The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is that leaders at all levels should be positive role models to staff to encourage a culture of caring and positive attitudes that supports service delivery. However, mental health care in practice is in contradiction to this ideology of how mental health should function. In reality, regular involuntary treatment, minimal patient contact with therapists, negative attitudes, pressure of beds not being available as well as regular seclusions due to unmanageable situations are experienced in practice. The aim of this study is to explore and describe the role of the nursing unit manager to improve nursing teamwork in a mental health care facility in Gauteng in order to improve the quality of health care. A qualitative, explorative, interpretive descriptive and contextual design was selected to address the research question at hand. Non-probability, purposive sampling was used. A focus group discussion was held (n=8) and graphic team sculptings were done with each participant (n=9). The state of the current nursing team was described and explored as well as the practical intervention aimed at improving nursing teamwork. Data of the focus group was analysed using content analysis. Graphic team sculptings were analysed by interpretation analysis. The results of this research study indicated that nursing teamwork is influenced by various factors that can be categorized as organisational-, unit specific- and unit manager specific factors. There might be a negative organisational culture and negative attitudes of team members. There is uncertainty in the hierarchy structures, below the unit manager that causes power struggles, this has an effect on the responsibility and accountability in the absence of the unit manager. Individual team member’s needs constant supervision and direction to complete their daily tasks. The unit managers feel like there is poor support from top management. The general ward assistants and administrative clerks is seen as part of the team, although they are not directly involved with patient care, they contribute to the teams functioning. Mental health care facilities are overcrowded and this increases the workload of the nursing team. Trust and cohesion within the teams is low with poor communication between team members due to clique formation. The unit manager plays a vital role through leadership, collaboration, fair delegation and guidance. Individualism and diversity should be embraced. The unit managers acts as a role model and leader that bring the teams together and solve problems, facilitates effective communication and involves all the team members in decision making. / MCur, North-West University, Potchefstroom Campus, 2014

The nursing team in a mental health care facility is a known dynamic at every hospital, rehabilitation centre and out-patient unit which enables these units to be functional. Currently nursing teams function in a challenged environment in mental health care facilities. The National Department of Health in South Africa states that one of the priority areas in the core standards of health care is to improve values and attitudes of health care professionals. One of the ways to accomplish this is that leaders at all levels should be positive role models to staff to encourage a culture of caring and positive attitudes that supports service delivery. However, mental health care in practice is in contradiction to this ideology of how mental health should function. In reality, regular involuntary treatment, minimal patient contact with therapists, negative attitudes, pressure of beds not being available as well as regular seclusions due to unmanageable situations are experienced in practice. The aim of this study is to explore and describe the role of the nursing unit manager to improve nursing teamwork in a mental health care facility in Gauteng in order to improve the quality of health care. A qualitative, explorative, interpretive descriptive and contextual design was selected to address the research question at hand. Non-probability, purposive sampling was used. A focus group discussion was held (n=8) and graphic team sculptings were done with each participant (n=9). The state of the current nursing team was described and explored as well as the practical intervention aimed at improving nursing teamwork. Data of the focus group was analysed using content analysis. Graphic team sculptings were analysed by interpretation analysis. The results of this research study indicated that nursing teamwork is influenced by various factors that can be categorized as organisational-, unit specific- and unit manager specific factors. There might be a negative organisational culture and negative attitudes of team members. There is uncertainty in the hierarchy structures, below the unit manager that causes power struggles, this has an effect on the responsibility and accountability in the absence of the unit manager. Individual team member’s needs constant supervision and direction to complete their daily tasks. The unit managers feel like there is poor support from top management. The general ward assistants and administrative clerks is seen as part of the team, although they are not directly involved with patient care, they contribute to the teams functioning. Mental health care facilities are overcrowded and this increases the workload of the nursing team. Trust and cohesion within the teams is low with poor communication between team members due to clique formation. The unit manager plays a vital role through leadership, collaboration, fair delegation and guidance. Individualism and diversity should be embraced. The unit managers acts as a role model and leader that bring the teams together and solve problems, facilitates effective communication and involves all the team members in decision making. / MCur, North-West University, Potchefstroom Campus, 2014

Doctor of Philosophy / Curriculum and Instruction Programs / Charles E. Heerman / As the world has changed over the last century, so has the world of work. Today’s knowledge workers have fewer individual repetitive tasks, more autonomy, and more need to work with and through people at every level of an organization (Overtoom, 2000). As a result of the ‘flattening’ of the organizational hierarchy, it is critical that employees at all levels are proficient in soft skills. Recent studies indicate that employers consistently rate these skills as deficient in their incoming hires. Skills such as communication, teamwork, leadership and adaptability are commonly ranked as deficient. Academic leadership education strongly emphasizes this valuable skill set often referred to as soft skills. This study examined the relationship of the soft skills gained to the amount of leadership education completed by Fort Hays State University graduates using the Teamwork Skills Questionnaire (O’Neil, Lee, Wang & Mulkey, 1999). Those who received no leadership education from the FHSU Department of Leadership Studies were compared with those who received a leadership certificate and those who received a bachelor’s degree in Organizational Leadership. The study provided insight into whether academic leadership education enhances graduate’s soft skill development and to assess the impact this has on their perception of teamwork proficiency in the workplace. Results indicate that the leadership certificate does not significantly change soft skill development in graduates’ self-reported perceptions, as compared to students with no leadership coursework. It was found that the bachelor’s degree does make limited significant changes in graduates’ soft skill proficiency as compared with graduates who received the leadership certificate. Multiple significant changes were found in graduates with bachelor’s degrees as compared with graduates who received no leadership coursework. Recommendations to be considered when conducting further research include the use of qualitative methodology, the inclusion of more universities that offer a degree in Organizational Leadership, and the measurement of other skills the leadership coursework may produce but was not reflected in this instrument.

Résumé : Confrontées à un environnement toujours plus turbulent et compétitif et à la nécessité de s'adapter avec souplesse et agilité, les entreprises ont de plus en plus recours aux technologies et aux applications informatiques collaboratives afin de créer et de mobiliser des équipes de projet. L'objectif sous-jacent est de les rendre aussi efficaces et efficientes que possible, indépendamment du lieu et du temps de travail. Dans ce contexte, les équipiers doivent s'approprier les technologies qui sont mises à leur disposition afin de se soutenir mutuellement et d'assurer la gestion des ressources dont ils disposent, de façon à produire leurs livrables efficacement et suivant le rendement attendu. L'objectif de cette thèse de doctorat est d'analyser si l'appropriation d'une technologie virtuelle de travail contribue effectivement à soutenir le fonctionnement interne et l'efficacité d'équipes de travail à durée déterminée, ainsi qu'à analyser le rôle médiateur du fonctionnement interne entre l'appropriation d'une part, et l'efficacité d'autre part. L'appropriation renvoie ici à la mesure dans laquelle les équipiers s'entendent a) sur les modalités d'utilisation (accord sur l'usage) de la technologie collaborative de travail qu'il partage et l'environnement virtuel qu'elle constitue, b) sur l'usage qu'ils en font, c) sur le sentiment de possession (appropriation psychologique) qu'ils peuvent exprimer à son égard. La présente recherche a été réalisée grâce à l'administration d'un questionnaire d'enquête auprès d'un échantillon de 304 personnes regroupées en 34 équipes de travail à durée déterminée. Les résultats obtenus permettent de constater que deux variables, soit l'appropriation psychologique et l'accord sur l'usage, sont liées positivement aux deux dimensions du fonctionnement interne de l'équipe, à savoir au soutien interpersonnel et à la gestion du travail d'équipe. L'accord sur l'usage est de surcroît lié aux trois critères d'efficacité, soit à la qualité de l'expérience groupale, à la pérennité et au rendement. L'appropriation psychologique n'est toutefois pas liée au troisième critère, soit au rendement. L'usage est lié uniquement au soutien interpersonnel et à la qualité de l'expérience groupale, et ce, de manière négative. Par ailleurs, les tests de médiation réalisés permettent de constater que le fonctionnement interne de l'équipe semble effectivement jouer un rôle médiateur entre, d'une part, l'appropriation psychologique et l'accord sur l'usage et, d'autre part, les trois critères d'efficacité. Cette thèse de doctorat contribue de plusieurs manières au développement de la connaissance. Elle permet d'abord de constater qu'il est possible de s'approprier psychologiquement un environnement virtuel de travail, et que cette appropriation est en lien avec le fonctionnement interne et l'efficacité des équipes de travail. De plus, elle permet aussi de constater que cette variable se distingue bien d'un autre construit, soit de l'accord sur l'usage. Il s'agit à ces égards d'une première qui a permis l'élaboration d'un instrument de mesure doté de propriétés psychométriques intéressantes. Elle contribue aussi à la généralisation possible d'une conception multidimensionnelle du fonctionnement interne et de l'efficacité des équipes de travail à durée déterminée. Le constat d'un rôle médiateur du fonctionnement interne entre deux formes d'appropriation et certains des critères d'efficacité constitue aussi une observation intéressante et inédite dans le contexte de l'usage d'une technologie collaborative au sein des équipes à durée déterminée. Ce cadre de mesure semble donc pouvoir s'appliquer aussi aux équipes de projet.||Abstract : Faced with an ever changing and compétitive environment, and with the necessity of adapting with agility and rapidly, companies rely more and more on technology and Groupware to create and mobilize project teams. The underlying objective is to make them as efficient and effective as possible, regardless of the time and place that members add their collaborations. In order to collaborate in such a context and to produce their work efficiently and according to the desired outcome, team members must first appropriate the technologies that are made available to them, whose purposes are mutual support and proper management of resources. The goal of this research is to analyze if the appropriation of a virtual office contributes effectively to support the team and the efficiency of project teamwork, as well as to analyze the mediating rôle of the internai functioning between appropriation and efficiency. In this case, appropriation refers to the measure of the team members' consent a) on the consensus on appropriation of the Groupware that they will be using and the virtual environment that it constitutes, b) on actual Groupware use, c) and on psychological appropriation towards the Groupware. This research was carried out by handing out a survey to a sample of 304 people grouped into thirty-four teams working on projects with fixed terms. The results of this study indicate that the two variables, psychological appropriation and consensus on appropriation, are positively correlated to the two dimensions of the internai functioning; interpersonal support and management of work. Moreover, the consensus on appropriatio is also linked to the three criteria for efficiency: the quality of the group work experience, the durability and the output. However, there is no indication of a corrélation between the psychological appropriation and the third factor of efficiency, output. The results do indicate that actual Groupware use is negatively connected to interpersonal support and to the quality of the group work experience. Indeed, the test for the mediating rôle of the internai functioning of the group indicate that there is, in fact, a relationship between the psychological appropriation and the consensus on appropriation, and the three factors of efficiency. This doctoral thesis contributes in many ways to the development of knowledge on this topic. Firstly, there is a clear démonstration that psychological appropriation is, in fact, possible for a virtual work environment, and that this appropriation has a link with the internai functioning and efficiency of a project team. Moreover, the research also helps to demonstrate that the psychological appropriation is distinct from other variables such as consensus on approproation. Indeed, this unique factor allowed for the création of an interesting new measuring device with psychometric attributes. The research also contributes to a certain généralization of the multidimensional conception of the internai functioning and efficiency of group work. Finally, the récognition of the mediating rôle of the internai functioning between two types of appropriation and some of the efficiency criteria is both interesting and un-heard of in the context of the use of Groupware by work group with fixed terms. So, it would seem that the measurement framework could also be applied to project teams.

Syfte. Att beskriva sjuksköterskors upplevelse av bedsiderapportering på postoperativ avdelning. Bakgrund. Sjukvården blir ständigt mer specialiserad vilket resulterar i att fler yrkeskategorier blir involverade i patientens vård. Därmed ökar antalet rapporter vilket gör att de behöver bli effektivare och mindre tidskrävande. Bedsiderapportering syftar till att vara patientcentrerad men i vissa fall kan sjuksköterskorna anse att bedsiderapportering bryter mot lagen om sekretess. Metod. Kvalitativ intervjustudie med 9 deltagare. Resultat. Ett övergripande tema kunde identifieras: Bristande följsamhet till lagen om sekretess och patientens integritet. Ur temat framkom två kategorier: Att känna sig maktlös samt Att kränka patientens privata sfär. Slutsats. Studien visar på att sjuksköterskor upplever konflikt mellan att skydda patientens sekretess, integritet och att delta i bedsiderapportering. Ett flertal olika bidragande faktorer identifierades / Aim. To describe nurses experiences of bedsidehandovers at the postoperative unit. Background. Healthcare is becoming increasingly specialized, resulting in several professionals involved in patient care. This increases the number of handovers, which means that they need to be more efficient and less time consuming. Bedsidehandover aim to be patient-centered, but in some cases, the nurses believe that bedsidehandover violate the law of confidentiality. Method. A qualitative interview study with 9 participants. Results. An overarching theme could be identified: Lack of adherence to the law on confidentiality and patient privacy. From the theme emerged two categories: to feel powerless and to violate the patient's privacy. Conclusion. The study shows that nurses are experiencing conflict between protecting patient confidentiality, integrity, and to participate in bedside handover. A plurality of various contributing factors where identified. Keywords. Bedsidehandover, patient-centered, teamwork, work, specialist nurse

Barnmorskan handlägger den normala förlossningen där förebyggande och sjukvårdande åtgärder ingår. Hela arbetslagets kunskaper och erfarenhet ska tillvaratas och vårdarbetet fördelas utifrån patientens behov. World Health Organisation (WHO) menar i definitionen av sexuell och reproduktiv hälsa att det är kvinnors rättighet att gå igenom en säker förlossning. En förlossningsskada eller komplikation kan påverka kvinnans sexuella och reproduktiva hälsa negativt postpartum. I Sverige har 23 förlossningskliniker av 49 implementerat ett arbetssätt med kollegial närvaro under förlossningens utdrivningsskede. Syftet med studien var att beskriva den förlösande barnmorskans upplevelse av kollegial närvaro under förlossningens utdrivningsskede. Ett frågeformulär med öppna frågor användes där 32 av 44 tillfrågade barnmorskor svarade. Resultatet analyserades med kvalitativ innehållsanalys. Kollegial närvaro upplevs som ett "Kollegialt stöd" genom att kollegan bidrar till en trygghet och det finns möjlighet till assistans. Det "kollegiala lärandet" innebär en upplevelse av möjlighet till vägledning och lärotillfälle. Barnmorskorna upplever att "Teamwork är en förutsättning för en fungerande kollegial närvaro" då det finns ett bristande teamwork barnmorskorna emellan och det finns en oklar kollegial betydelse för utförandet av perinealskydd. Arbetsplatsens kultur kan påverka barnmorskornas upplevelse och agerande. Stödet av kollegan kan påverka kvinnans vård då en högre säkerhet möjliggörs genom att någon mer bedömer handläggningen. Barnmorskor har olika synsätt på hur vården ska bedrivas, såsom "with woman" eller "with institution". Kollegial närvaro kan upplevas som teamwork om inte upplevelsen är att kollegan lägger sig i handläggningen eller tar över. Att reflektera förbättrar yrkesutövningen och kan även ha en terapeutisk effekt. Genom att lära av varandra kan barnmorskorna utvecklas i sin profession.

Bakgrund: Att överföra forskningsresultat till det kliniska arbetet beskrivs som komplext. Trots omfattande forskning kring implementeringsriktlinjer brister kunskapen om vilka de mest effektiva strategierna är. Syfte: Att undersöka vårdpersonalens erfarenheter kring implementering och tillämpning av Bergenmodellen inom psykiatriska vårdenheter inom Stockholms läns landsting. Metod:Kvalitativ forskningsintervju valdes som metod. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Resultaten visar att vårdpersonalen ansåg att Bergenmodellen har gett dem ett förebyggande verktyg i det dagliga arbetet med patienter, där det förekommer hot och våld situationer. De kategorier som uppkom var Otydlig arbetsledning, Ett förebyggande arbete, Vårdande perspektiv, Kommunikation och Repetitioner. Majoriteten av informanterna uttryckte en bristfällig arbetsledning under en pågående hot och våldssituation. Det fanns ingen struktur i arbetsledning under en aktuell hot och våldssituation och en önskan om tydlig arbetsledning önskades från majoriteten av deltagarna i form av att sjuksköterskan skulle inneha den ledande funktionen. Slutsats: Denna studie visar att Bergenmodellen har bidragit till det förebyggande arbetet inom hot och våld i psykiatrisk vård. Bergenmodellen ger förbättrade förutsättningar i omvårdnaden och arbetet med patienter i psykiatrisk vård. Det finns en tydlig önskan om att sjuksköterskan i psykiatrisk vård skall ta sig an den ledande rollen under akuta hot och våldssituationer. Klinisk betydelse: Många olika faktorer påverkar om forskningsresultat lyckas införas i praktiken eller inte. Den stora utmaningen är att hitta lösningar för att implementera rådande forskning i praktiken på ett enkelt sätt. Resultaten i denna studie kan också visa på ett behov av utvärdering av Bergenmodellen, vad gäller att klargöra ansvarsområden. / Background:Transferring results from research to clinical praxis seems to be very complex. In spite of extensive research about implementation guidelines there are insufficient facts about what strategies are the most effective. Specialist nurses within psychiatric care can with his/her specific competence improve the general care of psychiatric patients. Purpose: The aim with study was to examine health care personnel´s experiences of and work with the Bergen model within psychiatric health care wards in Stockholm Läns Landsting. Method:Qualitative interviews were chosen as method. Data was analyzed with content analysis. Results: The results showed that the health care personnel found the Bergen model to be an essential tool that could be used daily, in working with the patients. It is shown to be useful in situations where threats and violence occur. The categories that emerged from the content analysis were: Unclear staff management, A preventive undertaking, A caregiving perspective, and Communication and Repetition. The majority of the interviewees expressed inadequate staff management during threatening and violent situations and there was no structure during these situations. It was requested from the majority of the participants that the nurse was the one to take charge and to fill the leading role. Conclusions: in conclusion, the results from this study shows that the Bergen Model has contributed to help with the prevention of violence and threats. It has given the health care personnel a better decision-making capacity in threat full situations with patients in psychiatric wards. This study shows that a leader is needed in threatening and violent situations, and that the nurse was preferred to be the one to take on the leading role. Clinical significance: There are a lot of different factors that can affect the way the results from research can be used in clinical praxis. The biggest challenge is to find solutions to implement existing research into clinical praxis in a simple way. The results from this study can also show a need for an evaluation of the Bergen Model, pertaining to clarifying each and everyone´s responsibilities.

Bakgrund: Fundamenten i vården grundar sig i ett värdefullt bemötande där patientens grundläggande behov tillgodoses. Ett fungerande team i vårdarbetet är en viktig del i att skapa en personcentrerad och patientsäker hälso- och sjukvård. Dessa faktorer är viktiga delar i ett gott omhändertagande av patienter på en akutmottagning. Syfte: Syftet med denna studie var att utforska vilka omvårdnadsbehov som blir tillgodosedda hos kritisk sjuka eller skadade patienter samt funktionen av teamsamverkan på akutmottagningen på Akademiska sjukhuset i Uppsala. Metodbeskrivning: En kvalitativ fältstudie inspirerad av principerna för praktisk etnografi. Med hjälp utav ett observationsprotokoll utfördes 50 observationer som sedan analyserades med deskriptiv statistik samt en innehållsanalys. Resultat: Resultaten från denna studie visar att personalen var skickliga på att kommunicera och skapa en relation med patienterna. Däremot var de inte lika bra på att göra patienterna delaktiga i vården. Otillräckligt tillgodoseende av patientens omvårdnadsbehov förekom speciellt rörande behandling av patientens smärta och hänsynstagande till patientens integritet. Teamet kring patienten på akutmottagningen upplevdes strukturerat och fungerande. De arbetsmodeller för teamerabete och kommunikation som implementerats på akutmottagningen användes i liten utsträckning.  Slutsats: Personalen på akutmottagningen har en god förmåga till kommunikation och att skapa en relation med patienten samt att arbeta i team. Detta är värdefullt för att skapa en god och trygg vård. Patienternas behov av smärtlindring och integritet blir dock inte tillgodosedda på akutmottagningen. / Background: The fundamentals of care are the basic human needs that have to be met in the treatment of patients to maintain quality care. To ensure safe and person- centered care the team working with the patients needs to be organized and functional. Objective: The aim of this study was to explore how the fundamentals of care needs are met for critical ill patients, and the structure and function of the team in the emergency department. Method: A qualitative field study inspired by the principles of practical ethnography. Fifty observations were made in the emergency department using a protocol and analyzed with descriptive statistics and a content analysis. Results: The results in this study shows that the staff was skillful in communicating and creating a relation with the patients, but not so much in making the patients involved in their care. The basic needs of the patients where insufficient met, especially concerning treatment of pain and taking the patients integrity into account. The teamwork was perceived as structured and functional. The implemented models according teamwork and communication of working in the emergency department was not used sufficiently. Conclusion: The staff´s ability to communicate, establish a relationship with patients and to work in teams where identified which contribute to a sense of comfort and security for the patient. Although the needs for analgetica is not fulfilled and the respect for patient´s integrity is not fully taken into account.

No description available.

Coordination is a vital component in health care provision and teamwork. The need for better coordination is particularly prominent in outpatient setting where patients assume the primary responsibility to follow-up on their own health care, especially when treatment is complex and lengthy in duration. Relational coordination represents a type of informal coordination process reinforced by communication and supportive relationships. This concept has been associated with enhanced interprofessional team performance, including patient care outcomes. This study aimed to examine the theoretical underpinnings of relational coordination in the outpatient setting using social capital theory. It was hypothesized that social capital, resources embedded within network of relationships, would predict relational coordination. Additionally, social capital was hypothesized to be predicted by team tenure; and relational coordination was hypothesized to be predicted by formal coordination mechanisms. A non-experimental, cross-sectional survey design was used to examine the relationship between social capital and relational coordination. Participants (N=342) were physicians and nurses recruited from outpatient clinics in two University affiliated hospitals. Study surveys were sent to 501 nurses and 187 physicians with follow-up reminders sent at three, five and seven weeks after the initial distribution of surveys. The overall response rate was 49.71%. Study variables were measured using previously validated instruments with acceptable levels of reliability and validity. Structural equation modeling (SEM) was used for hypothesis testing. Final analysis revealed good fit of data to the hypothesized model (Chi-square=383.38, df=177, p<0.001; CFI=0.966; RMSEA=0.060; SRMR=0.0316). SEM revealed that social capital predicted both factors of relational coordination [communication (β=0.70, p<0.001); supportive relationship (β=0.81, p<0.001)], and team tenure predicted social capital (β=0.13, p<0.05). In addition, the association between team tenure and relational coordination (β=0.09, p<0.05) was found to be partially mediated by social capital. Findings of this study suggested that characteristics within relational ties are predictive of informal coordination. Administrators may facilitate teamwork through team building initiatives that foster these relational qualities, such as trust and shared language. Future research can further investigate the association between social capital and relational coordination in other health care settings, as well, in larger teams involving health care professionals in addition to physicians and nurses.