Thesis (M.S.)--Marshall University, 2001. / Title from document title page. Document formatted into pages; contains vi, 78 p. Includes bibliographical references (p. 56-61).

Intravenous cannulation of pediatric patients is a common procedure in emergency departments. It is a useful tool to facilitate medical investigations and drug administration. However, the pain induced by the procedure can lead to patient distress and bother the nursing and medical procedures afterwards. There are many kinds of topical anesthesia but no relevant evidence-based guideline for their use is available for the emergency departments. This dissertation synthesizes the available evidence in the literature to establish an evidence-based guideline for the use of topical anesthesia to reduce pain caused by pediatric intravenous cannulation in an emergency department. The communication, implementation and evaluation plan are also developed. A systematic literature review was conducted from 30th August to 2nd September, 2011. A number of electronic databases, including PubMed, CINAHL Plus and Embase were searched. Thirteen eligible randomized controlled trials were identified. They were integrated into a table of evidence and were critically appraised by the SIGN Methodology Checklist. After synthesis of evidence, it is suggested that needleless anesthesia with apparatus assistance significantly reduced pain as early as in five minutes. Patients should however be observed for two hours after the administration of anesthesia for signs of adverse effects. The implementation potential, in terms of the transferability, feasibility and cost-benefit ratio, was examined. Among the anesthesia devices, the Jet lidocaine device has satisfactory transferability, feasibility and cost-benefit ratio. The evidence is then translated into a practice guideline with the recommendations scored based on the “SIGN 50: A guideline developer’s handbook”. A fourteen-month implementation plan,including a communication plan, a pilot study and an evaluation plan is developed. The communication phase lasts for three months and the stakeholders including the Chief of Service, Department Operation Manager, Advanced Practice Nurses, frontline healthcare professionals and the pharmacy department are identified. The pilot plan lasts for ten weeks, which includes a two-week training period, a three-week observational period for baseline measurement, a three-week intervention period and an eight-week amendment period. The pilot study collects data regarding the pain level at baseline and identifies unanticipated problems in the guideline. Amendments would be made accordingly and the revised guideline would be sent for ethical approval before the implementation phase. In the evaluation plan, the primary outcome for the innovation is the level of pain. The secondary outcomes are the admission rate and length of hospital stay. Other outcomes are the satisfaction of healthcare professionals, utilization rate and cost. It is expected that the cannulation pain, admission rate and length of hospital stay would be lower with the application of topical anesthesia. / published_or_final_version / Nursing Studies / Master / Master of Nursing

Thesis (M.Nurs.)--Edith Cowan University, 2008. / Submitted to the Faculty of Computing, Health and Science. Includes bibliographical references.

Thesis (Ph. D.)--Kent State University, 2007. / Title from PDF t.p. (viewed July 10, 2008). Advisor: Ruth Ludwick. Keywords: Domestic Violence; Emergency Room; Factorial Survey; Responses; Vignettes Includes bibliographical references (p. 215-243).

Includes bibliographical references and index.

The traditional new graduate nurse (NGN) orientation process places NGN with an experienced preceptor for 24 weeks and requires clinical skills checklists to be completed by the preceptor, a practice which is not an evidence-based practice for orienting NGNs. The purpose of this quality improvement project was to develop an evidence-based orientation to decrease time requirements and standardize the processes and evaluation of the NGN in the emergency department. The project was informed by Benner's novice to expert theory and focused on acquisition of clinical skills. The project team included 6 stakeholders: the Doctor of Nursing Practice student-leader, the unit manager, and several preceptors and novice nurses. The current evidence was identified utilizing various search terms via OVID, CINAHL, and MEDLINE. Five emergency department nurse residency programs and 7 rubric-based criterion articles were identified and evaluated. The team synthesized the available evidence to create the program. Resulting products included guidelines, evaluation rubrics, and projected pathways for ongoing development. Content validation was undertaken using peer review by 2 nurse scholars with area expertise, after which the project team revised all products based on feedback. Together, these products comprise an evidence-based solution to the problematic orientation of NGNs in the institution's emergency department. Adoption of methods that have proven valuable in undergraduate education, such as incorporation of syllabi and rubrics, may increase retention and improve clinical judgment in the NGN. These improved educational outcomes will, in turn, promote improved health outcomes for patients. Outcomes for the project will be monitored using retention rates and the results of the Casey-Fink Graduate Nurse Experience Survey.

A thesis submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in fulfilment of the requirements for the degree of Doctor of Philosophy. September 2018 / Intensive care is a small but complex system; context-specific and continually confronted by dynamic changes and challenges in the environment. Initiatives following the traditional reductionist approach to improve the delivery of intensive care has had limited success. The aim of this research was to develop a systemic framework for the improvement of intensive care delivery. The factors affecting the delivery of intensive care – in South Africa and internationally – were elucidated by a comprehensive review and analysis of intensive care literature. A further understanding of intensive care delivery in South Africa was obtained by “making sense of the mess” using a systems approach. Systemic intervention served as the meta-methodology and methods and techniques from interactive planning, critical systems heuristics, soft systems methodology and the viable system model were employed. Making sense of the mess emphasised the complexity of intensive care delivery, on both a situational and a cognitive level. It became clear that a single methodology would not suffice, but that a pluralist methodology was required to guide improvement in intensive care delivery. Based on this understanding, nine principles were formulated to guide the development of a framework for the improvement of intensive care delivery. Systemic intervention was used as the meta-methodology. Interactive planning was identified as the key methodology, incorporating methods and techniques from critical systems heuristics, soft system methodology and the viable system model to build a systemic framework for the improvement of intensive care delivery. Embedded in the proposed framework are matters relating to systemicity, complexity, flexibility, empowerment, and transformation of intensive care delivery. The proposed framework allows for multiple-perspectives, including that of marginalised stakeholders, the mitigation of multi-vested interests and power relationships. It is both flexible and adaptable to promote learning about the complex problems of intensive care delivery and it accommodates the strengths of various relevant approaches to complex problem solving. The proposed framework aims to facilitate sustainable improvement of intensive care delivery and to ensure the “just-use” of resources to foster distributive justice. It acknowledges the trajectory of intensive care delivery – the patient comes from the community and returns to the community and intensive care delivery functions on a continuum that ranges from basic to highly sophisticated. / E.K. 2019

This study aims to understand the organization of Emergency Department (ED) nurses in Ontario after years of restructuring and cuts made to the healthcare system. The news is currently filled with ED closures across the country due to a shortage of nurses and high hospital occupancy. The recruitment and retention of nurses in the ED has proven extremely difficult due in part to the Ontario government's Bill 124 capping nurses' wage increases at 1%. This wage freeze is inscribed in a larger rationale present internationally advocating for efficiency and marketization of all spheres of life, healthcare included. Most of the literature published on the work of ED nurses refers to ideas of performance of flow. Using Institutional Ethnography (IE) as an approach and governmentality, more specifically neoliberalism, as a perspective, this study maps the ruling relations influencing the work of nurses in the ED. It also uncovers how the neoliberal discourse was not only internalized but applied by nurses in their work environment. The methodological approach and perspective used in this study highlight how a new rationale was implemented in the management and funding of healthcare, which then led to transforming the rationale of providing care in the ED. The ED now delivers care following a supply chain rationale employing technologies of governmentality such as Electronic Medical Records (EMR) to entice a specific conduct from nurses in order to meet the demands of the market. This new rationale, coupled with the implementation and sustaining of the technologies of governmentality, has come to completely transform what an ED nurse is nowadays. This new ED subject is responsible for most aspects of care, flow, and even her own training and security. The findings suggest that the use of algorithms based on best practices (such as medical directives) came to further erode the decisional power of nurses, resulting in "checkbox" practice.

Emergency department overcrowding is a growing problem worldwide including Rwanda. Literature shows that this problem has an impact on the functioning of the health care system and the quality of care provided. Research Methodology. This study aimed at exploring the phenomenon of overcrowding in ED/CHUK. Fifty one self-administered questionnaires were distributed to 40 ED nurses; these comprised three questions related to demographic data and 48 questions related to overcrowding. Correlation between overcrowding and causes and overcrowding with outcomes was explored and the pearson's test demonstrated that there is no linear correlation between these variables. Results. Findings from the demographic data demonstrated that the majority (92%) of ED nurse's were young (aged between 20 to 35 years). The majority (74%) of ED nurses had less than one to three years of experience in ED. With regard to overcrowding characteristics; nurses reported that the patient's waiting time for a physician varied between less than 30 min to more than 180 min; ED beds occupancy varied between 1 hour to more than 24 hours; patients were placed in the ED hallways for 1 hour to more than 24 hours; waiting room occupancy varied between less than 1 hour to more than 24 hours. Nurses attributed overcrowding to a variety of causes, including; a lack of inpatients beds (95%), large volume of trauma patients (87%), patients with no urgent condition (66), inappropriate referral of chronic cases (61 %), space limitation in emergency department (76%) and insufficient acuity ED beds (74%). Perceived outcomes (impact) were also multiples including, boarding patient in ED (92%), increased stress among nurses (79%), stress among physicians (60%), and risk of poor outcomes (60%), staff dissatisfaction (58%), violence between health care providers and patients (60%) and increased patient waiting time (58%). Regarding the undertaken interventions to reduce ED overcrowding, 100% of respondent asserted that there was some sporadic interventions, but not consistent. Recommendations: Like in other countries ED/CHUK overcrowding is a complex problem that needs to be addressed by all stakeholders: CHUK managers, hospital staff, ED staff, Rwandan district hospitals and Ministry of health. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2008.

Antalet besökare på akutmottagningar ökar runt om i landet och arbetsförhållandena för vårdpersonalen blir allt sämre. Triagesystemet används för att kunna sortera och prioritera akut sjuka patienter som är i behov av att omedelbart träffa läkare för bedömning. Den stora majoriteten av patienter som söker vård på en akutmottagning har dock inte livshotande tillstånd. De har således en lägre prioritering och står på så sätt inför en komplicerad situation med bristande information, okunskap och långa väntetider. Syftet med studien är att beskriva hur patienten upplever vården på en akutmottagning. Metoden författarna har valt att använda är litteraturstudie enligt Axelsons modell. Studien behandlar nio artiklar. De valda artiklarnas resultat sammanställs och bildar tillsammans teman och subteman i syfte att skapa en ny helhetsbild. I Resultat framkommer det att patienter upplever triageringen som positiv men att den efterföljande vården, med bland annat långa väntetider, bristande information och avsaknad av delaktighet, bidrar till en otrygg och frustrerande upplevelse för patienter av vården på en akutmottagning. Diskussionen belyser patientens upplevelse av triageringen och hur det kommer sig att just detta möte beskrivs som positivt av patienter. Vidare diskuteras den bristande informationen patienter upplever på akutmottagningar och hur detta påverkar patienten.