A new realm of discourse research has started examining medical interactions in the crowded space – hospitals (Iedema, 2007). Beyond clinical settings and dyadic doctor-patient interactions, scholars have begun investigating doctors’ interactions in various hospital settings including Emergency Rooms and hospitals’ wards (e.g., Eggins & Slade, 2012; Slade & Eggins, 2016; Slade et al., 2015). Other investigations have expanded this scope of discourse research to include other health professionals, such as nurses (e.g., Staples, 2015). Drawing on discourse analytic approaches (Critical Discourse Analysis, Halliday’s Systemic Functional Grammar, and Interactional Sociolinguistics), this study examined nurse-to-nurse handoff interactions in two hospitals in Saudi Arabia. Nursing handoff – the transfer of patient information, professional responsibility, and accountability between departing and incoming nursing teams (Manser et al., 2010; Riesenberg et al., 2010; Slade & Eggins, 2016; Wood et al., 2014) – is a critical communicative practice which ensures the continuity and quality of care provided to hospitalized patients. The aim of this study was to provide detailed analyses of the language used in this type of nursing discourse and its impact on the quality of handoffs. The data included 80 nursing handoff interactions, which were observed and audio-recorded in 7 different wards at two sectors (National Guard Hospital and King Fahad General Hospital) in Saudi Arabia including: Intensive Care Units, General-Adult, General- Pediatric, Oncology-Pediatric, Oncology-Palliative, ENT, Urology and Surgical wards. The nurse participants come from various cultural backgrounds including Philippines, Indonesia, India, Malaysia, Morocco, South Africa, Egypt, Jordan, and Saudi Arabia. The analyses provided a detailed description of this type of nursing discourse including the discourse pragmatic features (i.e., linguistic, interactional, and interpersonal features) which nurses use while delivering and receiving patient information. In addition, the findings provide insights into the various discourse features that contributed either positively (e.g., using discourse markers, presenting complete thoughts, presenting sufficient detailed patient information) or negatively (e.g., producing questions instead of statements, shifting verb tenses, focusing on one patient issue as opposed to providing detailed patient information report) to the nursing handoff practices in this setting. The findings also point to the vital role that head nurses play in this nursing discourse and its impact on enhancing the quality of nursing handoffs. Additionally, a six-stage nursing handoff model was developed from the data, which could be used for nursing training in the National Guard Hospital and its branches in Saudi Arabia. Finally, the findings provide further support for Eggins and Slade’s (2012) claim that communicatively effective handovers are achieved interactionally and with the collaboration of both departing and incoming teams. Furthermore, the use of standardized protocols (like SBAR) alone proved to be insufficient in guaranteeing effective nursing handoff.

The ward sister round presents an integral part of the nursing profession. The ward sister round comprises a regular visit of the nurse directly at the patient´s bed. Its objective consists in determining and satisfying the unsaturated needs of patients, further in ensuring and providing a high quality and efficiency nursing care in a close link with medical care. Nursing handover can be divided into two main sections: written and oral handover. The oral handover takes place directly in the patients´/clients´ room under the use of nursing documentation. Its advantage consists in the direct involvement of the patient/client in the handover process. The written handover is then entered by the nurses into the Handover Book. The significance of my diploma work consists in increasing the nurses´ standard of knowledge related to the modernization of ward sister rounds and nursing handover as an integral part of the nursing profession.

Bakgrund: Personcentrerad omvårdnad är något som läggs stor vikt vid i dagens sjukvård. I och med detta får sjuksköterskor större ansvar genom att sätta patienten i fokus. Traditionella överrapporteringar utförs utan patientens närvaro samtidigt som det finns en rapporteringsmetod som istället inkluderar patienten, vilket är bedsiderapportering. Bedsiderapportering är relativt nytt och forskning har främst undersökt sjuksköterskornas perspektiv. Dessutom är traditionella överrapporteringar inte i enlighet med de lagar som styr vården idag. Syfte: Syftet var att belysa patientens upplevelse av bedsiderapportering inom slutenvården. Metod: En litteraturstudie med 10 kvalitativa studier, som kvalitetsgranskades. Resultatanalysen gjordes med hjälp av en kvalitativ metod. Resultat: Generellt upplevde patienter en aktiv delaktighet samtidigt som önskan även framkom om mera delaktighet medan andra uppskattade en mer passiv roll. Språket som sjuksköterskor använde under överrapporteringen upplevdes som svårförståeligt. Bedsiderapportering möjliggjorde för patienter att få mer kunskap om sin vård och om sjuksköterskornas arbete. Patienter upplevde att sjuksköterskor skyddade deras integritet, samtidigt som andra patienter upplevde att sjuksköterskor inte uppmärksammade patienten som en person. Patienter förklarade att de kände sig mer trygga med sin vård då de visste att informationen från föregående sjuksköterska hade överlämnats till den kommande sjuksköterskan. Patienter upplevde att de behandlades som en person i första hand och en patient i andra hand. Slutsats: Eftersom patienter upplevde bedsiderapportering som inkluderande så kan metoden för överrapportering mellan sjuksköterskor ses som ett alternativ till den traditionella för att vården ska vara uppdaterad i enlighet med Patientlagen. Patienter upplevde inte att integriteten var ett bekymmer, vilket tidigare forskning har spekulerat som problematiskt. Mera forskning behövs utifrån patientens upplevelse av bedsiderapportering då forskning saknas. / Background: Person-centered nursing is something that attaches great importance to today's healthcare. With this, nurses become more responsible by focusing on the patient. Traditional nursing handovers are performed without the patient's attendance while there is a reporting method that includes the patient, which is bedside nursing handover. Bedside nursing handover is relatively new and research has primarily examined the nurses' perspective. In addition, traditional nursing handover are not in accordance with the laws governing health care today. Aim: The aim was to illuminate the patient's experience of bedside nursing handover in the field of primary care. Method: A literature study with 10 qualitative studies was used, which was quality-reviewed. The results analysis was done using a qualitative method. Results: Generally, the patients experienced active participation, while also wishing to see more involvement while others appreciated a more passive role. The language that nurses used during the handover were perceived as difficult to understand. Bedside nursing handover enabled patients to gain more knowledge about their care and the nurses' work. Patients perceived that nurses protected their privacy while other patients experienced that nurses did not pay attention to the patient as a person. Patients explained that they felt more secure with their care as they knew that the information from the previous nurse had been handed over to the oncoming nurse. Patients felt that they were treated as a person primarily and a patient secondly. Conclusion: Since patients experienced bedside nursing handover as inclusive, the method of handover between nurses can be seen as an alternative to the traditional nursing handover in care since it is updated in accordance with the Patient Act. Patients did not experience integrity as a concern, as previous research has speculated as problematic. More research on the patient's experience of bedside nursing handover is needed as research is lacking.

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The nursing handover report belongs to everyday activities of nurses. In the work of a nurse it is important to know exactly who, when, where, what and how. This is what the following activity and responsibilities of the duty period are derived from. This diploma thesis, focused on the Nursing Handover Report at a Patient´s Bedside, has a theoretical and practical part. The first, theoretical part, is composed of three chapters, the modern trend of nursing, the nursing report and legislation. The second, practical part, is based on quantitative and qualitative surveys with three defined objectives and four hypotheses. The first objective was to determine what nurses regard as a major contribution of the nursing handover report at a patient´s bedside. The second objective was to define the greatest obstacle in the nursing handover report at a patient´s bedside. The third objective was assessing the patients´ attitude towards the nursing handover report at their bedside. All three objectives were met by the research. The qualitative part of this diploma work was based on a conducted kvasiexperiment and subsequent questions for patients and nurses. The research sample was 5 nurses and 5 patients from the intermediate care unit (IMCU) and 5 nurses and 5 patients from the resuscitation station (RES) of the České Budějovice hospital, PLC. The semi-structured interview consisted of six to eight questions, surveying the feelings, contents, visualization, integration, advantages, disadvantages, departments, nursing handover at the bedside and the quality. The data collection was carried out by means of an anonymous questionnaire designed for nurses to find out how nurses hand the report over or how they would like to hand it over. 303 nurses from the České Budějovice Hospital, PLC, and the Příbram Hospital, PLC, took part in the research. The results were used to confirm or to reject the hypotheses. The first hypothesis: Nurses do not consider an oral handover report as a quality one when done without a visual completion, this has not been confirmed by the investigation. The second hypothesis: In terms of the risk of the patient's damage, the quality of the handover report done by the nurses in the IMCU and the RES is better than that done by the nurses in a standard unit, this has been confirmed. The third hypothesis: Nurses consider the time consuming nature of the handover report at the patient´s bedside as the greatest difficulty, this has not been confirmed. The fourth and last hypothesis: Patients have a positive attitude towards the nursing handover report at the bedside, this has been confirmed by the research. The output of this thesis is to suggest a standard for the nursing handover report at a patient´s bedside. The results can be used for nursing managers, deputy directors of nursing, medical students and nursing professionals.