Compassion fatigue (CF) is defined as a sudden onset of the inability to experience feelings or compassion for others that is triggered by a nurse's inability to separate his/her feelings of stress and anxiety associated with caring for patients who have suffered from a traumatic event. The practice problem addressed in this doctoral project was the lack of knowledge of emergency department nurses (EDNs) related to CF in the work setting, resulting in a negative impact on a nurse's ability to provide quality care to patients. The purpose of the project was to present an educational program on how to recognize, prevent, and manage CF. Framed within Stamm's theoretical model of compassion satisfaction and CF, the project was guided by the steps within the Walden University Manual for Staff Education Project and the practice question addressed whether the literature would support an evidence-based educational program on CF for EDNs. The evaluation/validation for the project included an evaluation of the curriculum by the three content experts (in which learning objectives were deemed met), content validation of the pre-/post-test items by the content experts (all test items were deemed relevant to the learning objectives, with the validity index scale analysis at 1.00), and finally, a paired t test to determine knowledge gained from pre- to post-test that resulted in a significant (p < 0.0001) improvement in knowledge. A potential positive social change resulting from the project is a healthy work environment where EDNs understand and reduce their risks for CF, which may ultimately promote optimal patient care and improved health outcomes.

Sepsis is a severe blood stream infection that claim the lives of almost 220,000 Americans annually. Delayed patient treatment results in multi-organ failure, morbidity, mortality, and increased hospital length of stay. Timely sepsis management enables hospitals to have decreased expenses, increased patient survival, and judicious interventions. The problem addressed in this project was the lack of sepsis- training for registered nurses (RNs) working in the emergency department (ED) of a 628-bed hospital in the southeastern United States. Under the direction of the director of the ED, 269 patient charts were reviewed during 2014 to February 2015 for data related to a sepsis diagnosis. Data showed that 19.4% (n = 103) of patients diagnosed with sepsis had the sepsis order set implemented by the ED nurse. The purpose of this project was to create an educational sepsis-training program for ED nurses. The program included a 2-hour educational module on signs and symptoms of sepsis, including guidelines from the Surviving Sepsis Campaign and the Emergency Nurses' Association. Stetler's Model of Research Utilization and Benner's Novice to Expert conceptual frameworks supported the project. The director of professional practice provided formative feedback on module content and the program evaluation tool. Director feedback indicated that content was beneficial in educating ED nurses on the signs and symptoms of early sepsis recognition. The ED director has now mandated that all ED nurses take the training module and posttest. The project has the potential to improve early sepsis recognition by ED staff and to improve patient outcomes, thus promoting positive social change for patients, families, and nurses.

No description available.

No description available.

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.

Bakgrund Vistelsetiden på akutmottagningen på Centralsjukhuset i Kristianstad har studerats och en skillnad identifierades där män i större utsträckning än kvinnor hade en vistelsetid kortare än fyra timmar. Ingen direkt orsak till skillnaden i vistelsetid kunde urskiljas. Det identifierade fenomenet valdes att bearbetas med genus som begrepp. Syfte Syftet med studien var att undersöka orsaken till varför det är en skillnad i vistelsetid mellan män och kvinnor på akutmottagningen. Metod Metod för datainsamling var kvalitativ intervju. Informanter valdes strategiskt utifrån kriteriet att de arbetade på en akutmottagning, och bestod av olika yrkesprofessioner, kön samt yrkeserfarenhet. Två olika sjukhus i södra Sverige deltog i studien. Totalt inkluderas nio informanter. Semistrukturerade enskilda intervjuer med öppna frågor genomfördes och insamlad data analyserades genom kvalitativ innehållsanalys enligt Graneheim och Lundman. Resultat Skillnaden i vistelsetid på akutmottagningen upplevdes bero på att kvinnor söker med ospecifika och diffusa symtom/orsaker eller oro, sökorsaker som upplevdes mer tidskrävande. I motsatts upplevdes män söka med konkreta/specifika symtom eller allvarlig sjukdom/skada, sökorsaker som upplevdes mindre tidskrävande. Skillnaden upplevdes även bero på när i sjukdomsförloppet patienten söker, sociokulturella faktorer, biologiska könsskillnader samt olika kommunikationsmönster. Slutsatser Skillnaden i män respektive kvinnors vistelsetid på akutmottagningen upplevdes inte bero på vårdpersonalens medvetna handlingar, utan på patientens sökorsak, vald tidpunkt för besök, biologiska faktorer, sociokulturella faktorer samt kommunikativa faktorer. / Background The length of stay in the emergency department at Central Hospital in Kristianstad has been studied and a difference was identified where men more often than women had a length of stay less than four hours. No direct reason for the difference in length of stay could be discerned. This identified phenomenon has been selected to be analyzed with gender as a cause of inequality. Aim The aim of this study was to investigate the reason why there is a difference in length of stay between men and women in the Emergency Department. Methods Method of data collection was qualitative interviews. Informants were chosen strategically based on the criterion that they work in an Emergency Department, consist of various professions, sex and work experience. Two different hospitals in southern Sweden participated in the study. It included in total nine informants. Semi-structured individual interviews with open-ended questions were conducted, and the collected data were analyzed through qualitative content analysis by Graneheim and Lundman. Results The difference in length of stay in the emergency department was experienced due to women seeking with non-specific and diffuses symptoms/cause or concerns, reason to seek experienced more time consuming. Contrarily experienced men seek with concrete/specific symptoms or serious illness/injury, reason to seek experienced less time consuming. The difference was experienced also depend on when in the course of the disease the patient is seeking, socio-cultural factors, biological gender differences, and different communication patterns. Conclusions The difference in men and women's length of stay in the Emergency Department is experienced not to depend on nursing staff aware actions, but on the patient´s reason to seek, the selected time for visit, biological factors, socio-cultural factors, as well as communicative elements.

Bakgrunden var att överbeläggningar inom akutsjukvården har ökat de senaste åren i och med högre patientantal. Syftet med denna studie var att beskriva sjuksköterskans upplevelser av arbetet vid överbeläggningar på en akutmottagning. Metoden var en kvalitativ deskriptiv design där information samlades in via intervjuer. För att analysera data från de åtta informanterna valdes en kvalitativ innehållsanalys. Studien genomfördes på en akutmottagning i mellersta Sverige. Huvudresultatet från de åtta intervjuer som genomfördes skapade tre kategorier med tio subkategorier. Samtliga informanter berättade om sina upplevelser av att arbeta vid överbeläggningar. De mest frekventa upplevelserna handlade om en stressad och frustrerande arbetssituation. De uppgav att upplevelserna av störningsmoment och irritation blev mer förekommande vid överbeläggningar samt att de upplevde otillräcklighet. Stressen uppenbarade sig på olika sätt hos sjuksköterskorna. De stressade situationerna avspeglade sig i sjuksköterskornas yrkesroll, hälsa och privatliv. Många sjuksköterskor upplevde även att patienternas säkerhet försummades vid överbeläggningar, då de fick ligga i korridoren. Detta upplevdes ge ökade risker för smitta, minskad sekretess och integritet för patienterna. Det sjuksköterskorna upplevde som positivt vid överbeläggningarna var att de inom arbetsgruppen försökte stötta varandra samt att arbetstiden gick fort. Slutsatsen var att sjuksköterskorna upplevde stress, frustration, irritation och störningsmoment på sitt arbete, akutmottagningen, vid överbeläggningar. Arbetsgivarna för akutmottagningen bör uppmärksamma arbetsmiljön för sjuksköterskorna så att de kan ge stöd till dem, så att de ska veta vart bristerna finns samt för hur de ska fördela resurserna vid överbeläggningar. / The background was that overcrowding in emergency care has increased in recent years with higher patient numbers. The aim of this study was to describe nurses' experiences of the work in an overcrowded emergency department. The method was a qualitative descriptive design where information was collected through interviews. To analyze the data from the eight informants a qualitative content manifest analysis was chosen. The study was conducted in an emergency department in a hospital in central Sweden. The main results from the eight informants indicate that overcrowding leads to major problems. The most frequent experiences was about a stressful and frustrating work situation. The nurses felt that distraction, insufficiency and irritation was occurring at the overcrowding. The stressful situations reflected in nurses' professional roles, health and personal life. Many nurses felt that patients' safety was overridden at overcrowding. Patients must be in the corridors which gives increased risk of infection, poorer and reduced privacy. The thing that nurses experienced as positive in overcrowding was that the work group tried to support each other and working hours passed quickly. The conclusion was that the nurses experienced stress, frustration, irritation and distraction from their work, the emergency department, at overcrowding. Employers at the emergency department should pay attention to the work environment for nurses so that they can support them, so they'll know where the weaknesses are and how they should distribute resources when the ward is overcrowded.

Emergency Departments have begun implementing new patient flow processes aimed at improving ED throughput and limiting ED crowding. The purpose of this study was to evaluate the effectiveness of two flow processes. &lt;br&gt;This was a retrospective quasi-experimental study designed to evaluate the impact of a Rapid Medical Assessment process versus Fast Track process on improving ED throughput. Data analysis included descriptive statistics and two-factor analyses of covariance (ANCOVA). ANCOVA statistics were calculated using “arrival to first provider contact time” and “arrival to departure time” as the dependent variables and RMA process versus FT process as well as ESI levels as the independent variables. There was a significant difference in the mean arrival to first provider contact times for all patients during all hours, F (1, 5744) = 9.5, p = .002. There was also a significant difference in the mean arrival to first provider contact time for low-acuity patients during all hours, F (1, 3131) = 14.6, p = &lt; .001 &lt;br&gt;There was a significant difference in the mean arrival to departure times for all patients during all hours, F (1, 6079) = 5.8, p = .016. There was no significant difference in the mean arrival to departure times for low-acuity patients during all hours, F (1, 3306) = 0.774, p = .379, or for all patients during FT hours, F (1, 2647) = 1.1, p = .295. The results of the study support the belief that rapid evaluation and disposition of low-acuity patients improve ED efficiency and reduce ED crowding. / School of Nursing; / Nursing / PhD; / Dissertation;

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / It is estimated over 20 million people aged 20‐74 have gallbladder disease, with biliary colic being a common and painful symptom in these patients. Likely due to the relatively recent approval of intravenous ibuprofen use for fever and pain in adults, no assessment of its analgesic efficacy for biliary colic currently exists in the literature. In this double‐blind, randomized, controlled trial we aim to assess the analgesic efficacy of intravenous (IV) ibuprofen given in the emergency department (ED) for the treatment of biliary colic. Analgesic efficacy was evaluated using a visual analog scale (VAS) to assess for a decrease in pain scores. A VAS score decrease of 33% in relation to the VAS taken at the time of therapy drug administration was considered a minimum clinically important difference (MCID) in patient‐perceived pain. A VAS was administered in triage upon enrollment, at the time of therapy administration, at 15‐minute intervals during the first hour post‐administration, and 30‐minute intervals in the second hour. As the standard of care for suspected biliary colic at the study institution is administration of a one‐time dose of IV morphine, patients were not denied initial morphine analgesia and were permitted to receive “rescue” morphine analgesia at any point during their ED course. A total of 22 patients completed the study. 9 were randomized to the IV ibuprofen arm, 9 to placebo, and 4 were excluded for a diagnosis other than biliary colic. Mean VAS values at time 0 to time 120 decreased from 5.78 to 2.31 in the ibuprofen group, and from 5.89 to 2.67 in the control group. There was no statistically significant difference in treatment status of ibuprofen vs. placebo (p‐value (p.) 0.93), though there was a significant decrease in the measured VAS scores over time (0 minutes to 120 minutes, p.0.031) in both ibuprofen and placebo groups. A statistically significant and clinically important decrease in average VAS scores were seen in both placebo and ibuprofen groups (55% and 60%, respectively). There was no difference in time needed to achieve a clinically significant reduction in pain between groups. The sample size of this study may be inadequate to fully assess the analgesic efficacy of IV ibuprofen for biliary colic. In the analysis group (n=18) no significant difference in treatment status of ibuprofen vs. placebo was seen, however there was a statistically and clinically significant decrease in pain in both groups. Two potential confounding factors may have affected the trial’s results: administration of standard‐of‐care IV morphine following initial triage assessment, and the inherent episodic and self‐limited nature of biliary colic.

Akut insjuknande patienter söker vård via akutmottagningen där bedömning av patientens hälsotillstånd sker vilket benämns som triagering. Akutmottagningens miljö utmärks av ett hektiskt arbetstempo som kan upplevas främmande och skrämmande för den inkomna patienten. Den stressiga miljön kan påverka det fysiska, psykiska och emotionella välmåendet och trigga stresspåslaget hos patienterna. Syftet med litteraturstudien var att undersöka patientens upplevelse av stressfaktorer på en akutmottagning. Metoden genomfördes som en litteraturstudie genom strukturerade sökningar efter vetenskapliga artiklar som analyserades och sammanställdes i ett resultat vilket skapade en ökad förståelse för problemområdet. Utifrån tio resultatartiklar genererades fyra teman som berörde stressfaktorer ur olika aspekter. De teman som uppkom var Miljöns påverkan, Psykisk påverkan, Väntetid och brist på information samt Sjuksköterskans påverkan. En betydande slutsats från resultatet är att sjuksköterske - patientrelationen är en viktig del i att förbättra patientens upplevelse och för att patienten ska känna förtroende, tillit samt solidaritet till sjuksköterskan. Lärdom från litteraturstudien kan utvinnas och sjuksköterskan kan erhålla bättre förutsättningar att bemöta patienten. / Acutely ill patients seek care through the emergency department, where assessment of the patient's health status occurs which is called triage. The environment of the emergency department is characterized by a hectic work pace that may feel foreign and frightening for the incoming patient. The stressful environment may influence the physical, mental and emotional well-being of the patient and trigger stress. The aim of this study was to investigate the patient's experience of stress factors at an emergency department. The method emerged as a literature study through structured searches for scientific articles, which were analyzed and compiled in a result that created a greater understanding of the problem. Based on the results of ten articles, four themes were generated which referred to stressors from different aspects. The themes that emerged was the environmental impact, psychological impact, waiting time and lack of information and the nurse impact. A significant conclusion from the result is that the nurse–patient relationship is an important part of improving the patient experience and make the patient feel confidence, trust and solidarity to the nurse. Knowledge from the literature study can be extracted which may improve the nurse’s encounter with the patient.