There are great expectations that collaboration among professions and various sectors will further develop health care and thus lead to improved public health. In the World Health Organization’s declaration “Health 21” the designated goal for health professions in the member nations in Europe by the year 2010 is to have developed health promotional competence, including teamwork and cooperation based on mutual respect for the expertise of various professions. The challenges faced by the interprofessional teams are, however, multifaceted, and these challenges place demands upon society, which, in turn, determines the fundamental conditions for collaboration among the health professions within the health care organizations. This licentiate dissertation contains discourse and content analyses of interprofessional teamwork in health care. The major objective of this dissertation is to study and describe how the team members construct and create the content and significance of teams and teamwork among health professions. One specific goal has been to study how the members of a multi-professional health care team refer to their team, especially the discursive patterns that emerge and the function that these patterns has (I). The second specific goal has been to identify and describe the difficulties that the health professionals have experienced within their interprofessional teamwork. One purpose has been to enable discussions of the implications for interprofessional learning (II). Focused group interviews with team members (n=32) from six teams were studied using discursive social psychological research approach. The analysis concentrated on the use of the pronouns “I”, “we” and “them”. The results were then analyzed in relation to theories on discursive membership and discursive communities (I). Individual semi-structured interviews with team members (n=18) from four of the six teams were carried out using critical incident techniques. The interviews were analysed via latent qualitative content analysis and the results were interpreted in the light of theories on sociology of professions and learning at work (II). The findings showed that two discursive patterns emerged in the team members’ constructions of “we the team”. These patterns were designated knowledge synergy and trustful support (I). The following three themes that touched upon the difficulties of interprofessional teamwork were identified in the personal interviews: (A) difficulties concerning the teams’ dynamics that arose when the team members acted as representatives for their respective professions; (B) difficulties when the various contributions of knowledge interacted in the team; and (C) difficulties that were related to the surrounding organisation’s influence on the team (II). The conclusion was reached that the discursive pattern provided rhetorical resources for the team members, both in order to reaffirm membership in the team and to promote their views with other care providers, but also to deal with difficulties regarding, for example, lack of unity in outlook. The conclusion was also drawn that, in addition to the individual consequences, one outcome of the perceived difficulties was that they caused limitations of the use of collaborative resources to arrive at a holistic view of the patient’s problems. Thus the patients could not be met in the desired manner. The practical implications of the research project concern the development of teams in which various forms of interprofessional learning can influence the continued development of the team and the management of health care in regard to the importance of implementation processes and organisational learning. / Stora förväntningar ställs på att samarbete mellan yrkesgrupper och mellan sektorer ska utveckla hälso- och sjukvården och leda till en förbättrad folkhälsa. I Världshälsoorganisationens policydokument “Health21” anges exempelvis målsättningen att hälsoprofessionerna i de europeiska medlemsländerna till år 2010 ska ha utvecklat en hälsofrämjande kompetens som bland annat innefattar teamarbete och samarbete på basis av ömsesidig respekt för de olika professionernas expertis. Det interprofessionella teamets utmaningar är dock mångfacetterade och kräver uppmärksamhet från det samhälle som skapar villkoren för hälsoprofessionernas samarbete inom hälso- och sjukvårdens organisationer. Denna licentiatavhandling innehåller diskurs- och innehållsanalytiska studier om interprofessionellt teamarbete i vården. Avhandlingens övergripandet syfte var att undersöka och beskriva hur teammedlemmar konstruerar och skapar innebörder av team och teamarbete mellan flera hälsoprofessioner. Det ena specifika syftet var att undersöka hur medlemmar i multiprofessionella vårdteam talar om sitt team, särskilt avseende de diskursiva mönster som framträdde och vilken funktion dessa mönster hade (studie I). Det andra specifika syftet var att identifiera och beskriva svårigheter som hälsoprofessioner har uppfattat vid interprofessionellt teamarbete, där avsikten även var att möjliggöra en diskussion om implikationer för interprofessionellt lärande (studie II). Fokusgruppintervjuer med teammedlemmar (n=32) från sex team analyserades utifrån en diskursiv socialpsykologisk forskningsansats och fokuserade på användningen av pronomina ”jag”, ”vi” och ”de”. Fynden relaterades sedan till teorier om diskursivt medlemskap och diskursiva samhällen (studie I). Individuella semistrukturerade intervjuer med teammedlemmar (n=18) från fyra av de sex teamen genomfördes med critical incident-teknik. Intervjuerna analyserades via latent kvalitativ innehållsanalys och fynden tolkades utifrån teorier om professionssociologi och lärande i arbetet (studie II). Resultaten visade att två diskursiva mönster framträdde i teammedlemmarnas konstruktioner av ”vi-som-team”. Dessa mönster benämndes kunskapssynergi och tillitsfullt stöd (studie I). Vid individuella intervjuer med teammedlemmar identifierades följande tre teman som rörde svårigheter vid interprofessionellt teamarbete; (i) svårigheter som gällde den teamdynamik som uppstod när teammedlemmarna agerade som företrädare för sina professioner i relation till teamet, (ii) svårigheter när medlemmarnas olika kunskapsbidrag interagerade i teamet och (iii) svårigheter som rörde den omgivande organisationens påverkan på teamet (studie II). Konklusionen gjordes att de diskursiva mönstren utgjorde retoriska resurser för teammedlemmarna, både för att bekräfta medlemskapet i teamet, för att hävda sina åsikter i kontakter med andra vårdgivare (”de andra”) och även för att hantera uppfattade svårigheter beträffande exempelvis bristande samsyn. Vidare drogs slutsatsen att en konsekvens av de uppfattade svårigheterna var, förutom individuella konsekvenser, begränsningar i användandet av de gemensamma resurserna för att nå en helhetssyn på patientens problem och att patienterna inte kunde bemötas på det sätt som önskades. Forskningsprojektets praktiska implikationer rörde teamutveckling där olika former av interprofessionellt lärande påverkar teamets fortsatta utveckling, samt ledning av hälso- och sjukvården avseende betydelsen av imple-menteringsprocesser och organisatoriskt lärande.

Syftet: Syftet med studien var att beskriva hur omvårdnadspersonal inom kommunens särskilda boende och korttidsboende upplever att vårda personer i livets slutskede.Metod: Studien bygger på åtta kvalitativa intervjuer med undersköterskor. Datainsamlingsmetoden baserades på Critical Incident Technique och som analysmetod användes kvalitativ innehållsanalys. Resultat: I intervjuerna framkom att samarbetet till de övriga i teamet och närstående hade en stor och avgörande betydelse för hur vården utvecklades. Omvårdnadspersonalen kände ibland att sjuksköterskan saknades i vissa omvårdnadssituationer. Fördelning av personal under dygnet bidrog till kontinuitet i samverkan. De upplevde att olika faktorer i miljön kunde vara både till hjälp eller till hinder i samspelet till den döende och närstående. De intervjuade talade också om vikten av att respektera patientens vilja. Omvårdnadspersonalen gav även stöd till de närstående och de kom familjerna nära. De upplevde att närvaro utan krav och stress var av betydelse för interaktionen till den döende och dess närstående. Det var viktigt att både den döende och de närstående var tillfreds med symtomlindringen. Det var viktigt att få ge ett värdigt omhändertagande efter döden. Slutsats: Det genomgåendet temat visade att interaktion och samverkan med vårdteamet, närstående och patienten var av avgörande betydelseför hur vården i livets slut skulle bli trygg och värdig. / Aim: The aim of this study was to describe how the nursing staff within themunicipality's special housing and short term care perceived their caring forpatients receiving palliative care.Method: The study is based on eight interviews with enrolled nurses. The datacollection method was based on the Critical Incident Technique. The analysis ofinterviews was carried out with qualitative content analysis.Result: Cooperation between the care team and the relatives had a great andsignificant impact on how care was delivered. At times the nursing staff felt thatthe nurse was not present during various nursing interventions. Distribution ofstaff during the day contributed to the continuity of the interaction. The enrollednurses expressed that different environmental factors were either helpful orobstacles in the interaction between the dying person and their relatives. Theenrolled nurses illuminated the importance of respecting the patient's wishes. Thenursing staff provided the families with support which contributed to a feeling ofcloseness. Furthermore, the enrolled nurses felt that their presence withoutdemands and stress were significant in the interaction between the dying personand their family. It was important that the dying patient and their families weresatisfied with symptom control. It was significant to provide a dignified treatmentafter death.Conclusion: The overall theme was that the nursing staff perceived that interactionand collaboration between the care team, family and the patient was of significantimportance for a secure and dignified end of life care.

My purpose with the envisaged study was to determine the effect a critical incident have on employees and how their functioning, psychosocially and at work is affected. Furthermore the goal was to determine if the employees who was affected by a critical incident was exposed to Critical Incident Stress Management (CISM) intervention, and if so did it have an impact on their functioning ( Psychosocial and work performance). An extended literature study was conducted to comprehend the meaning of trauma, the different facets of trauma, how it can impact on an emotional, physical, cognitive and behavioural level. The literature study further focused on the impact of a critical incident on the work performance and family life of the employee. Attention was given to the models in CISM intervention, the role of Employee assistance programs as well as the perceived outcomes of interventions the respondents were exposed to. In the study, data was collected in a qualitative as well as a quantitative manner. In the quantitative study two questionnaires were used as tool to collect information. In the qualitative study the researcher used clinical case notes as part of the document analysis as well as a semi structured interview with both the employee as well as the manager as data sources. Respondents (therapists) were selected according to the probability sampling procedure for the quantitative study and respondents volunteered to participate in the qualitative study after participating in the quantitative study. Participation in the study was voluntary and the participation rate in the quantitative study was 67.5% and in the qualitative study 22.22% It was evident from the study that employees were affected by a variety of critical incidents divergent in severity, circumstances and duration. The impact on each individual was unique and responses ranged in terms of severity. It was evident from the study that employees were affected by the critical incident and subsequently their work performance and psychosocial functioning was affected. The study managed to provide sufficient evidence on the impact of the critical incident on the psychosocial functioning and work performance of the employee. The research proved that individual counselling is effective in working through the incident and improving the psychosocial functioning and work performance significantly. The study also proved that intervention in the form of defusing, debriefing, individual counselling and aftercare is effective in addressing employees' reactions, supporting them to recover emotionally from the critical incident and improving their psychosocial functioning and subsequently their work performance. Conclusions and recommendations were made in terms of the empirical findings. The researcher hope that these conclusions and recommendations will be of value and contribute to the study field of CISM and EAP and have a positive impact on employees exposed to critical incidents and their recovery process. / Thesis (DPhil)--University of Pretoria, 2011. / Social Work and Criminology / unrestricted

För att handha patienter drabbade av akut stroke finns inom Region Gävleborg en rutin kallad Rädda hjärnan. Siffror från kvalitetsregistret Riksstroke visade att det på Gävle sjukhus tog längre tid till livsavgörande behandling än genomsnittligt i Sverige. Orsaken var okänd.   Ett förbättringsarbete inleddes enligt Vanguard metoden, som stipulerar att systemet måste granskas innan förändringar kan testas. Det uppdagades att patienterna ofta handhas av läkare under upplärning och att trombolysbehandlingen kunde tidigareläggas i flödet. En studie genomfördes samtidigt med critical incident technique (CIT). Sex intervjuer och fyra observationer utfördes kring personalens agerande och upplevelser.   Syftet med förbättringsarbetet var att förändra rutinen för att göra tiden till trombolys så kort som möjligt samt att höja kompetensen i två steg. Syftet med studien var att finna kritiska händelser som påverkar patienternas väg mot behandling.   Resultatet av förbättringsarbetet visar att det skett en förändring kring kompetensen i läkargruppen som handhade rädda hjärnan flöden. En ny rutin hann delvis införas, men arbetet pausades på grund av den världsomspännande Covid-19 pandemin. Delaktighet och samverkan över klinikgränser var avgörande för att åstadkomma förändring. Studien fann 123 kritiska händelser som påverkade patientens väg mot behandling, vilka bekräftade nyttan av förbättringsarbetets intentioner, samt fann ytterligare förslag till förändringar. / To treat patients suffering from acute stroke, there is a routine in the Gävleborg Region called Save the Brain. However, data showed that the time to life-decisive treatment was longer than average in Sweden. The cause was unknown.   An improvement project was initiated according to the Vanguard method. It was discovered that patients were often handled by physicians during training and that thrombolysis could be moved to the X-ray department. A study was conducted simultaneously using the critical incident technique (CIT), consisting of six interviews and four observations.   The purpose of the improvement work was to implement a new routine and to increase competence in two steps. The purpose of the study was to find critical events that affect patients' path to treatment.   The result showed that there had been a change in the competence of the medical team that handles the patient. A new routine was partially introduced, the work was paused due to a worldwide pandemic. Participation and collaboration across clinic boundaries were crucial in bringing about change. The study found 123 critical events that affected the patient's path to treatment. They confirmed the intentions of the project, and at the same time found new suggestions for change.

<p>Syftet med denna uppsats är att analysera hur tjänstekvalité inom B2B kan utvärderas samt att analysera om ViewsCapture, en frågeteknik med öppna frågor där respondenten själv kategoriserar sina egna kommentarer, kan tillföra något till befintliga metoder. Vidare avses att koppla samman utvärderingsmetoder med de olika syften företag har för att mäta kvalité.</p><p>Uppsatsen byggs upp av en omfattande litteraturstudie om vad tjänster och tjänstekvalité är, samt varför det är viktigt att utvärdera tjänstekvalité inom B2B. De utvärderingsmetoder som beskrivs i uppsatsen är dels attributbaserade och dels händelsebaserade metoder. Empiridelen består av material från Unified Dialogs AB som har utvecklat frågetekniken ViewsCapture som sedan analyseras tillsammans med befintliga metoder.</p><p>Undersökningen visar att tjänstekvalité handlar om att infria de förväntningar kunden har på en tjänst. Om kunderna skiljer sig signifikant ifrån varandra faller det sig naturligt att mer kvalitativa och mindre standardiserade metoder bör passa bättre. Det beror på att varje kund är unik och tillvägagångssättet många gånger inte är standardiserat, därför är det svårare att på förhand generalisera kring vad företagets kunder finner problematiskt. Genom användning av ViewsCaptures frågeteknik med öppna frågor skapas förutsättningar för att vidareutveckla de befintliga mätmetoderna i syfte att bättre tjäna företags och forskares syften för mätningen. Detta görs exempelvis genom att inhämtning av djupare information från attributbaserade mätmetoder möjliggörs samt att analys av de öppna svaren från en händelsebaserad metod underlättas.</p>

Emergency response team (ERT) member characteristics that contribute to High Reliability performance during patient care resuscitation events or other Critical Incident Management Situations are poorly understood. Findings from this study describe individual characteristics that experienced interprofessional ERT members perceive as contributing to High Reliability performance within the critical incident management context. This study supports the need for interprofessional research about emergency response teams’ High Reliability in hospital-based settings. ERT High Reliability, or “better than expected” team performance has been linked to overall patient care and safety. The purpose of this study was to identify and describe individual team member characteristics that contribute to High Reliability performance of ERT members and the overall emergency response team in a naturalistic setting during Critical Incident Management Situations. Using a qualitative descriptive design, data collection included participant observations, field notes, and interviews. Narrative data were audio-taped, transcribed and coded using Ethnograph v6©. Data content were analyzed thematically using inductive interpretive methods. Two major domains derived from the data were Self-Regulation and Whole-Team Regulation. The overarching theme, Orchestrating High Reliability at the Edge of Chaos, encompassed characteristics contributing to High Reliability performance of the ERT during Critical Incident Management Situations.

A significant amount of research in the field of small business management has correlated small firm performance with the sophistication of overall management skills (see, for example, Gasse, 1997; Gadenne, 1998; Zinger, leBrasseur and Zannibi, 2001; Balderson, 2003) and more particularly problem solving skills. Yet, even though problem solving skills are at the core of the small business management process (Jennings and Beaver, 1997), there has been little research to date that has focused on understanding the actual approach small business owner-managers take to solve the problems they encounter as the present study has done, through the utilization of an interpretive research design applied to a sample of small firms. The primary purpose of this exploratory study is to investigate the nature of problem solving practices adopted by 11 small business owner-managers on Central Vancouver Island, Canada, by identifying the types of problems encountered in the years following their establishment, the actions taken to solve these problems and the outcomes of these actions for the firm. It examines the characteristics of the problemm solving approaches utilized by owner-managers as they encountered problems, and identifies how they perceived the impact of the approach taken on the continued survival of their firm. The methodological approach taken in this study is positioned within an emergent body of research in the field of small business and entrepreneurship that applies an interpretive paradigm to uncover the complex facets of how individuals develop their capabilities and management practices (Chell and Allman, 2003) with a particular emphasis on the small business owner-manager. The interpretive assumptions guiding the research process have allowed new understandings to emerge about problem solving in small firms within the wider context of managerial capability as a critical contributor to small business survival. More specifically, the critical incident technique method (Flanagan, 1954; Chell, 1998), along with an approach to data analysis and coding that draws from grounded theory (Glaser, 1992; Glaser and Strauss, 1999; Strauss and Corbin, 1998), are combined and applied as a qualitative research strategy. This strategy has not previously been used in relation to the study of problem solving in small firms. This interpretive paradigm allows the exploration of how small business owner-managers attach meaning to their subjective experiences and the implications of these perceptions for the business outcomes of the firm, specifically as they relate to solving critical business problems. As a result, the interpretive methods applied in the course of this study make a novel contribution to the field, since they have yielded new interpretations on the nature of problem solving processes in the sample of small firms studied. The findings presented here reveal the intuitive, improvised and non-linear nature of how problems are actually solved in these small firms, in contrast to a number of well-known theoretical research frameworks that propose well-defined and delineated steps in the problem solving process. The results of this study make a valuable contribution to building new theory in this area of inquiry by demonstrating how more dynamic processes occur in practice. An alternative way to conceptualize problem solving in small firms is presented in Chapter 6, A Holistic Framework for Problem Solving in Small Firms.

Financial elder abuse is gaining increasing attention from researchers and policy makers. Such abuse can include theft of money as well as misuse of assets such as property. This research applied judgement analysis methodology to explore professional decision making in the context of such abuse and to identify the nature of the cues used to detect and prevent abuse. Participants included social care, health and banking professionals, who were established as key decision makers. In Phase I, semi-structured interviews (n = 63) were conducted. The critical incident technique was used to identify cue use and decisions taken in the most recent case experienced. Key cues for both social care and health professionals included the nature of the 'financial problem suspected', the older persons 'mental capacity' and the 'identifier of the abuse', this being whether the abuse was directly observed or instead reported by a third party. A separate cue used by health professionals was the individual's 'physical capacity'. Banking professionals did not use physical or mental capacity as cues, but independently considered 'who was in charge of the money'. Decisions made by social care professionals included determining whether safeguarding procedures should be implemented. In Phase II, a factorial survey approach was applied whereby social care, health and banking professionals (n=223) were presented with case scenarios incorporating the cues from Phase I in addition to cues from literature review. Multiple regression analysis and incremental F-tests identified the cues that explained a significant amount of the variance in judgements of certainty of abuse and likelihood of taking action. For example, for social care and health professionals this included the older person's mental capacity, and the nature of the financial problem suspected. The findings could be used to develop a training tool to enable other professionals to improve their strategies for detection and prevention of financial elder abuse.

Approved for public release; distribution is unlimited / This thesis investigates the problems in current naval aircraft cockpits as perceived by fleet naval aviators who are students at the U.S. Naval Aviation Safety School. A critical incident questionnaire provides data that examines the deficiencies of an individual aircraft. These individual aircraft deficiencies are then categorized into twelve major deficiency categories which are common to ore than one aircraft. Various recommendations are made concerning standards, specifications, cockpit research and cockpit design. / http://archive.org/details/pilotreportedhum00dani / Commander, United States Navy

Introduktion: En patient som genomgår en operation har många behov. De vaknar upp i en ny främmande miljö där sjuksköterskan ansvarar för att säkerställa patientens mående. Sverige är idag ett mångkulturellt samhälle med människor med olika bakgrund och språk. Studier visar att språkbrister i vårdmötet mellan sjuksköterska och patient leder till ett sämre omhändertagande och minskar patientsäkerheten. Syfte: Syftet med studien var att identifiera strategier hos specialistsjuksköterskor vid omhändertagande av patienter med annat språk än svenska eller engelska på en postoperativ avdelning. Metod: Studien genomfördes med en kvalitativ, icke-experimentell deskriptiv design. Femton semi-strukturerade intervjuer genomfördes. All insamlad data analyserades med hjälp av Critical Incident Technique. Resultat: Fem generella strategier vid omhändertagande av patienter med annat språk än svenska eller engelska på en postoperativ vårdavdelning identifierades; att kommunicera utan ord, att kommunicera med ord, att nyttja någon som förstår, att skapa en säker vårdmiljö, att använda hjälpmedel. Resultatetvisade att omhändertagande av patienter med ett annat språk än svenska eller engelska i en postoperativ kontext, är komplext.  Slutsats:Specialistsjuksköterskor upplevde att omhändertagandet fungerade bra i sin nuvarande form, trots språkliga svårigheter i kommunikationen med patienter.  Då vissa situationer ändå beskrevs kunna förekomma går det inte dra slutsatsen att de strategier som framkom i denna studie fungerar fullt ut för att skapa en trygg och säker vård. Forskning bör utföras på patienternas upplevelse av situationen i denna kontext.    Nyckelord: Omvårdnad, Postoperativ avdelning, specialistsjuksköterska, strategier, språkbarriärer, kommunikation, Critical Incident Technique Keywords: Nursing, PACU, Nurse specialist, strategies, language barriers, communication, Critical Incident Technique