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.

Bakgrund: Akutmottagningar kännetecknas av ett högt tempo och en hög patientomsättning. För patienten innebär detta ett möte med okända miljöer och rutiner. Aggression, hot och våld är en återkommande problematik inom vården och akutmottagningar är en särskilt drabbad sektor. Patientrelaterat våld har visat sig ha en negativ inverkan på sjuksköterskornas mentala och känslomässiga hälsa, men även på patienten som riskerar att erhålla sämre eller utebliven omvårdnad. Syfte: Syftet var att beskriva hur patientrelaterat våld uppstår på en akutmottagning. Metod: Syftet besvarades genom en litteraturöversikt av sex kvantitativa och fem kvalitativa artiklar. Resultat: Vid granskningen framkom fyra teman kring hur och varför våld uppstått på akutmottagningen: Våld som ett resultat av patienten berörde hur patientens egenskaper såsom ålder, kön och om de varit påverkade av sjukdom eller substanser ansetts bidra till att våld uppstått. Våld som ett resultat av sjuksköterskan visade på hur sjuksköterskan genom sitt beteende antingen kunde bidra till eller minska en potentiellt våldsam situation. Våld som ett resultat av yttre omständigheter belyste hur yttre faktorer utanför det direkta patientmötet bedömts inverka på hur utfallet blivit. Slutligen rörde temat våld som ett resultat av mötet hur intressekonflikter mellan sjukvård och patient uppfattats stå som bidragande till våld på akutmottagningen. Slutsats: Det fanns en mängd identifierbara faktorer som kunde påverka om ett möte blev våldsamt eller ej. Vissa av dessa var svåra att påverka, då de kunde knytas till inkommande patienter, så som alkoholintag och psykisk sjukdom. Däremot fanns det även faktorer som sjuksköterskan har möjlighet att påverka genom sitt bemötande och information. Klinisk betydelse: Genom att belysa faktorer som bidrar till patientrelaterat våld skapas ytterligare en förståelsedimension av patient-vårdarmötet. / Background: Emergency departments [ED] are characterized by fast-paced activity and high patient turnover. Patients visiting the ED are faced with an unfamiliar milieu and obscure routines. Aggression, threats and violence are recurring problems within emergency departments. Patient-related violence often has a detrimental effect to nurses’ mental- and emotional well-being. Consequently, patients may receive lesser quality of care, or none at all. Aim: The aim was to describe the genesis of patient-related violence in the Emergency Department. Method: This was a literature review of six quantitative and five qualitative articles. Results: The factors could be separated into four themes; Violence as a result of the patient comprised how patient attributes such as age, gender and substance-influence contributed to violence. Violence as a result of the nurse showed how the nurses behaviour either escalated or disarmed a potentially violent situation. Violence as a result of external circumstances encompassed how factors outside the immediate nurse-patient meeting influenced violence. The final theme regarded violence as a result of the encounter and how the conflict of interest between patient and healthcare was seen as contributing to violence. Conclusion: There were a variety of identifiable factors capable of influencing whether an encounter turned violent or not. Some of these were difficult to affect as they were linked to incoming patients, such as alcohol-intoxication and psychiatric illness. However, there were also factors the nurse was capable of influencing through approach and information. Clinical Significance: Describing factors that contribute to patient related violence furthers the understanding of the patient-nurse encounter.

Bakgrund: Till akutmottagningen kommer alla typer av patienter av olika etniciteter, åldrar och kön, med olika skador och sjukdomar och med olika tidigare erfarenheter av hälso- och sjukvården. Patienten har mycket kontakt med sjuksköterskan på akutmottagningen, och därför är det viktigt att mötet mellan sjuksköterskan och patienten uppfattas som positivt. Forskning tyder dock på att detta inte alltid är fallet.Syfte: Att beskriva hur patienten upplever mötet med sjuksköterskan på en akutmottagning.Metod: En litteraturstudie av mixad metod med konvergent design baserad på fem kvalitativa och fem kvantitativa studier.Resultat: Fyra teman framkom: Brist på information och kommunikation; Patienten vill inte vara till besvär; Ointresse och dåligt bemötande samt Bra vård och ett gott bemötande.Slutsats: Mötet mellan sjuksköterskan och patienten på akutmottagningen blev ofta lidande på grund av bristande information, ointresse och dåligt bemötande från sjuksköterskan. Mötet var mer positivt på akutmottagningar på landsbyggden, med anledning av att stressen och arbetsbördan där var lägre.Klinisk betydelse: Genom att öka medvetenheten om problemen som belyses i denna studie och genom att implementera resultatet till akutmottagningar, ges möjligheten att förbättra vården och öka välbefinnandet för patienterna på akutmottagningen. / Background: A large variety of patients come to the emergency department; people with different ethnicity, ages and gender, type of injuries and illnesses and experiences of health care. The patient have a lot of contact with the nurse in the emergency department, and therefore it is important that the encounter between the nurse and the patient is perceived as positive. Although research indicates that this is not always the case.Aim: To describe how the patient experiences the encounter with the nurse in the emergency department.Method: A review of mixed method with a convergent design based on five qualitative and five quantitative studies.Result: Four themes were identified: Lack of information and communication; The patient doesn’t want to be an inconvenience; Lack of interest and a negative encounter and Good care and a positive encounter.Conclusion: The encounter between the nurse and the patient was often negative in the emergency department; caused by lack of information, lack of interest and a negative encounter from the nurse. The encounter was more positive in emergency departments in rural areas since the stress and workload was lower in these places.Clinical importance: By increasing the awareness about the issues that are highlighted in this study, and by implementing the result in the emergency departments, the opportunity to improve the healthcare and the well-being of patients in the emergency departments is given.

Emergency department(ED) is one of the busiest clinical units in Winnipeg Victoria Gen-eral Hospital (VGH) which faces the challenge of patients’ long waiting-time as increas-ing healthcare demand and limited resources. This research investigates the critical factors of the ED operation to enhance the operational efficiency using simulation modeling and optimization. The contribution of this research is the integration of simulation and optimization for the performance improvement of ED operations. Discrete-events simula-tion (DES) methodology provides a cost-effective tool to analyse the performance of the ED operations and evaluates the potential alternatives. Design of experiments (DOE) and Scatter search (SS) of model optimization are proposed to search the ED potential capaci-ty for waiting-time reduction. The patient-flow is accelerated along with the waiting-time reduction, which results in better efficient patient throughput in the ED. A specific strate-gy is suggested to improve the ED operation based on the simulation model.

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.

OBJECTIVES: (1) to investigate trends in non-traumatic dental visits (NTDV) to hospital-based emergency departments (ED) in Rhode Island (RI) and to compare them with those for other ambulatory sensitive care conditions (ACSC); (2) to examine the effect of expansion of Medicaid coverage on the rate NTDV to ED; (3) and to examine community-level factors associated with NTDVs. METHODS: Data for ED visits in 2005–2014 were obtained from RI hospital discharge data and annual population estimates from the U.S.Census Bureau, and were used to calculate annual visit rates. Medicaid enrollment report for the calendar years 2013 and 2014 were used to calculate monthly enrollment and an interrupted time series analysis was used to examine the effect of expansion of Medicaid coverage on visit rates. Zip code was used as a unit of analysis for community-level factor analysis, 2010 data. A negative binomial regression model with log link was performed. RESULTS: From January 2005 to December 2014, the annual average number of ED NTDV was 7440, accounting for 1.4–2.1% of all ED visits each year, there was a slight but not statistically significant decrease in the NTDV rate between 2005 and 2014. Visits for asthma also declined slightly, but the decrease was statistically significant. There were statistically significant increases in ED visit rates for diabetes and back pain. The NTDV rate increased by 34.8/100,000 enrollees per month immediately and significantly after expansion, amounting to more than 1000 additional ED visits. ED visits for asthma and back pain declined immediately after the expansion of coverage, but not significantly so. Community-level factors associated with NTDVs were higher level of poverty and communities with younger population (more individuals aged 20–34 years) which had significantly higher ED NTDV rates. CONCLUSION: RI NTDVs slightly declined, but still accounts for around 1.6% of ED visits. Medicaid expansion under the ACA, caused an immediate increase in NTDVs to ED, that might be attributed to the increased number of Medicaid enrollees, with no change in the workforce. Among community-level factors, high poverty level and high percent of young population had the highest impact on visit rates. / 2019-09-26T00:00:00Z

abstract: ABSTRACT Nursing physical fatigue is a critical issue that may lead to degradation of care delivery and ultimately result in medical errors. This issue is equally relevant due to the looming shortage of nurses, which has been linked to the physical demands and potential occupational hazards intrinsic to the profession; as well as to the graying of the nursing workforce who experiences gradual loss of strength and agility that accompanies aging as time in the career advances. In a hospital Emergency Department, the level of nursing physical fatigue can potentially reach its threshold in light of challenging workloads, scope of job assignments and demanding schedules. While in other safety-sensitive industries such as aviation and nuclear plants, similar concerns have been the object of systematic research and addressed with consequent regulations, just recently, the healthcare sector has been engaged in further investigations. This study proposed to explore the linkage between Emergency Department design-layout and nursing physical fatigue. It was expected that further understanding on this relationship would support evidence-based design propositions linking nursing wellness, job satisfaction, and performance to a higher quality of care and improved patient safety levels. To this end, data collection was performed during four weeks in a community-based hospital. A convenience sample of twenty-four eligible nurses was invited to participate in this two-part study. The first section consisted of the completion of a self-administered questionnaire, which assessed nurses' perception of the impact of working conditions on nursing physical fatigue. The second section included the monitoring, through the use of accelerometers, of nurses' actual activity intensity levels during three consecutive shifts. Among other findings, data demonstrated that nurses perceive several attributes or components of the built environment as potential contributors to physical fatigue. In addition, various operational practices and organizational protocols were linked to physical fatigue. Contrary to nurses' perception of physical fatigue, their actual physical activity levels fell mostly between sedentary or light intensity ranges. This paradox offers the opportunity for design interventions that, in alignment with operational practices and organizational protocols will enhance nurses' performance and improve nurses' retention. / Dissertation/Thesis / M.S.D. Design 2011

abstract: Research has shown that the ability to smell is the most direct sense an individual can experience. With every breath a person takes, the brain recognizes thousands of molecules and makes connections with our memories to determine their composition. With the amount of research looking into how and why we smell, researchers still have little understanding of how the nose and brain process an aroma, and how emotional and physical behavior is impacted. This research focused on the affects smell has on a caregiver in a simulated Emergency Department setting located in the SimET of Banner Good Samaritan Medical Center in Phoenix, Arizona. The study asked each participant to care for a programmed mannequin, or "patient", while performing simple computer-based tasks, including memory and recall, multi-tasking, and mood-mapping to gauge physical and mental performance. Three different aromatic environments were then introduced through diffusion and indirect inhalation near the participants' task space: 1) a control (no smell), 2) an odor (simulated dirty feet), and 3) an aroma (one of four true essential oils plus a current odor-eliminating compound used in many U.S. Emergency Departments). This study was meant to produce a stressful environment by leading the caregiver to stay in constant movement throughout the study through timed tasks, uncooperative equipment, and a needy "patient". The goal of this research was to determine if smells, and of what form of pleasantness and repulsiveness, can have an effect on the physical and mental performance of emergency caregivers. Findings from this study indicated that the "odor eliminating" method currently used in typical Emergency Departments, coffee grounds, is more problematic than helpful, and the introduction of true essential oils may not only reduce stress, but increase efficiency and, in turn, job satisfaction. / Dissertation/Thesis / M.S.D. Design 2013

Hand-off communication from the emergency department (ED) to inpatient nurses is an important process for transfer of safe and quality patient care from one department to another. Annually, there are130.4 million ED visits with 12.2 million of those visits resulting in hospital admission, providing ample opportunities for poor communication (Rui, Kang, & Albert, 2013). Miscommunications during patient hand-off are estimated to contribute to 80% of adverse events (The Joint Commission, 2012). This theory-driven, quality improvement project sought to evaluate the hand-off communication process between nurses from the ED and nurses in the inpatient Medical/Surgical units using human factors System Engineering Initiative for Patient Safety (SEIPS) approach, originally created by Pasqual Carayon in 2006. An online survey was created using an adapted SEIPS Model evaluating the interactive concepts of person, tools and technologies, tasks, organization, and environment and their impact on staff and patient outcomes. The survey was distributed to both the ED and Medical/Surgical nurses to gain their perspective on the interdepartmental hand-off communication process and how it impacts the staff and patient outcomes. There as an included option for the bedside nurses to provide recommendations on how to improve the hand-off communication process. Data was collected, anonymously, through an online database and descriptive statistics were used to analyze the results. The quality improvement project found that majority of nurses prefer verbal hand-off communication with a structured standard format of delivery in conjunction with the electronic health record. The project found that nurses perceive that the nurse-to-patient ratio and surrounding tasks impact the effectiveness and quality of hand-off communication. The most common suggested hand-off communication improvements were to not allow hand-off communication or transfer of the patient from the ED to the Medical/Surgical unit during peak times, such as shift change, and to follow up on tools and technology compliance. Overall, the person, the tools and technologies, the tasks, and the environment are contributing to ineffective hand-off, while the organization has adequately provided the resources the staff needs to perform an effective hand-off communication. All of which were concluded to have an impact on the staff and patient outcomes.

Magister Curationis - MCur / Academic hospitals do recognise that all patients have basic human needs. Nurses have been obliged to pay attention to conditions that destabilise patient's health. An academic hospital in the Western Cape is dedicated to living up to its vision to deliver excellent nursing services, which include the fulfilment of the basic needs of patients who are making use of surgical emergency department. Emergency surgical departments should be created in a manner that provides safety and comfort to patients. Patient satisfaction is influenced by the manner in which their expectations about the successful addressing of their basic needs are met. At the moment, the extent of meeting these basic needs during the delivery of nursing care in the surgical emergency department of the academic hospital is unclear. The purpose of this study was to explore and describe the perceptions of patients about the fulfilment of their basic needs during nursing care in a surgical emergency department at an academic hospital in the Western Cape. The study was conducted according to a quantitative non-experimental descriptive survey design. A convenience sampling method was used to select patients (n = 150) after they were discharged from a surgical emergency department. A self-administered questionnaire was compiled within the framework of Alderfer's theory, with closed and a few open questions, that was for distribution to respondents. Descriptive statistics were extracted. The responses to items were indicated on a continuum starting at 1 (never) to 7 (always) on a 5-point Likert scale. Respondents signed informed consent before they completed the instrument in a private room that took around 30 minutes. In this study, validity and reliability were maintained during the research process, and ethical principles were adhered to. Descriptive data was presented through mean values and standard deviations and a factor analysis performed. The findings were presented according to six factors that indicated that the responses varied on the basic existence, relatedness and growth needs of patients in a surgical emergency unit. From the findings, recommendation was described for the operational nursing managers in the surgical emergency department to take action during addressing patients' basic needs in the delivery of nursing care. It can be concluded that patients perceive that many of their basic needs are not being met while receiving surgical emergency care.