Bakgrund: Sjuksköterskor på akutmottagning arbetar ofta i en oförutsägbar och stressig miljö där omprioriteringar behöver göras hela tiden. Att arbeta under dessa förutsättningar kan medföra en risk att uppleva samvetsstress. Forskning inom detta område har gjorts i flera kontexter men väldigt lite forskning är gjord hur den yttrar sig på en akutmottagning. Syfte: Syftet med denna studie var att beskriva sjuksköterskans upplevelse av samvetsstress på akutmottagningen. Metod: En kvalitativ semistrukturerad intervjustudie genomfördes med tio sjuksköterskor från två akutmottagningar med olika storlek. Resultat: Utifrån resultatet framkom sex kategorier och ett tema. Kategorierna var följande: Att medverka till vårdlidande; Bristande kollegialitet som grund för samvetsstress; Organisatoriska brister som grund för samvetsstress; Hantering av upplevd samvetsstress; Konsekvenser av samvetsstress och Lindring av samvetsstress. Temat mynnade ut i Samvetsstress- en börda att förhålla sig till. Slutsats: Tillräckliga resurser och organisatoriskt stöd är viktiga medel för att lindra samvetsstress hos sjuksköterskan. Genom att sjuksköterskan arbetar med sin etiska kompetens och nyanserar kraven på sig själv kan upplevelsen av samvetsstress lindras. / Introduction: Nurses in the emergency room are often working in an unpredictable and stressful environment where constant re-prioritizing is made. Working under these conditions could cause stress of conscience. Research in this field has been made in different contexts but there is little research made in the emergency room. Aim: The aim with this study is to describe the nurse´s experience of stress of conscience in the emergency room. Method: A qualitative semi structured interview study was carried out with ten nurses from two emergency rooms of different size. Result: Six categories and one theme emerged from the result. The categories where the following:  To contribute to care suffering; Lack of collegiality as a cause of stress of conscience; Organizational shortcomings as a reason for stress of conscience; Managing stress of conscience; Consequences for the nurse and Alleviation of stress of conscience. The theme was Stress of conscience - a burden to relate to. Conclusion: Sufficient resources and organizational support are important means to alleviate stress of conscience. If the nurse improves ethical competences and nuances the existing demands, the experience of stress of conscience can decline.

Bakgrund: Det är uppskattningsvis 2,5 miljoner svenskar som söker akutsjukvård på akutmottagningar per år (Socialstyrelsen, 2015). Detta gör att belastningen blir hög då resurser ofta saknas vilket bidrar till ökade väntetider. Patienters missnöje och organisatoriska problem är något som ofta framkommer i media. Genom att ta reda på patienternas faktiska upplevelse skapas förutsättningar för att mottagandet och omhändertagandet kan förbättras och i sin tur också vårdsituationen på akutmottagningen. Syfte: Med grund i Travelbees teori beskriva personers upplevelse av att vårdas på en akutmottagning. Metod: En deduktiv litteraturöversikt genomfördes och nio artiklar analyserades utifrån Travelbees omvårdnadsteori. Resultat: Travelbees begrepp lidande, mening, mellanmänskliga relationer, människan som individ och kommunikation utgör teman. Patienter upplever att kommunikationen mellan dem och vårdpersonal har stor betydelse. Den mänskliga kontakten som detta möte innebär gör att patienten känner sig bekräftad. Saknar patienten bekräftelse i form av mänsklig kontakt eller kommunikation leder det till missnöjdhet i vårdsituationen. Slutsatser: Vårdpersonalens bemötande påverkar patientens upplevelse av akutmottagningen och hjälper patienterna att hantera situationen. Kontinuerlig kontakt med vårdpersonal har visat sig ha betydelse för patienten då de blir bekräftade. Sjuksköterskan bör vara medveten om vilka förväntningar patienten har och kunna hantera de olika vårdsituationerna på ett professionellt sätt. / Background:  It´ about 2,5 million Swedes who seek emergency treatment per year (Socialstyrelsen, 2015).  This leads to high pressure at the emergency department. Resources are often scarce and contributes to increased waiting times. Media shows a negative image of care and organizational problems often appears. Looking at patients' experiences of the situation at the emergency department, creates conditions for improving the healthcare situation at emergency department.  Aim: To describe peoples experience of being treated at the emergency department by using Travelbees nursing theory. Method: A deductive literature review was conducted and nine articles were analyzed by Travelbees nursing theory. Results: Travelbees concepts suffering, meaning, human relation, human as an individual and communication creates theme in the result. Patients experiencing that communication between them and the healthcare professionals is of great importance. This contact makes the patient feel confirmed. If the patient feel that they are not confirmed because of lacking communication or human contact it leads to a feeling of dissatisfaction.  Conclusion: Healthcare professional’s treatment affects the patients experience in the emergency department and helps them to cope with the situation. Continuous contact with health professionals is of importance for the patient and makes them feel confirmed. The nurse must be aware of which expectations the patient has when they seek emergency care and be able to give professional care.

After emergency department (ED) discharge, Spanish-speaking patients with limited English proficiency are less likely than English-proficient patients to be adherent to medical recommendations and are more likely to be dissatisfied with their visit.

Emergency department (ED) overcrowding has been a common complaint in Emergency Medicine in Canada for many years. Its adverse effects of prolonged waiting times cause patient dissatisfaction and unsafety. Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluation. However, the scientific evidence of the PIT impact on ED is far away from sufficient before its widespread implementation. This research is to search solutions using PIT to identify areas of improvement for the ED patient flow, based upon a validated discrete-event simulation (DES) model. As an efficient decision-making tool, the DES model also helps to develop an understanding of the current ED performance and quantitatively test various design alternatives for ED operations. / February 2017

A mixed methods approach was used for this study. The setting was a low-income, subsidized housing apartment building for community-dwelling older and younger disabled adults identified as a health care hot spot due to high rates of ambulance use. The study purpose was to identify reasons for ED use and problems during transition from ED to home, predictors of zip code 23220 (health care hot spot) in emergent and non-emergent ED visits, and predictors of total ED costs in community-dwelling older adults living in a health care hot spot. Semi-structured interviews with residents who used the ED, an existing database from an interprofessional care coordination and wellness program for residents, and community-dwelling older adults’ electronic medical record and billing data from 2010-2013 ED visits from an academic medical center were used. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was utilized. A total of 14 interviews were conducted. Themes related to ED use included: high use of ambulance services, timely use of the ED or attempt at self-care, and lack of communication with a health care provider prior to ED visit. Themes related to care transitions were: delay in medication receipt after discharge, lack of a current medication list and personal health record, PCP follow-up instruction, and education on warning signs of a worsening condition. The interprofessional program’s care coordination activities were education, disease monitoring, referral for PCP visit, and discrepancy reconciliation. A total of 7,805 ED visits were included, of which 3,871 were non-emergent and 1,179 were emergent. Common primary ED visit diagnoses were chest pain and abdominal pain. White race, a Charlson Comorbidity Index score of 3, and a total disease count of 10 or more were significant predictors of zip code 23220 in non-emergent ED visits. White race was a significant predictor of zip code 23220 in emergent ED visits. Significant predictors of total ED costs were white or other race, arrival by ambulance, emergent visit type, and year of visit. Pain was a common reason for ED use. Care transition problems related to medication management and follow-up care indicate an area for targeted interventions after ED discharge.

Bakgrund: Akutmottagningen är dit akut sjuka eller skadade människor söker sig med sina symtom. Det kan vara allt från en traumatisk- till en livshotande situation. Patienter triageras efter standardiserade metoder där patienter bedöms efter sina symtom. God kommunikation och information har en stor betydelse för tillfrisknandet, välbefinnandet och hälsan. Bemötandet och omhändertagandet räknas som en av de grundläggande aspekterna där patienters initiala behov av vård tillgodoses. Trots det fick Inspektionen för vård och omsorg under år 2015, 515 anmälningar beträffande bemötande. Syfte: Syftet var att beskriva patienters erfarenheter av sjuksköterskors bemötande på akutmottagningen. Metod: En litteraturöversikt där totalt elva artiklar inkluderats, varav nio artiklar med en kvalitativ utgångspunkt och två med en kvantitativ utgångspunkt. Resultat: Sammanställs i fyra övergripande kategorier; Information och kommunikation mellan sjuksköterska och patient, patienters erfarenhet beträffande väntetiderna, patienters erfarenhet av sjuksköterskors bemötande och känslan av att vara ett objekt. Konklusion: Information- och kommunikationsbristen ligger till grund för patienters negativa inställning till akutmottagningen och bör belysas fortsättningsvis i framtida studier. / Background: The emergency department is where people with acute and non-urgent care goes to with their symptoms. It can include everything from trauma- to a life threatening situation. Patients goes through the triage by standardized methods in which the patients are assessed for their symptoms. Good communication and information are important for the patient’s recovery, well-being and health. The encounter and caretaking is considered as one of the basic aspects where the patient’s initial needs of care have to be satisfied. However, during 2015 the health and social care inspectorate (IVO) got 515 reports concerning encounter and treatment. Aim: The aim of the study was to describe Patients’ experiences of the nurse’s encounter at emergency departments Method: A literature review was made containing eleven scientific articles with both a qualitative and a quantitative basis. Nine of these had a qualitative basis and two had a quantitative basis. Results: The results are compiled in four categories: Information and communication between nurse and patient, patient’s experiences regarding waiting times, patient’s experiences of nurses encounter and the feeling of beeing an object. Conclusion: The lack of information and communication is the foundation of patient’s negative attitude towards the acute care.

Background: Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. Methods/design: This trial uses a randomized, two-group design in which caregiver-smokers of children 0-17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child's illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control "5-2-1-0" counseling that focuses on improving the child's health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. Discussion: This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

Healthcare industry in United States of America is facing a big paradox. Although US is a leader in the industry of medical devices, medical practices and medical researches, however there isnt enough satisfaction and quality in performance of US healthcare operations. Despite the big investments and budgets associated with US healthcare, there are big threats to US healthcare operational side, that reduces the quality of care. In this research study, a step by step Systems Engineering approach is applied to improve healthcare delivery process in an Emergency Department of a hospital located in Indianapolis, Indiana. In this study, different type of systems engineering tools and techniques are used to improve the quality of care and patients satisfaction in ED of Eskenazi hospital. Having a simulation model will help to have a better understanding of the ED process and learn more about the bottlenecks of the process. Simulation model is verified and validated using different techniques like applying extreme and moderate conditions and comparing model results with historical data. 4 different what if scenarios are proposed and tested to find out about possible LOS improvements. Additionally, those scenarios are tested in both regular and an increased patient arrival rate. The optimal selected what-if scenario can reduce the LOS by 37 minutes compared to current ED setting. Additionally, by increasing the patient arrival rate patients may stay in the ED up to 6 hours. However, with the proposed ED setting, patients will only spend an additional 106 minutes compared to the regular patient arrival rate.<br>

Bakgrund: Hot och våld inom vården är ett växande problem både globalt och i Sverige. Dessa händelser inträffar särskilt inom akutsjukvården. Sjuksköterskor är en av de yrkesgrupper som mest löper risk att utsättas för hot och våld på grund av deras närhet till patienter och närstående. Inom akutsjukvården finns olika riskfaktorer som kan bidra till hot och våld. Konsekvenserna leder till ökade sjukskrivningar och försämrat välbefinnande samt ökat antal uppsägningar. Det kan påverka verksamhetens kostnader och därmed ökade kostnader för samhället. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att ha blivit utsatt för hot och våld inom akutsjukvård från patienter och närstående. Metod: Litteraturöversikten baserades på sammanställning och tolkning av tio vetenskapliga artiklar med både kvalitativ och mixad metod där två databaser genomsöktes. Artiklarnas analys gjordes enligt Friberg. Resultat: Litteraturöversiktens resultat sammanställdes i sex centrala teman: Hot och vålds psykiska inverkan, Hot och vålds fysiska inverkan, Hot och vålds sociala inverkan, Hot och vålds inverkan på yrkesutövning, Normalisering av hot och våld och sjuksköterskans upplevelser av brist på stöd. Diskussion: Resultatdiskussionen tar upp hot och vålds negativa konsekvenser såsom psykiska, fysiska och sociala välbefinnande samt förmågan att ge god vård. Sjuksköterskor upplevde att hot och våld var en del av arbetet trots dess negativa inverkan. Det fanns en avsaknad för stöd från verksamhet och ledning vilket resulterade i att hot och våld normaliserades. Utgångspunkt tas framförallt i Joyce Travelbee omvårdnadsteori med fokus på mellanmänskliga relationer. / Background: Threats and violence in health care is a growing problem both globally and in Sweden. These accidents occur especially in emergency care. Nurses are one of the professional groups most at risk of being subjected to threats and violence because of their proximity to patients and families. In emergency care there are various risk factors that may contribute to threats and violence. The consequences lead to increased sick leave and poorer welfare, but also increased number of layoffs. It can affect business costs and increase costs for society. Aim: The aim was to describe nurses’ experiences of having been subjected to threats and violence in emergency care of patients and families. Method: The literature review was based on the compilation and interpretation of the ten scientific articles with both qualitative and mixed method was searched in two databases. Articles analysis was done according to Friberg. Results: The literature review results were compiled in six central theme; Threats and violent mental influence, threats and violent physical influence, threats and violent social influence, threats and violent impact on the profession, Normalization of threats and violence and the nurse's perceptions of lack of support. Discussion:The result discussion addresses how threats and violence’s negative consequences such as mental, physical and social well-being and the ablity to provide good care. Nurses experienced threats and violence as a part of their job, despite the negative impact. They found no support from the company or the management, which resulted in that threats and violence became normalized. Starting points are taken primarily in Joyce Travelbee´s nursing theory with a focus on the concepts of interpersonal relationships.

A enfermagem é considerada uma profissão que sofre o impacto do stress, que advém do cuidado constante com pessoas doentes e situações imprevisíveis, principalmente na unidade de pronto socorro. A finalidade deste estudo foi de levantar os estressores dos enfermeiros atuantes em unidades de pronto socorro nas cinco regiões brasileiras. A população do estudo constituiu-se de uma amostra de 143 enfermeiros atuantes em unidades de pronto socorro das regiões brasileiras e que estavam inseridos em instituições de alta complexidade de assistência prestada. Os dados foram coletados utilizando-se a Escala Bianchi de Stress, constituída por caracterização sócio-demográfica e por 51 itens, que versavam sobre as atividades desempenhadas pelos enfermeiros. A análise estatística dói descritiva e inferencial, usando análise de variância ANOVA. Com a finalidade de promover a comparação e estudo dos dados, foi realizado o escore de stress, em seis domínios, englobando o relacionamento(A), funcionamento da unidade(B), administração de pessoal(C), assistência de enfermagem(D), coordenação da unidade(E) e condições de trabalho(F). Os níveis obtidos foram classificados em baixo (até 3,0), médio (de 3,1 a 4,0) alerta (de 4,1 a 5,9) e alto (acima de 6,0).A amostra foi eminentemente feminina (90,9%), jovem (71,1% com menos de 40 anos), com 2 a 5 anos de formação, atuantes na unidade de pronto socorro há aproximadamente 36 meses, sendo 82,5% dos enfermeiros com cargos assistenciais, 73,2% com pós-graduação latu sensu, e 46,2% dos enfermeiros atuavam em instituições da região Sudeste. Verificou-se que, os enfermeiros obtiveram escore individual de stress entre 3,1 e 5,9, o que denota médio nível a alerta para alto nível de stress. Considerando-se o escore de stress por região obtive-se que SE > NE > S > CO > N. Na análise dos seis domínios, obteve-se, em ordem decrescente, F > C > E > D > B > A, independentemente da região geográfica a que pertencia o enfermeiro. O cargo de \"gerência\" foi a variável com relação estatisticamente significante (p < 0,05), demonstrando que \"ser gerente\", é estressante e aumenta à medida que aumenta também o tempo de formado. Pode-se inferir que tanto a estrutura organizacional da instituição hospitalar tem responsabilidade no nível de stress dos enfermeiros de pronto socorro como também o próprio enfermeiro, na procura de estratégias para enfrentamento da situação, que pode interferir no âmbito pessoal e profissional. / The nursing is considered as stressed work due to treating sick people and improvable situations as in Emergency Department (ED). The goal of this study is to search stressors among Brazilian nurses who work at ED. The sample was constituted by 143 nurses who work at high complexity hospitals. Data was obtained using a \"Bianchi Stress Inventory\" that enclosed socio-demographic data and 51 activities developed by nurses. Statistical analyses was descriptive and inferential using ANOVA. In order to compare data, there was used a score of stress and classified into six areas: relationship(A), unit functioning(B), staff administration(C), nursing assistance(D), unit coordination(E) and work conditions(F). The stress level was determined as low (under 3,0), medium (from 3,1 to 5,9) and high (above 6,0). The sample was feminine (90,9%); young (71,1% under 40 years old); from 2 to 5 years after finishing of undergraduate course; has worked at ED for 36 months as staff nurse (82,5%), concluded graduate course latu sense (73,2%) and 46,2% work in Southeast States. The individual score of nurses varied from 3,1 to 5,9 considered medium level. The stress score among states, in decrescent order, was: Southeast > Northeast > South > Center-West > North. After analyzing the six areas, the classification was: F > C > E > D > B > A and was independent of geographical localization. The \"management\" nurses were more stressed than the others and the result was statistically significant (p < 0,05) and increased with the period after finished undergraduation. The consequences of those results are that the hospital has the responsibility to offer work conditions for nurses and, on the other hand, nurses must know their stress reaction and stressors and improve the use of coping strategies, to diminish personal and professional interferences.