Background: The last 30 years have seen considerable growth in the scope of emergency medicine and the size, scale and expectations of emergency departments (EDs) in the USA and other countries, including Australia. The emphasis has changed from direct referral to departments in the hospital to treatment in and disposition from the ED. At the same time, emergency clinicians face increasing pressure to address patient needs with greater efficiency. Within this context, this project describes the character of the unique domain of work and collective identity that emergency clinicians carve out in their interactions with other emergency clinicians and with clinicians from other departments. Methods: Fieldwork was conducted over 10 months in the EDs of two tertiary referral hospitals in Sydney, Australia. It comprised approximately 535 hours of unstructured and structured observation, as well as 56 field interviews. Results: Emergency clinicians have a unique role as "gatekeepers" of the hospital. This ensures that their clinical work is inherently organisational - that is, interdepartmental and bureaucratic work. Emergency clinicians explicitly and implicitly negotiate the "patient pathway" through the hospital which is organised according to the "fragmented" body. This role demands previously under-recognised and complex immaterial work. Emergency clinicians seek to reconcile the individual trajectories of patients present in the ED with the ED?s broader function as a "carousel" in order to seek to provide the greatest good for the greatest number of future patients. The research uniquely charts the socialisation processes and informal education that produce tacit organisational expertise with which emergency nurses and doctors, both separately and jointly, negotiate the bureaucracy of the hospital. Conclusion: EDs are destined to struggle to provide the greatest good for the greatest number, reconciling shortcomings in the structure and provision of public and community health care. However, recognition and support for the unique clinical-organisational domain of ED care presents an opportunity for improved holistic care at the front door of the hospital. Our ageing population and its promise of more patients with complex health issues demand further research on the interdepartmental work of other whole-body specialties, such as Aged Care.

Thesis (Ph. D.)--University of Akron, Dept. of Public Affairs and Urban Studies, 2007. / "May, 2007." Title from electronic dissertation title page (viewed 05/06/2008). Advisor, Raymond Cox, III; Committee members, Ralph Hummel, Nancy Grant, Lawrence Keller, Dena Hanley; Department Chair, Sonia Alemagno; Dean of the College, Ronald F. Levant; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.

Thesis (M.A.)--University of Michigan. / Also issued in print.

Seminar paper--University of Wisconsin--La Crosse. / Appendices: leaves [33]-ll5. Bibliography: leaves 31-32.

Thesis (M.A.)--University of Michigan. / eContent provider-neutral record in process. Description based on print version record.

Dissertation (Ed. D.)--University of Akron, Dept. of Educational Foundations and Leadership, 2005. / "August, 2005." Title from electronic dissertation title page (viewed 12/27/2005) Advisor, Sandra C. Coyner; Committee members, Isadore Newman, Nancy K. Grant, Duane M. Covrig, Catharine C. Knight; Department Chair, Susan J. Olson; Dean of the College, Patricia A. Nelson; Dean of the Graduate School, George R. Newkome. Includes bibliographical references.

Background: Studies have shown that healthcare workers in Emergency Units (EUs) are at a high risk of both physical and non-physical workplace violence. While several international studies have focused on the experience of workplace violence by Emergency Medicine (EM) specialist physicians, there is a paucity of data regarding that of EM physicians in training. Objectives: This study aimed to determine the amount of workplace violence (and the subtypes thereof) perpetrated against Western Cape EM registrars and consultants, and their perceived level of, and identified barriers to and facilitators of, job safety and satisfaction. Methods: This cross-sectional study relied upon responses to a survey, electronically disseminated over a 6-week period, in May/June 2018, amongst Western Cape public sector EM registrars and consultants. The primary outcome was the incidence of workplace violence experienced. The secondary outcomes were the sub-types of workplace violence perpetrated, as well as the perceived level of job safety and satisfaction, and identified barriers thereto and facilitators thereof. Results: In total, 66% of respondents had experienced at least one act of physical violence while working in Western Cape EUs, specifically by patients. Regarding non-physical violence, 90.6% of respondents had experienced at least one act of verbal harassment, 84.9% of verbal threat, and 45.3% of sexual harassment. The rates of both physical and non-physical workplace violence (especially sexual harassment), perpetrated by patients specifically, were found to be higher in female than in male respondents. Apart from acts of verbal harassment, which were perpetrated equally by patients and visitors, all other acts of physical and nonphysical workplace violence were perpetrated at a higher rate by patients than visitors. The rates of both physical and non-physical workplace violence, perpetrated by patients specifically, were found to be higher in EM consultants than in EM registrars. The factors most commonly indicated by respondents as contributory to workplace violence were patient and/or visitor alcohol use, drug use and psychiatric illness. Other factors commonly indicated were long waiting times and unmet expectations, and resultant patient and/or visitor frustration. Conclusion: Workplace violence against EM registrars and consultants is a significant problem in Western Cape EUs. The information gained during this study will be useful in improving safety and security policies at an EU (and hospital) level. It may even be applicable at a provincial (or national) level in changing legislation, in order to reduce, and ultimately prevent, workplace violence in the EU.

No description available.

The following doctoral thesis provides an ethnographic account of sudden deathwork performed by emergency personnel. The study centres on three accident and emergency departments in the North East of England. Sudden death practices and perceptions are revealed using thick description from focus groups, narratives and informant accounts. Three emergency disciplines: accident and emergency nurses, police traffic officers and paramedics provide the backdrop to describing three sudden death trajectories, which take the dead body from a state of collapse to a mortuary. Particular attention is paid to the significance of status passage as a temporal dimension of deathwork with due consideration being given to the concept of body handling as 'dirty work'. A feminist concept of embodiment challenges the dominant discourse of the death processing industry in relation to beneficence and non- maleficence for those who are left behind to grieve. The theatrical representation of the body to relatives is discussed within a dramaturgical frame, questioning what is appropriate and achievable within the boundaries of an emergency care environment. An exploration of the roles of emergency personnel illuminates problems of dealing with a phenomenon, which annihilates the possibility of a sense of order and emotionally incapacitates emergency personnel. The procedural base to sudden death is presented through accounts of emergency personnel contact with human suffering and emotional pain with the intention to build a substantive theory of a sudden death milieu. Finally, Schutzian relevances highlight key concepts of significance within the data demonstrating how, despite an evidence-base to practice, some myths are highly influential in shaping the behaviours of emergency personnel throughout the sudden death event. It is hoped that insight gained may provide a catalyst to inform change where needed, in service provision and enhance interprofessional working relationships.

M.Fam.Med., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Aim: to describe the pattern of attendance from patients to the Emergency Department (ED) at Carletonville Hospital and explanations for the pattern. Methods: The study used a descriptive cross sectional design, exploring the patient’s demographics, clinical domain, factors related to patients and the system, in 250 participants. Results: The typical attendee was either a female or a male, in the age group of 14 to 28 years, unemployed (60.2 %), having medical problems (30.0 %), coming during afterhours (78.8 %), using an ambulance for transportation (51.2 %) and residing in Khutsong (31.6 %). Eighty seven percent reported their problems as serious, but were coded as green (59.6 %) in the triage tool, and 79.2% were discharged after the visit. Conclusions: Need exist for educating the local community in the use of the ED, and attending other local health resources like clinics and general practitioners. Further studies are required to explore the appropriateness of ED use and help seeking behaviour of the local community.