Bakgrund: Akutmottagningar behöver vara utformade för att kunna erbjuda en varierad patientgrupp akut vård. Arbetet på en akutmottagning karakteriseras av teamwork där sjuksköterskan förväntas kunna handla snabbt och kombinera omvårdnadsarbetet med medicinska och administrativa arbetsuppgifter. För att kunna uppleva en god arbetsmiljö krävs ett socialt kapital på arbetsplatsen, förmågan att uppleva mening och tillfredsställelse i arbetet samt ett gott stöd från organisationens olika skikt.  Syfte: Belysa sjuksköterskans arbetsmiljö på en akutmottagning.  Metod: Metoden som använts är en litteraturöversikt enligt Fribergs metod med syftet att skapa en överblick över det aktuella kunskapsläget inom ämnesområdet. Översikten utformades på tio vetenskapliga artiklar hämtade från CINAHL Complete och PubMed. Artiklarna analyserades enligt Fribergs modell för en litteraturöversikt, likheter och skillnader identifierades och tematiserades. Som teoretisk utgångspunkt användes Watsons omvårdnadsteori.  Resultat: Resultatet presenteras i form av tre huvudteman; fysiska, psykologiska och sociala aspekter av arbetsmiljön. De fysiska aspekterna utgjordes av undertemana Lokaler och säkerhet samt Bemanning och patienttäthet. De psykologiska aspekterna behandlade ämnena Att arbeta under tidspress samt Förekomst av utmattning, ångest och arbetsrelaterad stress. De sociala aspekterna inkluderade Teamwork och Konflikthantering.  Diskussion: Resultatet diskuterades med utgångspunkt i Watsons omvårdnadsteori och analyserades i relation till hur organisationen och ledningen såväl som sjuksköterskans inställning till omvårdnad kunde påverka arbetsmiljön. Resultatet tolkades även utifrån arbetsmiljöns påverkan på sjuksköterskans patientbemötande.

The purpose of this study was to describe the experiences, symptoms, and effects of compassion fatigue among emergency nurses, and to identify potentially effective interventions. Compassion fatigue within the profession of nursing is of growing concern due to its negative impact on nurses' mental and physical health, productivity, and patient care. There is a notable paucity of available qualitative research related to compassion fatigue in nursing, but available quantitative data indicates that emergency nurses could be especially at risk for developing compassion fatigue. Compassion fatigue is commonly conceptualized as being composed of burnout and secondary traumatic stress; however, previous exploratory research indicated that this definition might not adequately fit emergency nurses. Focus group interviews were conducted with emergency department nurses from four local hospitals. The participants were asked about their experiences, symptoms, and perceptions of the effects of compassion fatigue, and about potentially effective interventions to address compassion fatigue within their work setting. A content analysis of the interview data was performed to identify categories, common threads and patterns, and related themes. Although the participants' average length of time working in the emergency setting was less than two years, they all reported having intense experiences related to professional burnout, secondary traumatic stress, and the negative effects of compassion fatigue. The development of compassion fatigue was contributed to both organizational (time pressure and lack of resources and leadership support) and patient (clinical uncertainty, reason for seeing care, and witnessing grief) factors. The main symptoms of compassion fatigue were exhaustion, impaired communication, decreased emotional tolerance, coping with dark humor, and detachment/dissociation. These symptoms affected the participants both at work and home. The suggested potential interventions comprised of self-care activities, debriefing with clinical staff, continuing education, and increasing awareness about compassion fatigue in the work setting. The data from this qualitative descriptive study expands our knowledge of the concept and ramifications of compassion fatigue in nursing, specifically in the emergency setting. It also offers potentially effective interventions to prevent and address the negative effects of compassion fatigue.

Esse estudo teve como objetivo geral identificar as evidências científicas sobre os riscos psicossociais aos quais estão expostos os trabalhadores de enfermagem de Unidades de Pronto Atendimento e Serviços de Emergência. Trata-se de um estudo de Revisão Integrativa em que foi realizada a busca nas bases de dados LILACS, MEDLINE, BDENF e Biblioteca Virtual SciELO. Os descritores utilizados na busca foram: risco psicossocial, enfermagem em emergência e serviços médicos de emergência. De 413 artigos, foram selecionados seis, a maioria de âmbito nacional. Quanto as características dos trabalhadores de enfermagem, identificou-se que a maioria foi constituída por mulheres com nível superior de escolaridade, adultas jovens, casadas/solteiras, trabalhando em turnos alternados, com carga horária de até 40 horas semanais, com ritmo acelerado de trabalho, com tempo de atuação profissional de cerca de cinco anos. Os principais fatores de riscos psicossociais, identificados foram: trabalho de alta exigência; condições laborais inadequadas, de baixo controle e alta demanda; conflitos entre equipes de saúde; falta de motivação; sobrecarga de trabalho; insatisfação profissional; ambientes negativos de trabalho, entre outros. Alguns dos danos à saúde identificados foram: estresse, transtorno mental comum, insônia, mal estar gástrico, angústia, sofrimento, depressão, tristeza, alteração no sono e repouso, fadiga, nervosismo, entre outras. Como proposta para orientação dos trabalhadores de enfermagem, elaborou-se um produto tecnológico na modalidade cartilha intitulada \"Riscos Psicossociais e os Trabalhadores de Enfermagem que atuam em Emergência\" / This study aimed to identify the scientific evidence on the psychosocial risks to which nursing workers from Emergency Care Units and Emergency Services are exposed. This is an Integrative Review study in which the search of the databases LILACS, MEDLINE, BDENF and SciELO Virtual Library was carried out. The descriptors used in the search were: psychosocial risk, emergency nursing and emergency medical services. Of 413 articles, six were selected, most nationwide. Regarding the characteristics of nursing workers, it was identified that the majority were women with a higher educational level, young adults, married / single, working in alternating shifts, with a workload of up to 40 hours a week, with a fast pace of work, with a professional time of about five years. The main psychosocial risk factors identified were: high-demand work; inadequate working conditions, low control and high demand; conflicts between health teams; lack of motivation; work overload; professional dissatisfaction; negative work environments, among others. Some of the health damages identified were: stress, common mental disorder, insomnia, gastric distress, anguish, suffering, depression, sadness, altered sleep and rest, fatigue, nervousness, among others. As a proposal for the orientation of nursing workers, a technological product was developed in the booklet modality entitled \" Psychosocial Risks and Nursing Workers that work in Emergency\"

Esse estudo teve como objetivo geral identificar as evidências científicas sobre os riscos psicossociais aos quais estão expostos os trabalhadores de enfermagem de Unidades de Pronto Atendimento e Serviços de Emergência. Trata-se de um estudo de Revisão Integrativa em que foi realizada a busca nas bases de dados LILACS, MEDLINE, BDENF e Biblioteca Virtual SciELO. Os descritores utilizados na busca foram: risco psicossocial, enfermagem em emergência e serviços médicos de emergência. De 413 artigos, foram selecionados seis, a maioria de âmbito nacional. Quanto as características dos trabalhadores de enfermagem, identificou-se que a maioria foi constituída por mulheres com nível superior de escolaridade, adultas jovens, casadas/solteiras, trabalhando em turnos alternados, com carga horária de até 40 horas semanais, com ritmo acelerado de trabalho, com tempo de atuação profissional de cerca de cinco anos. Os principais fatores de riscos psicossociais, identificados foram: trabalho de alta exigência; condições laborais inadequadas, de baixo controle e alta demanda; conflitos entre equipes de saúde; falta de motivação; sobrecarga de trabalho; insatisfação profissional; ambientes negativos de trabalho, entre outros. Alguns dos danos à saúde identificados foram: estresse, transtorno mental comum, insônia, mal estar gástrico, angústia, sofrimento, depressão, tristeza, alteração no sono e repouso, fadiga, nervosismo, entre outras. Como proposta para orientação dos trabalhadores de enfermagem, elaborou-se um produto tecnológico na modalidade cartilha intitulada \"Riscos Psicossociais e os Trabalhadores de Enfermagem que atuam em Emergência\" / This study aimed to identify the scientific evidence on the psychosocial risks to which nursing workers from Emergency Care Units and Emergency Services are exposed. This is an Integrative Review study in which the search of the databases LILACS, MEDLINE, BDENF and SciELO Virtual Library was carried out. The descriptors used in the search were: psychosocial risk, emergency nursing and emergency medical services. Of 413 articles, six were selected, most nationwide. Regarding the characteristics of nursing workers, it was identified that the majority were women with a higher educational level, young adults, married / single, working in alternating shifts, with a workload of up to 40 hours a week, with a fast pace of work, with a professional time of about five years. The main psychosocial risk factors identified were: high-demand work; inadequate working conditions, low control and high demand; conflicts between health teams; lack of motivation; work overload; professional dissatisfaction; negative work environments, among others. Some of the health damages identified were: stress, common mental disorder, insomnia, gastric distress, anguish, suffering, depression, sadness, altered sleep and rest, fatigue, nervousness, among others. As a proposal for the orientation of nursing workers, a technological product was developed in the booklet modality entitled \" Psychosocial Risks and Nursing Workers that work in Emergency\"

Thesis advisor: Dorothy A. Jones / Thesis advisor: Pamela J. Grace / The purpose of the study was to explore the relationship between multiple variables within a model of critical thinking and moral reasoning that support and refine the elements that significantly correlate with accuracy and clinical decision-making. <bold>Background:</bold> Research to date has identified multiple factors that are integral to clinical decision-making. The interplay among suggested elements within the decision making process particular to the nurse, the patient, and the environment remain unknown. Determining the clinical usefulness and predictive capacity of an integrated ethically driven environmental model of decision making (IEDEM-CD) in emergency settings in facilitating accuracy in problem identification is critical to initial interventions and safe, cost effective, quality patient care outcomes. Extending the literature of accuracy and clinical decision making can inform utilization, determination of staffing ratios, and the development of evidence driven care models. <bold>Methodology:</bold> The study used a quantitative descriptive correlational design to examine the relationships between multiple variables within the IEDEM-CD model. A purposive sample of emergency nurses was recruited to participate in the study resulting in a sample size of 200, calculated to yield a power of 0.80, significance of .05, and a moderate effect size. The dependent variable, accuracy in clinical decision-making, was measured by scores on clinical vignettes. The independent variables of moral reasoning, perceived environment of care, age, gender, certification in emergency nursing, educational level, and years of experience in emergency nursing, were measures by the Defining Issues Test, version 2, the Revised Professional Practice Environment scale, and a demographic survey. These instruments were identified to test and refine the elements within the IEDEM-CD model. Data collection occurred via internet survey over a one month period. Rest's Defining Issues Test, version 2 (DIT-2), the Revised Professional Practice Environment tool (RPPE), clinical vignettes as well as a demographic survey were made available as an internet survey package using Qualtrics TM. Data from each participant was scored and entered into a PASW database. The analysis plan included bivariate correlation analysis using Pearson's product-moment correlation coefficients followed by chi square and multiple linear regression analysis. <bold>Findings: </bold>The elements as identified in the IEDEM-CD model supported moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. Findings reported that in complex clinical situations, higher levels of moral reasoning significantly affected accuracy in problem identification. Attributes of the environment of care including teamwork, communication about patients, and control over practice also significantly affected nurses' critical cue recognition and selection of appropriate interventions. Study results supported the conceptualization of the IEDEM-CD model and its usefulness as a framework for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

A organização do fluxo de atendimento de emergência é um dos grandes desafios para as instituições de saúde. Os sistemas de classificação de risco auxiliam os enfermeiros na priorização do atendimento dos pacientes com maior risco, que podem ter sua condição de saúde agravada durante a espera. Avaliar o desempenho de um sistema de classificação de risco institucional para pacientes com infarto agudo do miocárdio permite conhecer a sua capacidade para estabelecer adequadamente a prioridade de atendimento. Objetivos: Determinar a sensibilidade e especificidade de um sistema institucional de classificação de risco para infarto agudo do miocárdio em pacientes com dor torácica; verificar associações entre as variáveis sociodemográficas com o desempenho do sistema na priorização desses pacientes. Método: Estudo observacional em um hospital de cardiologia. A estimativa da sensibilidade foi avaliada pela capacidade do sistema em classificar nas categorias de maior prioridade (vermelha e amarela) os pacientes com diagnóstico de infarto agudo do miocárdio. A estimativa da especificidade foi avaliada pela capacidade do sistema em classificar com baixa prioridade (verde e azul) os pacientes sem infarto agudo do miocárdio. O padrão de referência foi o registro médico de infarto agudo do miocárdio. Resultados: A amostra foi constituída por 3.032 eventos de classificação de risco, sendo 1.534 (50,6%) do sexo masculino; idade média de 57,9 (DP 15,1) anos;146 (4,8%) eventos de infarto agudo do miocárdio. A sensibilidade do sistema foi de 73,3% (IC 65,2% - 80,1%) e a especificidade de 61,3% (IC 59,4% - 63,0%). O desempenho do sistema foi pior com o aumento da idade dos pacientes (p<0,001); melhor com prioridades mais elevadas (p<0,001) e na presença de supra desnivelamento de segmento ST (p<0,001). Conclusão: O sistema institucional de classificação de risco teve bom desempenho na avaliação de pacientes com queixa de dor torácica por otimizar o atendimento de pacientes com infarto agudo do miocárdio, embora haja espaço para melhoria de desempenho do sistema considerando o aumento do valor de sensibilidade e identificação dos falsos negativos. / The organization of the flow of emergency care is one of the great challenges for health institutions. Risk classification systems assist nurses in prioritizing the care of patients at higher risk, who may have their health condition aggravated during waiting. Evaluating the performance of an institutional risk classification system for patients with acute myocardial infarction allows to know their capacity to adequately establish the priority of care. Objectives: To determine the sensitivity and specificity of an institutional system of classification of risk for acute myocardial infarction in patients with chest pain; to verify associations between the sociodemographic variables with the performance of the system in the prioritization of these patients. Method: Observational study in a cardiology hospital. Sensitivity estimation was assessed based on the ability of the system to classify patients with a diagnosis of acute myocardial infarction into the highest priority categories (red and yellow). Estimating specificity was assessed based on the ability of the system to classify patients without acute myocardial infarction with low priority (green and blue). The gold standard was the medical record of acute myocardial infarction. Results: The sample consisted of 3,032 risk classification events, of which 1,534 (50.6%) were male; mean age of 57.9 (SD 15.1) years, 146 (4.8%) events of acute myocardial infarction. The sensitivity of the system was 73.3% (CI 65.2% - 80.1%) and the specificity was 61.3% (CI 59.4% - 63.0%). System performance was worse with increasing patient age (p <0.001); with higher priorities (p <0.001) and in the presence of ST-segment elevation (p <0.001). Conclusion: The institutional system of risk classification performed well in the evaluation of patients with chest pain for optimizing the care of patients with acute myocardial infarction, although there is space for improvement of the system performance considering the increase of sensitivity and identification of false negatives.

Este estudo teve como objetivo analisar a produção científica relacionada ao estresse ocupacional que a equipe de enfermagem de urgência e/ou emergência está exposta. Para isto realizou-se uma revisão integrativa da literatura nas bases de dados Lilacs e Scielo. Os critérios de inclusão para a seleção da amostra foram: artigos em português que retratassem a temática em estudo, publicados nos últimos cinco anos. Com a busca foram encontrados vinte e quatro artigos, dos quais foram selecionados sete. A análise destes artigos gerou três categorias para discussão – carga horária excessiva, síndrome de Burnout e satisfação profissional. Apesar das poucas publicações no período estudado, seus dados reforçam que a atividade de enfermagem em emergência intrahospitalar se mostra sensível quando relacionada às doenças que o ambiente laboral pode desencadear. Além disto, os estudos selecionados indicam a importância da atuação do gestor priorizando ações, que minimizem o esgotamento dos profissionais e promovam sua motivação, reduzindo a possibilidade de doença relacionada ao trabalho. / This study aimed to analyze the scientific production related to occupational stress that the emergency and / or emergency nursing team is exposed. For this, an integrative review of the literature in the Lilacs and Scielo databases was carried out. The inclusion criteria for the sample selection were: articles published in Portuguese that portrayed the subject under study, published in the last five years. In view of the seven articles selected, 3 categories were chosen for discussion - excessive hours, Burnout syndrome and professional satisfaction. Despite the few publications during the period studied, their data reinforce that the activity of nursing in hospital emergency is sensitive when related to the diseases that the work environment can trigger. In addition, the selected studies indicate the importance of the manager's actions prioritizing actions that minimize the exhaustion of professionals and promote their motivation, reducing the possibility of work-related illness.

Em situação de desastres, o atendimento às vítimas dependerá muito da atuação sincronizada de uma equipe multidisciplinar, na qual o enfermeiro tem papel essencial. Espera-se que os profissionais de saúde estejam preparados para o enfrentamento desta situação. Para isto, têm se desenvolvido internacionalmente competências profissionais, sendo que não há na literatura descrição de quais são aquelas necessárias para o enfermeiro no hospital. Foi realizada uma investigação com o objetivo de identificar as competências do enfermeiro no atendimento hospitalar em situação de desastres. Pesquisa de caráter qualitativo com utilização de grupo focal como técnica de coleta de dados. Os sujeitos foram 11 enfermeiros que atuam há mais de 2 anos em um hospital do Oeste Catarinense, instituição de alta complexidade que atua como referência de atendimento a vítimas de Desastres. A análise dos dados foi realizada com a utilização da análise temática. Para a padronização dos enunciados, foi adotado um formato que consistente com um verbo e substantivo, partindo do entendimento de que a competência é indissociável da ação. Foram identificados 17 competências e classificadas conforme as fases ou aspectos globais das ações de redução dos desastres conforme preconizado pela defesa civil e pela Organização Mundial de Saúde de preparação e resposta. Para cada fase, as competências foram classificadas em áreas de domínio, sendo que na de Preparação os domínios foram, gerencias e Educacionais. Na fase de Resposta os domínios foram gerencias, de atenção a saúde e de comunicação. As competências construídas servem de base para a realização da assistência prestada pelos enfermeiros no atendimento hospitalar em situação de desastres e para preparação das equipes, com resultados que poderão ser capazes de prover melhores respostas na assistência, na formação e regulação dos profissionais de saúde e também no campo científico. / In disaster situations, care for victims depend greatly on the synchronized activity of a multidisciplinary team, in which the nurse plays an essential role. It is expected that health professionals are prepared to face this situation. For this, they have developed professional skills internationally, and no description in the literature of which are necessary for those nurses in the hospital. An investigation was conducted with the objective of identifying the competencies of nurses in hospital care in situations of disaster. Qualitative research study using focus group as data collection technique. The subjects were 11 nurses working for more than 2 years in a hospital in the West Catarinense, highly complex institution that acts as a reference service to victims of disasters. Data analysis was performed using thematic analysis. For the standardization of the statements, we adopted a format that is consistent with a verb and noun, based on the understanding that competence is inseparable from action. 17 competencies were identified and classified as phases or aspects of the global stock of disaster reduction as recommended by civil defense and by the World Health Preparedness and Response. For each phase, the skills were classified in domain areas, and in the preparation of the fields were, managerial and educational. In response phase domains were managerial, health care and communications. The skills built the basis for the realization of care provided by nurses in hospital care in situations of disasters and preparedness teams, with results that may be able to provide better answers in assisting in the formation and regulation of health professionals and also in the scientific field. / En situaciones de desastre, la atención a las víctimas dependen en gran medida de la actividad sincronizada de un equipo multidisciplinario, en el que la enfermera tiene un papel esencial. Se espera que los profesionales de la salud están preparados para enfrentar esta situación. Para ello, se han desarrollado las habilidades profesionales a nivel internacional, y no hay una descripción en la literatura de las cuales son necesarias para las enfermeras en el hospital. Se realizó una investigación con el objetivo de identificar las competencias de las enfermeras en la atención hospitalaria en situaciones de desastre. Estudio de investigación cualitativa mediante grupos focales como técnica de recolección de datos. Los sujetos fueron 11 enfermeras que trabajan desde hace más de 2 años en un hospital en el oeste catarinense, institución muy compleja que actúa como un servicio de referencia para víctimas de desastres. El análisis de datos se realizó mediante el análisis temático. Para la estandarización de los estados, hemos adoptado un formato que sea compatible con un verbo y un sustantivo, basado en el entendimiento de que la competencia es inseparable de la acción. 17 competencias fueron identificados y clasificados como fases o aspectos de la acción global de la reducción de desastres a lo recomendado por la defensa civil y la preparación para Mundial de la Salud y la respuesta. Para cada fase, las competencias se clasifican en las zonas de dominio, y en la preparación de los campos eran, de gestión y educativa. En los dominios de la fase de respuesta fueron de cuidado de gestión, salud y comunicaciones. Las habilidades que construyó la base para la realización de la atención prestada por las enfermeras en la atención hospitalaria en situaciones de desastres y los equipos de preparación, con resultados que pueden ser capaces de ofrecer mejores respuestas para ayudar en la formación y la regulación de los profesionales de la salud y también en el campo científico.

The delivery of quality care has been a priority for the health care industry in the United States. Researchers have established positive correlations between the levels of emotional intelligence of registered nurses and their clinical performances. However, new evidence suggests the need to enhance the use of emotional intelligence (EI) in high-risk clinical units. With the intent to understand the use of EI, a phenomenological research approach was used to identify the emergency room nurse's understanding of EI. The Four-branch Model of Emotional Intelligence was used as the theoretical framework, while the research question identified the emergency room nurse's perception of EI. Eight emergency room nurses from two facilities participated in the study. The inclusion criteria consisted of emergency room nurses with one to ten years of experience, nurses that worked thirty-six hours or more per week, and were not in leadership roles. The data were collected through face-to-face interview sessions and analyzed using the Colaizzi's Method of Data Analysis. All participants reported unfamiliarity with the concept of EI. Nevertheless, evidence that indicated the presence of all elements of this concept such as the ability to perceive emotions, understand emotions, use emotions to enhance reasoning, and manage emotions, were apparent in the stories shared by the nurses. The results of the study indicated a potential influence toward positive social change at the organizational and professional level. The implementation of educational activities to improve the use of this concept and the modification of current health care policies to incorporate emotional intelligence as clinical competencies are actions that can influence positive social change.

AIM: The aim of this research was to describe how the health professionals manage sudden/abrupt deaths in the ED and to foster change in current practice by involving the clients (dead or dying clients and their families) and the health professionals. METHOD: Action research was the approach used in this four year research project, and co-researchers (nurses) from three Level I ED's in KwaZulu-Natal were actively involved in shaping and guiding the project. The participants involved in the research were health professionals, bereaved families and mortuary staff members. FINDINGS: An intervention model, the Dealing with Sudden Death Model, was developed in order to guide the therapeutic management of sudden/abrupt deaths in ED's. Along with this was the development of the family pamphlet, the Preparation Checklist and the Incident Evaluation Checklist. Following the implementation of this model the health professionals emphasized the fact that this model provided guidance and meaning to the care rendered to the dead or dying client, the bereaved families and fellow colleagues. The Dealing with Sudden Death Model had resulted in a production of knowledge and planned changes in the management of sudden/abrupt deaths in the ED's. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2004.