Thesis (Ph. D.)--Illinois State University, 2003. / Title from title page screen, viewed Oct. 15, 2004. Dissertation Committee: Edward R. Hines (chair), Kenneth H. Strand, Ross A. Hodel, Zeng Lin. Includes bibliographical references (leaves 92-99) and abstract. Also available in print.

Sjuksköterskor ifrågasätter ibland sin närvaro under ronden och för motivation krävs förståelse för yrkesrollens betydelse. Trots rondens potential för vårdutveckling saknar den erkännande som ett viktigt forskningsområde. Syftet var att studera ronden som företeelse på sjukhus. En litteraturstudie grundad på 13 artiklar utfördes. Resultatet belyser att ronden skedde på rutin, aldrig ställdes in samt innehade främst tre funktioner: planering och utvärdering av patientvården, en pedagogisk funktion samt en samordnande funktion. Rondens upplägg påverkade patienters upplevelse och delaktighet. Sjuksköterskor kände sig ofta exkluderade, hade svårigheter att förmedla information och bidrog sällan till beslutsfattandet. Sjuksköterskans bidrag under ronden var nödvändigt och höjde patientsäkerheten. Gemensamma verktyg för kommunikation, dokumentation och riskanalyser inom vårdteamet har utvecklats för att förbättra ronden. Det förekom att patienter och vårdpersonal var missnöjda med upplägget av ronden och i båda grupperna fanns de som kände oro under ronden samt hade bristfällig kunskap om dess innebörd och syfte. Ronden bör därför lyftas i utbildningen och studenter tränas i att kommunicera med andra inom vårdteamet. Yrkesverksamma bör främja patienters delaktighet och förståelse under ronden. Kommande forskning bör utgå från ett omvårdnadsperspektiv och riktas mot hur ronden kan användas som ett effektivt arbetsverktyg och hur teamarbete kan uppmuntras. / Nurses sometimes question their presence during the ward round and understanding of the importance of their professional role is required as motivation. In spite of the ward rounds’ potential for care development it lacks recognition as an important research area. The aim was to study the ward round as a phenomenon. A literature review was conducted using 13 papers. The findings reveal that the ward round was conducted as a routine part and was never cancelled. It consisted of mainly three functions; planning and evaluation of the patient care, a pedagogical function and a coordinating function. The format affected patients experience and participation. Nurses often felt excluded, experienced difficulties in providing information and rarely contributed to decision making. Nurses’ contribution in the ward round was essential and increased patient safety. Common tools for communication, documentation and risk analysis within the care team have been developed to improve the ward round. There were patients and staffs who were dissatisfied with the format and there existed anxiousness during the ward round and lack of knowledge about the meaning and purpose in both groups. The ward round needs to be highlighted in education and students need to practice communication with other care team members. Professionals should promote patient participation and understanding during the ward round. Future research should include a nursing perspective and address how the ward round could be used as an effective tool and how to promote teamwork.

Made available in DSpace on 2015-07-22T20:50:32Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-04-28 / Os hospitais brasileiros, tanto do setor público quanto privado, vêm experimentando um marcado processo de racionalização de suas práticas, através de estratégias que visam disciplinar, regulamentar e controlar as várias dimensões da vida no hospital, portadoras de uma racionalidade ―instrumental‖ caracterizada pela busca de maior eficiência e eficácia institucional. Considerando a existência de um sistema dual de autoridades no hospital composto pelos poderes médico e administrativo, a introdução de uma lógica racionalizadora pela administração hospitalar impacta potencialmente no poder de decisão do corpo clínico que, por sua vez, ativa estratégias de conservação de autonomia que visam, em última instância, a manutenção do seu poder na instituição. Este estudo tem como objetivo compreender como os médicos vivenciam e dão sentido às políticas racionalizadoras da gestão hospitalar implementadas pela direção de um hospital da Secretaria de Saúde do Estado de São Paulo gerenciado por uma universidade através de convênio, contratualizado como hospital de ensino e certificado como de excelência pela Organização Nacional de Acreditação. Trata-se de um estudo de caso, com metodologia qualitativa de análise, que, a partir de entrevistas semi-estruturadas realizadas com seis médicos ligados diretamente à assistência, pôde identificar um aparente paradoxo entre os evidentes avanços dos mecanismos de controle institucional sobre o trabalho médico e a percepção ‖subjetiva‖ de tais avanços pelos médicos, que não os reconhecem como limites para sua autonomia técnica. Além disso, demonstra o quanto a resistência dos médicos às medidas racionalizadoras se faz em ato, na realização do seu trabalho, na criação de redes informais de contatos e conhecimentos que vão produzindo fluxos, modos de funcionamento do hospital, de produção do cuidado, que extravasam a racionalidade, o formalismo e a previsibilidade desejadas pela direção. / Brazilian hospitals, either in public or private sectors, have experienced a remarkable rationalization process in their practices through strategies aimed at regulate, discipline and control the diverse dimensions of hospital life. Such strategies convey a specific, instrumental rationality that is outlined by the search for greater institutional efficiency and effectiveness. Regarding the existence of a dual system of authorities in hospitals composed by both medical and administrative powers, the introduction of a rationalizing logic by the hospital administration potentially impacts the power of decision-making within the clinical board, whose professionals, on their turn, activate autonomy conservation strategies ultimately concerned with the maintenance of their power in the institution. The present study is aimed at understanding how medical doctors experience and assign meaning to the rationalizing hospital management policies implemented by the management board of a hospital belonging to the State Health Department of São Paulo. This hospital is managed by a university through a formal agreement as a teaching hospital. It is also certified by the National Accreditation Organization as an institution of excellence. As a case study carried out through an analytical qualitative methodology, which, from semi-structured interviews performed with six medical doctors directly concerned with health care, this research is able to identify an apparent paradox involving the evident advancement of the institutional mechanisms of control over medical work as well as the ―subjective‖ perception of such advancements by the physicians, who do not recognize them as limits for their technical autonomy. In addition, it demonstrates how far the resistance of physicians against the rationalizing measures is made in act, when performing their work, when creating informal networks of contact and knowledge, which follow through by producing flows, ways of operation for the hospital, ways of producing care, which go far beyond the rationality, the formalism, and the previsibility as aimed by the administration. / TEDE / BV UNIFESP: Teses e dissertações

<p><strong>Background:</strong> The objective of this mixed methods study is to understand, from the perspectives of seriously ill hospitalized patients, the effect of modifiable physician behaviours on the perceived quality of end-of-life and ACP communication. <strong></strong></p> <p><strong>Methods:</strong> A convergent parallel mixed methods design is used. Participants were recruited from inpatient medical wards at two academic hospitals, and a population with a high risk of mortality at 6-12 months was selected. In the quantitative strand, a questionnaire was administered to measure patients’ self-rated satisfaction with their physician’s ACP communication skills. The primary analysis involved calculation of the strength of correlation between individual QOC items and a global satisfaction score. In the qualitative strand, interpretive description methods were used to explore seriously ill patients’ perceptions of the quality of ACP communication with their physicians. The mixed methods analysis phase involved the creation of a merged analysis table.</p> <p><strong>Results: </strong>From the quantitative strand, three priority behaviours pertained to eye contact, providing full attention, and listening. The three major qualitative themes related to nonverbal behaviours; situating a patient in the context of their background, family and social roles; and assisting patients to make the challenging end-of-life transition. The merged analysis allowed for a fuller, contextualized understanding of why the QOC items with the strongest correlation measures were important from a patient perspective.</p> <p><strong>Conclusions:</strong> This mixed methods study is well-positioned to understand, holistically and from the patient perspective, physician behaviours that influence quality of communication at the end of life.</p> / Master of Science (MSc)