Bakgrund: Grundläggande för välfungerande sjukvård är möjligheten att efter bedömning av patienten vårdbehov kunna prioritera och hänvisa till lämplig vårdnivå på ett snabbt och säkert sätt. Det är viktigt att det sker på gemensamma grunder oavsett hur den initiala kontakten sker. När patienten anländer till sjukhus via ambulans, är han/hon redan bedömd via triage av en specialistutbildad sjuksköterska. Syfte: Syftet med studien är att belysa vilka faktorer som är av betydelse för sjuksköterskans triagebedömning prehospitalt. Metod: Uppsatsen genomfördes som en kvalitativ litteraturstudie. Resultat: Resultatet av litteratursökningen presenterar vilka faktorer som påverkar sjuksköterskan i beslutprocessen vid triagering. Triageutbildning, yrkeserfarenhet, personliga resurser och den psykosociala arbetsmiljön redovisas av de valda artiklarna. Diskussion: Triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön har betydelse vid triagebedömning. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet. Konklusion:  Många faktorer är av betydelse för sjuksköterskans triagebedömning, både triageutbildning, yrkeserfarenhet och psykosociala arbetsmiljön. Ett gemensamt kvalitetsdokument är också en förutsättning för ett bra triagearbete. Diskussionen belyser behovet av kvalitetssäkring och att fler studier utförs inom prehospital verksamhet. / Background: The foundation of a well functioning healthcare service is correct patient assessment and onward referral to the appropriate level of care. It is important that this transfer is conducted safely and effectively and that care considerations are the same no matter how the initial contact is made. Optimally the patient is evaluated by a triage trained specialist nurse before arrival at the hospital. Aim: The aim of this study is to highlight factors which are relevant to the nurse´s triage assessment pre-hospital. Method: Literature study. Results: This literature study discusses a number of factors which are important to the nurse in the process of triage evaluation e.g. triage training, work experience, and the psycho-social workplace environment. Discussion: Special training in triage procedures, the nurse's work experience and the psycho-social workplace environment have an affect on the triage evaluation process. The discussion emphasises the need for quality control and suggests the need for more studies in regard to pre-hospital medical care. Conclusion: Many factors are relevant to the nurse's triage assessment, both triage training, work experience and psychosocial work environment. A common quality documents is also a prerequisite for a good triage work. The discussion highlights the need for quality assurance and that more studies be performed in the prehospital operations.

Abstract Hospital global budget payment of national health insurance in Taiwan starts from July 1, 2002. The payment of emergency department has fixed point-value from July 1 , 2002 to December 31,2003 ( one point of hospital global budget payment equals one NT dollar) . But the payment of emergency department becomes floating point-value, shared with out patient department from January 1,2004. Hospital global budget payment of national health insurance in Taiwan suppressed excessive medical supply through the mechanism of floating point-value. The emergency department of hospital in Taiwan can¡¦t refused patient¡¦s visiting by the regulation of law. We collect the figure of people¡¦s medical utility in emergency department of one regional hospital with 653 beds in Kaohsiung city from July 1 , 2002 to December 31,2003.( one point of hospital global budget payment equals one NT dollar)then the same data also collected from January 1,2004.to July 31,2005.( floating point-value),analyzed by T test. The research result indicates that : the numbers of patient¡¦s transfer to emergency department increased (p value: ¡Õ¡Õ0.05), the numbers of triage1,2 at emergency department increased (p value : ¡Õ¡Õ0.05), the numbers of emergency visiting each month increased (p value:0.036), the growth of admission don¡¦t have statistic significance (p value:0.509). Key word: global budget payment¡Bfloating point-value¡Btransfer¡Btriage

Bakgrund: Flera svenska sjukhus utvecklade under 1990-talet triageskalor för att prioritera och sortera patienter på akutmottagningar. En av anledningarna var att patientantalet ökade och resurser på tillgängliga doktorer var begränsade. Syfte: Att beskriva vilka faktorer som kan ha betydelse för sjuksköterskans triagebedömning på akutmottagningar och att beskriva vilka datainsamlingsmetoder de valda artiklarna har använt sig av.Metod: En litteraturstudie med deskriptiv design som baseras på 12 vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. Sökningarna efter artiklar har skett i databaserna Cinahl, PubMed och Google Scholar.Resultat: Hög arbetsbelastning och brist på personal var faktorer som hade betydelse för sjuksköterskans arbete. En del sjuksköterskor ansåg att hög arbetsbelastning kunde leda till färre korrekta prioriteringar, att det är svårare att prioritera en patient när sjuksköterskan är stressad. Mindre erfarna sjuksköterskor ändrade sina beslut i triageringen och tog längre tid på sig vid triagebedömningen. Utbildning och simuleringsträning var viktigt i triageprocessen för att sjuksköterskorna skulle kunna utveckla färdigheter, fatta beslut och samla in mer korrekt information vid bedömningen. Triagesjuksköterskor kunde bli avbrutna av patienter som frågar hur lång tid det tar innan de blir bedömda. Detta var en källa till stress och otillfredsställelse samt påverkade koncentrationen. Sju artiklar har använt sig av intervjuer, fyra har använt sig av observationer och fem har använt sig av andra datainsamlingsmetoder.Slutsats: En stor anledning till färre korrekta triageprioriteringar är hög arbetsbelastning och stress. Sjuksköterskans koncentration påverkas av patienter som avbryter under triageprocessen och bristen på personal gör att patientflödet genom akutmottagningen påverkas negativt. / Background: Several Swedish hospitals developed triage scales in the 1990s to prioritize and sort patients in emergency rooms. One of the reasons was that the number of patients increased and resources of available doctors were limited. Aim: To describe the factors that may be important for the nurse’ triage assessment in emergency departments and to describe the data collection methods the chosen articles have used.Method: A literature study with descriptive design based on 12 scientific articles with both qualitative and quantitative approach. The search for articles have occurred in the databases Cinahl, PubMed and Google Scholar.Results: The high workload and lack of staff were factors that were relevant to the nursing profession. Some nurses felt that the high workload could lead to fewer correct priorities, it is difficult to prioritize a patient when the nurse is stressed. Less experienced nurses changed their decisions in the triage and took more time at the triage assessment. Training and simulation training was important in the triage process so the nurses could develop skills, make decisions and gather more accurate information in the assessment. Triage Nurses could be interrupted by patients asking how long it takes before they are assessed. This was a source of stress and dissatisfaction and affect concentration. Seven articles have used interviews, four have used observations and five have used other methods of data collection.Conclusion: A major reason for fewer correct triage priorities are high workload and stress. Nurse's concentration is affected by patients who discontinue during the triage process and the lack of staff means that the patient flow through the emergency department adversely affected.

Att arbeta som sjuksköterska på en psykiatrisk akutmottagning innebär ansvar att ta beslut i komplexa situationer samt ställer stora krav. För att underlätta bedömning av patientens vårdbehov och minska risken för subjektiva bedömningar genomfördes ett utvecklingsarbete genom införande av triageringsverktyget och beslutsunderlaget RETTS-Psy vid en psykiatrisk akutmottagning i Västsverige. Syftet med pilotstudien var att ur ett omvårdnadsperspektiv belysa sjuksköterskans erfarenhet av införandet och arbetet med RETTS-Psy. Studien genomfördes utifrån en kvalitativ ansats via semistrukturerade intervjuer med fyra strategiskt utvalda sjuksköterskor. Materialet analyserades med kvalitativ innehållsanalys och fyra teman kunde urskiljas. Resultatet visade sjuksköterskans erfarenhet av att arbetssättet och akutjournalen tydliggjort patientens vårdbehov och då underlättat i prioriteringsarbetet samt bidragit till ökad patientsäkerhet. Att patienten blir bedömd efter snar ankomst erfors ha bidragit till bättre överblick, men även att sjuksköterskan upplevde en begränsning i omvårdnadssamtal och dokumentation. Valet av kvalitativ ansats som analysmetod ansågs passande då den insamlade datan svarade på pilotstudiens syfte som var att undersöka sjuksköterskans erfarenhet. Vidare forskning inom akutpsykiatrisk omvårdnad vore önskvärt likaså forskning om patientens upplevelse av omvårdnad och triagering på en psykiatrisk akutmottagning.

This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.

Introduction: Emergency department usage for non-urgent care has been identified as an issue worldwide. Many health professionals have an opinion as to why parents seek care for their children at an emergency department. In Australia, although it is known that there is increasing usage of paediatric emergency departments for non-urgent care; there is a paucity of research on the reasons for this high usage. Aim: This study aims to provide a better understanding of the motivations and actions of parents of children with non-urgent injury or illness who attend the emergency department (PED) at a tertiary paediatric hospital seeking care. Method: This study was designed as a cross sectional descriptive survey to ascertain information fiom parents about their care-giving and care-seeking behaviours prior to presenting with their child to the paediatric emergency department (PED) for professional assessment and treatment. Demographic characteristics were compared with those of the general population to ensure representativeness. Results: A total of 355 parents were surveyed in the three-month period between May and July 2005. This represented 8% of the parents/carers who had presented to the PED for nonurgent (Australian Triage Score Category 4 and 5) care of their child. Just over half of the children presenting were male (185 (53%)) with an overall mean age of 5.45 years (*SD 4.25). The factors the study identified as seminal as to why parents sought care for their child at the paediatric emergency department are that parents rated their child's condition as moderate to very serious (242 (68%)) and that two thirds of parents (234 (66%)) had sought advice prior to attending PED. Other pertinent factors identified were that 54% of children attended with an injury (137) presented promptly to PED (i-e. within four hours of injury) whereas of those presenting with illness (88 (41.3%)) presented within two to seven days of the onset of the illness. The majority of children attended with an illness (213 (60%)) and of these, 98% had medication administered prior to presentation to PED. The presenting child was most likely to be the youngest sibling. Conclusions: The results of the study highlight the accuracy of 'parental triage', that is that parents assess their child's health, and generally engage in appropriate care-giving and careseeking behaviours before presenting to paediatric PED. This study highlights the deficiencies in current primary care services available to families and the perception that not all cases deemed as non-urgent by the emergency department are able to be dealt with in a primary care setting. In recognising that presentation is multifactorial, an issue that needs to be addressed is that there will always be non-urgent presentations at the paediatric emergency department and service delivery and W i g models need further development to address the increasing paediatric requirements for care. In identifying these multiple factors, this study will provide a solid base for future planning within paediatric hospitals, the emergency department setting and in provision of care in the community.

Diss., 2007--Leipzig. Universiẗat.

Thesis (Ph. D.)--Carleton University, 2004. / Includes bibliographical references (p. 196-215). Also available in electronic format on the Internet.

Thèse (M.Sc.)--Université Laval, 2007. / Bibliogr.: f. 77-83. Publié aussi en version électronique dans la Collection Mémoires et thèses électroniques.

Varje dag söker sig ett stort antal människor till akutmottagningar runt om i Sverige. Alla som uppsöker akutmottagning har enligt hälso- och sjukvårdslagen rätt att bli bedömda av en sjuksköterska och denna bedömning ska ske i samråd med patienten för att denne ska känna sig sedd och bekräftad. Denna bedömning sker i ett så kallat triage där huvuduppgiften är att se till att den sjukaste patienten får vård först. Att bemöta en patient i triaget ska ske med lyhördhet för patientens symtom och patienten ska i lugn och ro få berätta om sina problem för att på så sätt kunna skapa ett förtroende hos patienten. Med en ökad tillströmning av patienter som kommer till akutmottagning ökar också stressen och tidspressen på sjuksköterskan som arbetar med triage och triagering.   Syfte med denna studie var att undersöka sjuksköterskors upplevelse av att arbeta med triage i relation till personcentrerad vård på akutmottagning.   Metod och design var kvalitativa intervjuer. Tio sjuksköterskor på olika akutmottagningar i södra Sverige intervjuades. Intervjuerna transkriberades och analyserades med en latent innehållsanalys med en induktiv ansats.   Resultatet i studien utmynnade i två kategorier. Den första var patientrelation och förtroende för vården med sina underkategorier anpassa sig och möta patienten och dess behov av trygghet och bekräftelse, samråd med patienten, när patienten eller beslutsunderlaget säger emot samt att avvika från rutinerna för patientens skull. Den andra kategorin var förväntningar i triaget med underkategorierna förväntan att ingen ska ta skada eller dö, förväntan att patienten blir nöjd, förväntan på verksamheten och kollegorna samt förväntan om att kunna ge personcentrerad vård.   Slutsatsen av studien är att sjuksköterskorna som intervjuats beskriver en bild av personcentrerad vård i samband med triage vilken i stort stämmer överens med hur det beskrivs i aktuell litteratur. Verksamhetens begränsningar och rädslan att undertriagera var båda faktorer som orsakade stress. Mot sjuksköterskans egen vilja får den personcentrerade vården komma i andra hand samband med stress orsakat av resursbrist vid triagering. Olikt tidigare forskning upplevde sjuksköterskan att personcentrerad vård var eftersträvansvärt och viktigt i triaget, ibland så viktigt att man gick ifrån beslutsunderlag då det ansågs motverka att patientens behov och förutsättninga satts i centrum. / Every day a large amount of people seek care at emergency rooms in Sweden. Everyone who seeks care at the emergency room has, according to hälso- and sjukvårdslagen the right to be assessed by a nurse and this assessment should be done in joint consultation with the patient with the aim that the patient feels seen and validated. This assessment occurs in something called triage where the key task is to make sure that the patient who is the most ill receives care first. The treatment of the patient in the triage should come about with attentiveness regarding the patients’ symptoms and the patient should be let to recount his or her symptoms in peace as to create a trust with the patient. With an increase of inflow of patients to the emergency room the stress and time pressure for the nurse in the triage increases.   The aim of this study was to examine nurses’ experience of working with triage in relation with patient centred care in the emergency department.   Method and design used was qualitative interviews. Ten nurses on different emergency departments in southern Sweden were interviewed. The interviews were transcribed and analysed with latent content analysis with an inductive approach.   The findings resulted in two categories. The first one was patient relations and trust in health care system with its sub categories adapt and meet the patient and its needs for safety and validation, joint consultation with the patient, when the patient or the decision support objects and to deviate from routines for the patient’s sake. The other category was expectations in the triage with its sub categories expectations that no one is harmed or dies, expectations that the patient is satisfied, expectations on organisation and colleagues and expectations on the ability to give patient centred care.   The conclusion of the study is that nurses view patient centred care in a similar way as current literature on the subject. Organisational limitations and the fear of undertriage where both factors that caused stress. Against the will of the nurse the patient centred care comes second-hand during stress caused by lack of resources during triage. Unlike previous studies the nurse perceived patient centeredness as pursuable and important in the triage, sometimes important enough to deviate from the decision support as it was perceived to counteract that patients’ needs and preconditions where put first.