Magister Curationis - MCur / The provision of mental health care, treatment and rehabilitation of the acutely ill mental health care users (MHCUS) poses a major challenge to the nurses working in acute units. Nurses spend long hours ensuring that acutely ill psychiatric patients receive quality patient care in acute admission units in different psychiatric hospitals in South Africa. With few studies showing a rise in the prevalence of mental disorders in the South Africa and the Western Cape Province, acute psychiatric inpatient units across the province have experienced intense pressure and persistent rise in the number of acute patient admissions. Dealing with this group of patients is a difficult task particularly for nurses who spent prolonged hours caring for them. Despite the continuing provision of care to MHCUS by nurses in acute admission units, very little is known about the lived experiences of nurses in acute admission units. The aim of this study was to explore and describe the lived experiences of nurses who care for the acutely ill MHCUS in an acute male admission unit at a psychiatric hospital in the Western Cape. Acutely ill MHCUS in acute psychiatric units show severely disturbed behaviour at times, aggression, hostility, acute psychotic symptoms and many other symptoms related to psychiatric illness. Methods: a qualitative, descriptive phenomenological research design was used to explore and describe the lived experiences of nurses who care for acutely ill patients in an acute admission unit. A purposive sample of eight nurses was selected. Individual, semi structured phenomenological interviews were used to collect data from nurses caring for MHCUS in an acute admission unit. Data saturation was reached after carrying out the eight interviews. These interviews were audio taped and transcribed verbatim and Collaizi’s (1978) seven steps method of qualitative data was applied to analyse the collected data. Findings: The study found that nurses in the acute admission unit experienced several challenges while caring for MHCUs. Nurses reported both negative and positive experiences. Positive experiences included MHCUs recovery, teamwork and passion for caring while negative experiences were feeling unappreciated and unsupported by authorities. Furthermore, they reported physical assault by MHCUs which led to fear. Challenges experienced included shortage of staff and increased workload which led to burnout amongst nurses in acute admission units.

Bakgrund: Personer över 80 år har ökat med nästan 22 % under åren 1992 – 2005. Under samma tid har vårdplatserna inom hela akutsjukvården nästan halverats. Detta har lett till ökat vårdbehov och större belastning på framför allt akutmottagningar, medicinkliniker, primärvården och kommunen. Tidigare studier har visat att inadekvata akutmedicinska inläggningar sker ofta runtom i Europa. Syfte: Syftet med studien var att studera inskrivning och utskrivning av patienter vid akutmedicinska avdelningar på ett sjukhus i Sverige. Metod: Studien genomfördes under 2007 på en akutmedicinsk klinik i Sydöstra Sverige. 411 akutmedicinska patientinläggningar bedömdes med Appropriateness Evaluation Protocol (AEP). Lika många hade möjlighet att besvara en enkätfråga, riktad till patienter, sjuksköterskor och läkare, om bedömning av utskrivningen. Resultat: Studien visar att 28,7% av patientinläggningarna inte uppfyllde AEP’s kriterier. De flesta patienter hade bröstsmärta som inskrivningsorsak oavsett adekvat eller inadekvat inläggning. Nära 30 % av patienterna, sjuksköterskorna och läkarna bedömde möjlig utskrivning ett dygn tidigare. Slutsats: Studien visar att inadekvata akutmedicinska inläggningar, enligt instrumentet AEP utgör en betydande del av beläggningen på en medicinklinik som är potentiellt påverkbar. Studien visar också att beläggningen kan påverkas genom tidigarelagd utskrivning enligt bedömningar av såväl patienter som sjuksköterskor och läkare. Resultatet talar för att en bättre kommunikation mellan patienter, sjuksköterskor och läkare skulle kunna optimera längden för akuta medicinska vårdtillfällen. / Background: Persons aged over 80 has increased by almost 22% during 1992-2005. In that time, bed occupancy throughout the emergency medical services has almost decreased to the half. This has led to increased care needs and greater burden, especially on emergency wards, medical clinics, primary care and community. Previous studies have shown that inadequate emergency medical admissions are frequently around Europe. Aim: The aim was to study admission and discharge of patients in acute medical wards at a hospital in Sweden. Method: The study was conducted in 2007 at an acute medical clinic in Southeast Sweden. 411 acute medical patient admissions were assessed with the Appropriateness Evaluation Protocol (AEP). Just as many were able to answer a survey question, directed to patients, nurses and doctors, on the assessment of discharge. Results: The study shows that 28.7% of patients' admissions did not meet AEP's criteria. Most patients had chest pain that enrollment cause any adequate or inadequate curing. Almost 30% of patients, nurses and doctors thought that discharge of the patient was possible one day earlier. Conclusion: The study shows that inadequate emergency medical admissions, with the instrument AEP, are an important part of the hospital bed occupancy of a medical clinic that is potentially impressionable. The study also shows that the hospital bed occupancy can be influenced by earlier discharge according to assessments by both patients, nurses and doctors.