threats. Voice means negotiation conflictresolution. Loyalty both correspond to coalition patterns and forces keeping theregime in place. Material is informant interviews with key actors and officialdocuments from bargaining and negotiation. The results of the study are that therelations have been stabilized by the IA of 1997, since which the development istowards increased peak-level organizational involvement. Because of labour marketfragmentation this takes the form in confederation coordination between differentparties. To conceptualize this I propose the concept peak-level coordinatedbargaining. In this the coalition development is towards the reemergence of oldloyalty patterns and the inclusion of new actors in this system. To explain this pathdependency due to well established loyalties and actor continuity is suggested.

This study sought to examine how teachers' experiences with instructional rounds helped develop the tenets of a learning organization. This case study used observations, semi-structured teacher interviews, and document analysis to gather data from a low-income, rural school located in California's Central Valley. The theoretical framework on learning organizations developed by Garvin, Edmondson, and Gino (2008) helped in examining the data. Findings from the research suggests that leadership and the four-step process that guides instructional rounds, along with the protocols used within the instructional rounds practice, influences the development of a learning organization. As a consequence of this study, educators may focus on utilizing instructional rounds to develop habits of learning, while leading and developing a learning organization in a collaborative setting.