<p>Patientsäkerhet och arbetet för att hindra uppkomsten av vårdskador är ett högaktuellt område. Problemet med undvikbara vårdskador är omfattande och i Sverige uppges vårdskador orsaka 630 000 extra vårddygn på ett år, vilket medför både ett mänskligt lidande men också ekonomiska konsekvenser för samhället. Antalet patienter som skadas av vården är ett direkt mått på patientsäkerheten. Brister i kommunikation och teamarbete är en betydande orsak till att vårdskador uppstår. Syftet med studien, som utfördes som en litteraturöversikt, var att belysa faktorer som kunde påverka kommunikationen och teamarbetet i hälso- och sjukvården samt vilken betydelse dessa hade för patientsäkerheten. Femton vetenskapliga artiklar analyserades och resultatet visar att kommunikation och teamarbete påverkas av faktorer såsom <em>tillåtande klimat</em>, <em>arbetsmiljö</em>, <em>organisation och</em> <em>ledarskap</em> samt <em>utbildning i kommunikation och teamarbete.</em> Kunskap och färdigheter inom kommunikation och teamarbete ansågs vara lika viktigt som den kliniska kompetensen men har hittills inte prioriterats i tillräcklig utsträckning. Detta visar på ett ökat behov av utbildning för att på så vis kunna förbättra förutsättningarna för att utöva en patientsäker vård.</p> / <p>Patient safety and the task of preventing the occurrence of adverse events is a highly current issue. The problem with adverse events is extensive and in Sweden, adverse events are causing 630 000 additional days of health care each year resulting in human suffering as well as financial consequences for the society. The number of patients harmed due to hospital-acquired conditions is a direct measurement of patient safety.  Inadequate communication and teamwork is a significant reason for the occurrence of adverse events. The purpose of this study, performed as a literary survey, was to illustrate factors that could influence the communication and teamwork in the health care setting and the significance this had for patient safety. Fifteen scientific articles were analyzed and the results showed that communication and teamwork were influenced by a number of factors such as <em>permitting climate, work environment, organization and leadership, </em>and <em>education in communication and teamwork. </em>Knowledge and skills in communication and teamwork is just as important as the clinical skills but has, as of yet, not been prioritized enough which indicates that there is an increased need for education and training in order to improve the conditions for a safe practice in patient care.</p>

Patientsäkerhet och arbetet för att hindra uppkomsten av vårdskador är ett högaktuellt område. Problemet med undvikbara vårdskador är omfattande och i Sverige uppges vårdskador orsaka 630 000 extra vårddygn på ett år, vilket medför både ett mänskligt lidande men också ekonomiska konsekvenser för samhället. Antalet patienter som skadas av vården är ett direkt mått på patientsäkerheten. Brister i kommunikation och teamarbete är en betydande orsak till att vårdskador uppstår. Syftet med studien, som utfördes som en litteraturöversikt, var att belysa faktorer som kunde påverka kommunikationen och teamarbetet i hälso- och sjukvården samt vilken betydelse dessa hade för patientsäkerheten. Femton vetenskapliga artiklar analyserades och resultatet visar att kommunikation och teamarbete påverkas av faktorer såsom tillåtande klimat, arbetsmiljö, organisation och ledarskap samt utbildning i kommunikation och teamarbete. Kunskap och färdigheter inom kommunikation och teamarbete ansågs vara lika viktigt som den kliniska kompetensen men har hittills inte prioriterats i tillräcklig utsträckning. Detta visar på ett ökat behov av utbildning för att på så vis kunna förbättra förutsättningarna för att utöva en patientsäker vård. / Patient safety and the task of preventing the occurrence of adverse events is a highly current issue. The problem with adverse events is extensive and in Sweden, adverse events are causing 630 000 additional days of health care each year resulting in human suffering as well as financial consequences for the society. The number of patients harmed due to hospital-acquired conditions is a direct measurement of patient safety.  Inadequate communication and teamwork is a significant reason for the occurrence of adverse events. The purpose of this study, performed as a literary survey, was to illustrate factors that could influence the communication and teamwork in the health care setting and the significance this had for patient safety. Fifteen scientific articles were analyzed and the results showed that communication and teamwork were influenced by a number of factors such as permitting climate, work environment, organization and leadership, and education in communication and teamwork. Knowledge and skills in communication and teamwork is just as important as the clinical skills but has, as of yet, not been prioritized enough which indicates that there is an increased need for education and training in order to improve the conditions for a safe practice in patient care.

Sammanfattning Syftet med studien var att utvärdera hur barnperspektivet beskrivs och tar sig uttryck på det skyddade kvinnoboendet Siri i Uppsala, ur personalens perspektiv. Verksamheten riktar sig primärt till våldsutsatta kvinnor, men även kvinnornas barn är i behov av stöd och skydd. Av tidigare forskning framgår att barn som har upplevt våld löper risk att utveckla psykiska och sociala problem, vilket därmed innebär att de kan ha särskilda behov som Siri försöker tillgodose. Utvärderingen präglas av en kvalitativ ansats och har genomförts med hjälp av utvärderingsmetoden programteori. Programteorin beskriver hur barnperspektivet är tänkt att genomföras i Siris verksamhet. Utvärderingen ger svar på om personalen upplever att arbetet med barnen genomförs på det sätt som det är tänkt, om arbetet är kunskapsbaserat och om det förefaller vara så att Siri kan nå de mål som programteorin föreskriver. Kvalitativa intervjuer av semistrukturerad karaktär genomfördes med personal med olika utbildningsbakgrund som arbetar eller har arbetat på Siri. Vid analysen har, förutom programteorin, de teoretiska begreppen omsorgs- och delaktighetsperspektivet samt Harts delaktighetsstege använts. Av resultatet framkom att respondenternas uppfattningar gällande Siris målsättning i arbetet med barnen samt vilka aktiviteter det är tänkt att barnen ska erbjudas, överensstämmer med hur de beskrivs i programteorin. Det framkom även att aktiviteterna är förankrade i tidigare forskning gällande behov hos barn som har upplevt våld. I praktiken genomförs emellertid inte alltid de aktiviteter som det är tänkt att Siri ska erbjuda barnen. Hinder för genomförandet som lyfts fram i studien är personal- och bemanningsfrågor, att aktiviteterna inte har hunnit bli välförankrade i praktiken och att Siri är en svårplanerad verksamhet. Till vissa delar förefaller barnperspektivet vara knutet till olika personer även om personalen till stora delar var överens om att verksamheten har ett utvecklat barnperspektiv. Gällande barnens delaktighet på Siri framkom ett dilemma. Då mamman har det yttersta ansvaret för barnet kan personalen inte uppmuntra till mer delaktighet för barnet än vad mamman tillåter, varför olika barn upplevs ha olika möjlighet till delaktighet. Nyckelord: barnperspektiv, skyddade boenden, barn, omsorgsperspektiv, delaktighetsperspektiv / Abstract The aim of this study was to evaluate how the child perspective is described and expressed at the domestic violence shelter Siri in Uppsala. The organisation primarily focuses on women but their children are also in need of shelter and support. Research shows that children who have been exposed to domestic violence are at risk of developing mental and social problems. This means there is a possibility that they have special needs which Siri is trying to provide for. This evaluation is based on program theory and has a qualitative approach. The program theory describes how the child perspective is meant to be implemented in the organisation. The evaluation answers whether the staff experience that the program theory is being implemented as it is meant to be implemented. Furthermore the evaluation answers if the theory is evidence based and if Siri can reach the goals expressed in the program theory. The study is based on semi-structured interviews with members of the staff. The framework for analysing the results, besides the program theory, was the care perspective, the rights perspective and Rogers Harts ladder of children’s participation. The results show that the respondents’ opinions about the organisation’s activities and goals are consistent with the program theory, and that the theory seems to be based on previous research about needs of children who have been exposed to domestic violence. The activities that Siri intends to provide the children are not, however, always implemented in practice. The respondents expressed that the difficulties to implement the activities in the organisation mainly depends on staff issues, but also the fact that Siri is an unpredictable organisation. Furthermore the results show that the organisations’ child perspective, to a certain extent, depends on which member of the staff that is working; the child perspective varies from person to person. In general, however, there was an agreement among the respondents that the organisation is characterised by a child perspective. Keywords: child perspective, domestic violence shelter, children, care perspective, rights perspective

Magister Artium (Social Work) - MA(SW) / This thesis explores the personal, social and environmental factors of caregivers from the Groblershoop community to determine whether these factors influence the caregiver’s ability to provide care to children from birth to six years. Using the Human Capabilities Approach and the Ethics of Care Perspective, this study seeks to examine the resources that are available for caring in Groblershoop. It also explores how the factors above (personal, social and environmental) play a role in how the resources are used by caregivers to increase the well-being of children under six years. The Human Capabilities Perspective purports that caregiving resources are not an end in itself. The resources are only as valuable as they are able to improve the functioning of the caregivers to provide care and assist in ensuring the well-being of the care receivers, namely the children. The Ethics of Care Perspective is used to examine the consequences of inadequate care by the State, community and caregivers themselves.This study was conducted among caregivers from the community of Groblershoop, which is 150km from the main town of Upington in the Northern Cape Province. The town is rural in nature and unemployment, poverty and social ills such as substance abuse and teenage pregnancies are rife. Work is largely seasonal in nature and is found mainly on the surrounding grape and cattle farms. This study is qualitative in nature and used a purposive sampling method. Ten caregivers were selected using the criteria that they must reside in the community of Groblershoop and must be the primary caregiver to children from birth to six years of age, to participate in the semi-structured interviews. Seven other caregivers were also selected using the same criteria above to participate in a focus group interview using participatory action learning techniques. Participant Observation was conducted in the homes of three caregivers that participated in the individual interviews. Additionally, seven individual interviews were conducted with service providers that provide services to the community of Groblershoop.The main findings of the study reflect that the personal, social and environmental factors do influence the caregiver’s ability to provide care to children from birth to six years among a small group of caregivers from the Groblershoop community. The personal factors explored in the study included the age, gender, health status, substance usage, educational level and income of the caregiver. Ill health was found to be a key factor which posed a challenge to caregivers in terms of being able to provide care to children. The World Health Organisation’s five key elements of care was used to provide a framework for assessing adequate caregiving. These factors were sustenance, stimulation, support, structure and surveillance. Factors such as educational levels were closely linked to income levels. The higher the educational level the better the income for the caregiver. The Child Support Grant was a major source of income for the majority of caregivers. Low levels of income also meant that the caregivers were unable to provide adequate nutrition to children.The social factors focused on in this study was public policies which make provision for care resources, parenting practice, support systems, and the gender practices of caregivers. The consequences of inadequate care were examined through focusing on the children and the associated developmental delays experienced by them. The study found that while good public policies exists not enough resources were available to enable these policies to increase the well-being of people at community level. The lack of resources available for caring in the Groblershoop community impacted on parenting practices of caregivers. Caregivers in this study, due to the lack of resources as well as other factors such as limited knowledge of child care, resulted in care being considered inadequate using the World Health Organisation’s five elements of care. Gender practices among the caregivers are based on the stereotypical gender roles which sanction the ideology of patriarchy. Women are the primary caregivers and the biological fathers were absent from the caring process. The environmental factors that were explored in this study were the climate, the physical home environment and the neighbourhood condition. Due to the excessive summer heat and the harsh cold of winter, physical activity and movement in the community is severely hampered. During summer, families sleep outside as the housing structures are built in a way that retains the heat and is freezing in the winter. Dwellings are small and typically compromises of a big room sub-divided by the family themselves. No ablution facilities are available inside dwellings and some homes still make use of chemical toilets and pit latrines.Crime and violence is closely linked to the alcohol usage at the local shebeens. These factors impact on caregiving as the environment with the lack of facilities and the harsh climate lends itself to fostering of illnesses amongst children.The study concludes that the personal, social and environmental factors significantly influence the caregiver’s ability to provide care to children from birth to six years in Groblershoop. To assist the development of children, it is essential that the above factors are considered as they influence the ability of the caregiver to use resources to achieve wellbeing. The findings of this study provides a good argument for an integrated coordinated approach to service delivery which takes into account the distinct challenges of rural communities, with regards to their distance from urban centres and the current lack of infrastructure within these communities. The study highlights the importance of focusing on how resources can effectively improve the quality of life of caregivers in communities as opposed to just making resources available and ensuring uptake. As this study demonstrates through the Human Capabilities lens, that resources alone do not result in people being able to live the lives they value. Ensuring that they are able to convert the resources into wellbeing should be the focus of how the State evaluates the effectiveness of programmes. November 2009