Dissertation submitted in fulfilment of the requirements for the Degree of Master in Technology: Emergency Medical Care, Durban University of Technology, 2010. / South Africa currently has 1631 registered Advanced Life Support (ALS) paramedics to tend to the pre-hospital advanced life support needs of just under 50 million people. Compared to the globally accepted ratio of 1:10 000, the number of ALS paramedics in South Africa is grossly inadequate. The current shortage of South African ALS paramedics may be ascribed to migration. However, although literature on health worker migration in general abounds, there is a marked lack of national or international statistics and information on migration of ALS paramedics and their migration. Current measures to manage migration appear to be ineffective. The success of future strategies is dependent on an understanding of the migration of South African ALS paramedics - an understanding that presently does not exist. Purpose The purpose of this study was to describe the migration of South African undergraduate Advanced Life Support paramedics who qualified between 2001 and 2006, and to then develop a framework of retention strategies. In particular, it determined the extent and nature of their migration, identified the factors that have contributed to their decision to work outside South Africa and identified strategies to retain or encourage the return of ALS paramedics to practice exclusively in South Africa. Methods The study consisted of a two-phase mixed method descriptive survey. Paramedics with ALS undergraduate diplomas who qualified in South Africa between 2001 and 2006 made up the study population. Quantitative data (Phase One) was obtained from a web-based survey distributed to the accessible population (N=97). Thereafter, qualitative data (Phase Two) was gathered through in-depth interviews with selected information rich participants (n=10) also from within the accessible population. Through methodological triangulation, data from Phase One and Phase Two were Page vi integrated to obtain an in-depth understanding of South African ALS paramedic migration. Results Significant differences existed in the distribution of age (p=0.035), and years of experience post-graduation (p=0.007) and the ALS paramedic deemed most likely to migrate were individuals between the ages of 21 – 30. 15 (55%) of the participants working outside the country were engaged in short term contracts while all 24 (100%) of participants working inside South Africa were permanently employed. 18 (75%) of respondents working inside South Africa intended migrating, 12 (67%) of which intended to do so within 0 to 2 years. Nine major factors or reasons for migration were identified by participants. Working conditions, physical security and economic considerations were ranked as the top three major factors most likely to contribute to the decision or intended decision to migrate. This study also found five primary decisions that likely emerge during the life of a South African ALS Paramedic. The outcome of each decision is a result of facilitators weighted against barriers. Facilitators are factors that supported each of the primary decisions while barriers weakened or rejected them. Findings indicated that many barriers existed which rejected or weakened the decision of ALS paramedics to work inside South Africa, return to South Africa or remain in South Africa. On the converse, a vast number of facilitators existed which spurred continued migration. Conclusions As the decision to migrate may be conceptualised as early on as when individuals decide to become ALS paramedics, the constructs of return and retention strategies have to extend as far as revising recruitment policies. Preference or places into training programmes should be given to individuals who are less inclined to migrate, these include: military personnel; those already employed in the EMS, older mature candidates; candidates with families that have already settled in SA; and recognition of prior learning (RPL) candidates who are predominately obligated by contract to remain in South African EMSs.

Introduktion: Sjuksköterskor inom somatisk vård möter och vårdar vid ett antal tillfällen per år patienter med diagnosen anorexia nervosa. Anorexia nervosa är en allvarlig sjukdom med hög dödlighet. Diagnosen påverkar både patientens somatiska och psykiatriska status. Patienter med diagnosen anorexia nervosa beskriver ett omvårdnadsbehov ur både ett somatiskt- och psykiatriskt omvårdnadsperspektiv. En framgångsrik allians är viktig för att vård och behandling ska kunna uppnås och upprätthållas. Sjuksköterskor inom somatisk vård upplever flera utmaningar i mötet med patientgruppen, däribland fördjupad förståelse för sjukdomens komplexitet. Syfte: Att undersöka hur sjuksköterskor inom somatisk vård upplever omvårdnaden i förhållande till patienter med diagnosen anorexia nervosa. Metod: Intervjustudie med kvalitativ ansats samt ett induktivt förhållningssätt. Studien bygger på åtta semistrukturerade intervjuer med sjuksköterskor på en somatisk vårdavdelning. Tematisk analys användes för analys av intervjuerna. Resultat: Dataanalysen resulterade i tre övergripande teman: Sjuksköterskan och anorexi, Komplex somatisk omvårdnad samt Ropet efter psykiatrin. Sjuksköterskorna upplevde svårigheter som starka känslor, bristande vårdstruktur och otillräcklig kunskap om diagnosen anorexia nervosa i omvårdnadsarbetet med patientgruppen. Sjuksköterskorna önskade handledning och utbildning om sjukdomens komplexitet samt ett förbättrat samarbete mellan somatiken och psykiatrin. Slutsats: Sjuksköterskor inom somatisk vård upplevde flera svårigheter i mötet med patienter med diagnosen anorexia nervosa. Brist på tid, omvårdnadsstruktur och fördjupad kunskap om sjukdomen upplevdes försvåra möjligheterna till god kommunikation och allians med patientgruppen. Stöd, kunskap och ett välfungerande samarbete med psykiatrin ansågs kunna förbättra och utveckla omvårdnadsarbetet på den somatiska avdelningen för patienter med diagnosen anorexia nervosa. / Introduction: Nurses working in an acute medical care setting sometimes participate in the treatment of patients diagnosed with anorexia nervosa. Anorexia nervosa is a serious disease with a high mortality-rate. The disease affects the body as well as the mind. Patients diagnosed with anorexia nervosa describe nurses' lack of knowledge about the diagnosis. Nurses in medical care settings describe several challenges in the nursing process involving patients diagnosed with anorexia nervosa. Purpose: To examine the experiences of nurses working in an acute medical care setting when treating and nursing patients diagnosed with anorexia nervosa. Method: A qualitative interview study. Semi-structured interviews were conducted with eight nurses working in an acute medical care setting. The text material was analyzed with thematic analysis. Results: The nurses experienced strong feelings when nursing patients diagnosed with anorexia nervosa. The nurses described unclear treatment structures and insufficient knowledge about the diagnosis. A well-established cooperation with the psychiatric unit as well as improved knowledge about the diagnosis were described as requirements in order to offer the patients advanced nursing. Conclusion: Nurses in a medical care unit experienced several challenges when nursing patients with anorexia nervosa. The nurses described a constant lack of time, unclear treatment structures and insufficient knowledge about the diagnosis. Tutorials, education and cooperation with the psychiatric unit could support nurses in medical health units to improve in order to understand the complex needs of patients diagnosed with anorexia nervosa.

Bakgrund: Regionalt Läkarstöd (RLS) har utformats för att säkra prehospital involvering från läkare. Dagens ambulanssjukvård ställer höga krav på att bedöma och triagera patienter till rätt vårdnivå. Till sin hjälp i sitt dagliga arbete med detta behöver sjuksköterskan en läkare som är väl insatt i verksamheten. Syfte: Att beskriva läkares erfarenhet av att fungera som rådgivare till sjuksköterskor inom ambulanssjukvården Metod: Kvalitativ intervjustudie med tio läkare som tjänstgör som RLS. Analysen genomfördes med en kvalitativ innehållsanalys. Resultat: Resultatet beskrivs med de fyra kategorierna Teamsammanhållning, Frustration, Bristande ansvarskänsla och Lyhördhet, som speglade läkarnas erfarenheter av att vara telefonstöd till sjuksköterskor. Ett latent huvudbudskap identifierades som Skör tillit. Att som en del i teamet finnas som stöd och rådgivare till sjuksköterskor i ambulanssjukvården upplevdes som positivt och funktionen ses som relevant och viktig. Det krävs en god teamsamverkan mellan professionerna för en patientsäker vård och för att uppnå det utkristalliserades tillit som en nyckelfaktor. Konklusion: En telefonbaserad bakjourslinje dit sjuksköterskor kan vända sig för råd och stöd är en relevant funktion för läkarna, där de känner sig som en del i det prehospitala teamet. I arbetet med bättre teamsamverkan inkluderande god kommunikation för säker vård, är gemensamma möten och övningar en viktig del för att ge professionerna en chans att mötas som personer och främja ökad förståelse för varandras kunskap och utforma gemensamma mål. / Background: Regional Medical support has been designed to ensure an involvement of doctors in the prehospital field. The current system for ambulance care raise high demands to ensure a correct patient assessment and triage to the right level of care, and for their assistance in this daily work, the nurse needs a doctor who is very knowledgeable in the organization. Purpose: To describe doctors’ experience of functioning as advisors for nurses working in the ambulance. Method: A qualitative research design was conducted including interviews with nine doctors serving as Regional Medical support. The content analysis was conducted according to a qualitative content analysis method.  Result: The analysis resulted in the four categories team spirit, frustration, lack of sense of responsibility and responsiveness, which mirrored the doctors’ experiences of acting as a phone support for specialist nurses on the ambulance. An underlying main message was identified as delicate trust. To be part of the team and act as a support and advisor for nurses working on the ambulance was perceived as positive, relevant and important. Good teamwork between the professions is required to guarantee patient safe care, and to obtain that, trust came through as a key factor. Conclusion: For the nurses to have an on call doctor that they can reach on the phone for support and advice was seen as a relevant system for the doctors, where they feel as a part of the prehospital team. In the continuous work for better teamwork, including good communication for safe care, it's important with common gatherings and training sessions to give the professions a chance to meet in person and gain a better understanding for each other’s roles, and enunciate common goals.

Aim: To describe and interpret patients’, family members’ and ambulance personnel’s experiences with regard to survival, attendance, and caring at cardiac arrests and deaths, and to analyze ethical conflicts that arise in relation to families and how the personnel’s ethical competence can affect caring and the ability to handle ethical problems. Method: The three interview studies were guided by a reflective lifeworld approach grounded in phenomenology and analyzed by searching for the essence of the phenomenon in two studies and by attaining a main interpretation in one study. In the fourth study, the general approach was supplemented by “reflective equilibrium” that guided the ethical analysis. Results: The survivors are striving towards a good life by means of efforts to reach meaning and coherence, facing existential fear and insecurity as well as gratitude and the joy of life. Family members lose everyday control through feelings of unreality, inadequacy and overwhelming responsibility. Ambulance personnel’s care mediates hope and despair until the announcement of survival or death. After the event, family members risk involuntary loneliness and anxiety about the future. For the ambulance personnel, caring for families involves a need for mobility in decision making, forcing the personnel to balance their own perceptions, feelings and reactions against interpretative reasoning. To base decision making on emotional reactions creates the risk of erroneous conclusions and a care relationship with elements of dishonesty, misdirected benevolence and false hopes. Identification with family members can promote recognition of and response to their existential needs, but also frustrate meeting family members emotions’ and handling one’s own vulnerability and inadequacy. It was found that futile cardiopulmonary resuscitation, administered to patients for the benefit of family members, is not an acceptable moral practice, due both to norms of not deliberately treating persons as mere means and to norms of taking care of families. Conclusions: Ethical conflicts exist when it comes to conveying realistic hope, relief from guilt, participation, responsibility for decision making, and fairness in the professional role. Ambulance personnel need support to enhance ethical caring competence and to deal with personal discomfort, as well as clear guidelines on family support.

In this thesis, we propose novel optimization and spatial queueing models that expand the currently existing methods by allowing multiple servers to be located at the same station and multiple servers to be dispatched to a single call. In particular, a mixed integer linear programming (MILP) model is introduced that determines how to locate and dispatch ambulances such that the coverage level is maximized. The model allows multiple servers to be located at the same station and balances the workload among them while maintaining contiguous first priority response districts. We also propose an extension to the approximate Hypercube queueing model by allowing multi-server dispatches. Computational results suggest that both models are effective in optimizing and analyzing the emergency systems. We also introduce the M[G]/M/s/s queueing model as an extension to the M/M/s/s model which allows for multiple servers to be assigned to a single customer.

M. Tech. Business Administration / The city of Tshwane Emergency Services is the first in South Africa to be certified ISO 9001:2008 in 2013. This saw the department leading the course of quality management both in the city and throughout the country. As a service rendering undertaking their efficiency and effectiveness requires evaluation from a quality management perspective. The city seeks to roll-out certification throughout all city departments so as to enable a quality driven municipal entity. This study was conducted to identify the factors that affect adherence to ISO 9001:2008 within the city. The results of this study can be used by managers throughout the Emergency Services and related services around the world to evaluate the importance of the implementation of the management system. The study is descriptive and cross-sectional. A quantitative method was used to collect data and analyse it. A stratified random sampling techniques was used with sample size of n=121 on employees within the Emergency Services of the city of Tshwane. Frequency tables, pie-chart, histograms and tables were used to present and analyse the data collected. The study identified qualification, effective communication and proper record keeping (documentation) as key factors affecting adherence to ISO 9001:2008.

O estudo tem por objetivo caracterizar a organização da rede de atenção de urgência do SUS no município de Ribeirão Preto, caracterizando a rede de pronto atendimento não hospitalar 24 horas, o processo de trabalho dentro da Central de Regulação de Urgência para avaliação da solicitação e as opções de encaminhamento dos pacientes, os hospitais conveniados ao SUS com sua disponibilidade de leitos de urgência, e a capacidade de resolução em termos de complexidade de recursos (humanos, diagnósticos e terapêuticos). Método: Estudo transversal, de caráter descritivo e retrospectivo. Os dados foram coletados nos bancos de dados da Secretaria Municipal de Saúde presentes nos Sistemas Hygia® e True® e exportados para planilhas do Microsoft Excel para consolidação. Resultados: O município está dividido em cinco distritos de saúde e cada distrito possui uma unidade não hospitalar de pronto atendimento de 14 urgência 24 horas: Central (Unidade Distrital de Saúde Central ou P.S. Central), Norte (Unidade Distrital de Saúde do Simioni), Oeste (Unidade Distrital de Saúde do Centro de Saúde Escola - Sumarezinho), Leste (Unidade de Pronto Atendimento - UPA - Leste) e Sul (Unidade Distrital de Saúde da Vila Virgínia). A rede hospitalar de referência do SUS de Ribeirão Preto é composta pelos hospitais: A, B, C, D, E, F, G e H. O número de regulações efetivas anual gira em torno de 41.000 regulações, a média de indeferimento de solicitações é de 2.468 e a média de casos regulados em vaga zero é de 5.741. Considerações finais: O aumento de atendimentos nos pronto atendimentos extrahospitalares, do número de solicitações, do número de solicitações indeferidas e do número de regulações realizadas em vaga zero, indicam a baixa resolutividade da rede pré-hospitalar fixa e a escassez de leitos hospitalares para pacientes agudos, o que prejudica o processo de assistência em todos os níveis de atenção do SUS. Um sistema único de informatização do processo regulatório possibilitará o desenvolvimento de indicadores de processo e resultados com subsídios para revisão de práticas, conceitos e estratégias / The purpose of this study is to characterize the organization of the SUS emergency network in the city of Ribeirão Preto, characterizing the network of 24-hour non-hospital care, the work process within the Emergency Regulation Center for assessment of the request and the patient referral options, hospitals agreed to the SUS with their availability of emergency beds, and the ability to solve in terms of resource complexity (human, diagnostic and therapeutic). Method: Cross-sectional study, with a descriptive and retrospective character. The data were collected in the databases of the Municipal Health Department present in Hygia® and True® Systems and exported to Microsoft Excel spreadsheets for consolidation. Results: The municipality is divided into five health districts and each district has a non-hospital 24-hour emergency care unit: Central (Central Health Unit or PS Central), North (Simioni District Health Unit), West (District Health Unit of the School Health Center - Sumarezinho), Eastern (Emergency Care Unit - UPA - Lest) and South (District Health Unit of Vila Virginia). The hospital network of reference of the SUS of Ribeirão Preto is made up of hospitals: A, B, C, D, E, F, G and H. The number of annual approved regulations revolves around 41,000 regulations and of these the average of rejection is of 2,468 and the average of cases regulated in vacancy zero is of 5,745. Final considerations: The increase in outpatient visits, the number of requests, the number of requests rejected and the number of regulations made in vacancy zero indicate the low resolution of the fixed prehospital network and the shortage of hospital beds for acute patients , which undermines the care process at all levels of SUS care. A unique system of computerization of the regulatory process will enable the development of process and results indicators with subsidies to review practices, concepts and strategies

Os efeitos do trauma no organismo do idoso são sistêmicos e as complicações são comuns, o que pode resultar em aumento do tempo de hospitalização e maior número de mortes. Conhecer as características específicas deste evento para o idoso pode auxiliar os enfermeiros na tomada de decisões no atendimento pré-hospitalar móvel avançado. Os objetivos deste estudo foram analisar as evidências disponíveis na literatura científica acerca das intervenções de enfermagem no atendimento pré-hospitalar móvel para idosos pós-trauma e construir um protocolo assistencial de enfermagem para o atendimento pré-hospitalar móvel avançado de idosos pós-trauma. A pesquisa foi conduzida em duas fases: revisão integrativa e estudo metodológico e descritivo. A busca dos estudos primários foi realizada nas bases de dados PubMed, CINAHL e LILACS. A amostra da revisão integrativa foi composta por 26 estudos, agrupados em seis categorias temáticas, a saber: intervenções de enfermagem: circulação com controle da hemorragia (n=11); intervenções de enfermagem: disfunção, estado neurológico (n=7); intervenções de enfermagem: via aérea com proteção da coluna cervical (n=3); intervenções de enfermagem: avaliação secundária (n=3); intervenções de enfermagem: ventilação e respiração (n=1) e intervenções de enfermagem: exposição\\controle do ambiente (n=1). Em relação à construção do protocolo assistencial de enfermagem, as evidências encontradas na literatura e as recomendações de dois programas e duas diretrizes de atendimento ao trauma contribuíram para sua construção. O protocolo assistencial de enfermagem foi estruturado contendo título, objetivo, intervenções de enfermagem, atividades de enfermagem e suas respetivas justificativas, com ênfase na avaliação primária e secundária do atendimento ao trauma e reuniu de forma organizada as especificidades da senescência e senilidade. As evidências levantadas na literatura contribuíram para a elaboração do protocolo assistencial de enfermagem, que poderá subsidiar o atendimento imediato e avançado ao idoso pós-trauma / The effects of a trauma in the organism of elderly individuals are systemic and complications are common, which may result in longer hospitalizations and a greater number of deaths. Being aware of the specificities of this event among elderly individuals can aid the decision-making of nurses when providing advanced prehospital care in a mobile unit. This study\'s objective were to analyze evidence available in the scientific literature addressing nursing interventions provided to elderly individuals in prehospital care provided in mobile units after a trauma and develop a nursing protocol for elderly trauma patients specific for advanced prehospital care provided in mobile units. The study was conducted in two phases: integrative review and methodological and descriptive study. Primary studies were searched in the PubMed, CINAHL and LILACS databases. The sample for the integrative review was composed of 26 studies grouped into six thematic categories, namely: nursing interventions: circulation with hemorrhage control (n=11); nursing interventions: disorder, neurological status (n=7); nursing interventions: cervical spine protection in airway management (n=3); nursing interventions: secondary assessment (n=3); nursing interventions: ventilation and respiration (n=1); and nursing interventions: exposure/environment control (n=1). Evidence found in the literature and recommendations from two programs and two guidelines for essential trauma care contributed to the development of this nursing care protocol. The nursing care protocol was structured with a title, objective, nursing interventions, nursing activities, and respective justifications, with an emphasis on primary and secondary assessment of trauma care, and organized the specificities of senescence and senility. Evidence found in the literature contributed to develop a nursing care protocol that can support the immediate and advanced care provided to elderly patients after a trauma

A depressão pode ser considerada um problema de saúde pública devido aos agravos e perdas sociais conseqüentes. É um problema que por si já debilita a pessoa, levando a pior evolução, se assim estiver associada a alguma doença clínica. Freqüentemente é negada pelo próprio indivíduo por questões de preconceito social, visto provocar queda na produtividade pessoal, perda de iniciativa e de interesse. Este estudo objetivou conhecer a presença de depressão entre usuários de plantão noturno em unidade de emergência de uma instituição privada, relacionando esse fato aos condicionantes clínicos e biopsicossociais. Metodologia: A pesquisa foi realizada com 62 pacientes adultos que passaram por atendimento durante o período noturno, em casos que não envolviam situação de risco iminente de vida, no Pronto Socorro do Hospital Irmãos Penteado, uma instituição privada de assistência em saúde no município de Campinas-SP, nos meses de outubro e novembro de 2007. Foram aplicados dois instrumentos durante a entrevista: a) Identificação, informações clínicas e contextualização psicossocial; b) Inventário de Depressão de Beck. Os dados foram analisados estatisticamente por análise bivariada e multivariada pelo teste de Fisher. Os resultados mostraram que a amostra era composta por maioria de mulheres (75%), solteiras, brancas, com predomínio de faixa etária entre 18 e 30 anos, bom nível educacional, com mais de 20% em nível superior e nenhum analfabeto; todos declaravam alguma ocupação, sendo destaque para comércio e administrativo, boa satisfação com moradia e salienta-se que todos os pacientes possuem convenio de saúde, seja pela empresa em que trabalham, seja porque pagam paralelamente. Entre as queixas clínicas mais comuns apareceram cefaléia como sintoma prevalente e problemas do sistema digestivo. Mais de 12% já tiveram diagnóstico anterior de depressão. Maioria pratica atividade física. Mais de 23% apresentavam hipertensão leve, moderada ou severa durante o atendimento. Mais de 77% relataram dormir entre 6 e 8 horas diárias, mas quase metade alega problemas de sono. Estresse no trabalho e problemas relacionados a ele apareceram com certa freqüência. Álcool também chamou atenção, pois 45,2% alegavam fazer uso, mesmo que socialmente, enquanto que problemas com álcool ou drogas na família foram relatados para quase 20 %. A depressão apareceu em 21% dos entrevistados, sendo 8,1% moderada, 12,9% leve e não houve depressão grave. O Inventário de Beck mostrou-se eficaz e chamou a atenção negativamente nos itens prazer, autocrítica, irritabilidade, sono, cansaço e preocupação com a saúde. Os dados mostraram correlação negativa para os itens hábito de fumar (p=0,021), insônia (p=0,005) e problemas econômicos (p<0,000). Conclui-se que sintomas depressivos estavam aumentados se comparados à amostra não diagnosticada e insuspeita, mas em acordo com os dados de depressão associadas a outras doenças clínicas em hospital geral, qualquer patologia pode aumentar a prevalência de sintomas depressivos e vice versa. Essas informações permitem conhecer melhor o cliente atendido neste serviço de saúde e demonstra que ações de enfermagem em Emergência e Pronto Socorro podem e precisam ser pensadas a fim de garantir a integridade da pessoa que sofre psíquica e fisicamente, tendo em vista que cabe ao hospital geral atender as descompensações antes designadas exclusivamente aos serviços manicomiais. Sugerem-se estudos mais detalhados a fim de elucidar melhor a relação entre \"estresse no trabalho\", manifestação clínica e/ou somática e sintomas depressivos, bem como o fator \"problemas econômicos\" e impacto econômico, a fim de despertar o interesse das grandes empresas privadas de assistência a saúde para com a temática da saúde mental e incentivar a melhoria da assistência de pacientes, sejam conveniados ou não. / Depression may be considered a public health problem due to consequential aggravation and social losses. It is a problem by its own and it weakens the person, leading to worse development, if associated with any clinical disease. Often it is denied by the individual himself for social prejudice issues, since it provokes drop in personal productivity, loss of initiative and interest. This study aimed to know the presence of depression among night call users at a private institution emergency unit, relating this fact to clinical and biopsycho- social indicators. Method: The research was conducted with 62 adult patients who have undergone care during the night time, in cases not involving imminent risk of life situations, in the Emergency Unity of Hospital Irmãos Penteado, which is a health care private institution, in the city of Campinas-SP, in October and November 2007. Two instruments were applied during the interview: a) Identification, clinical information and psychosocial contextualization b) Beck Depression Inventory. Data were statistically analyzed by bivariate analyses and multivariate by Fisher test. The results showed that the sample was composed by a majority of women (75%), single, white, with predominance of age between 18 and 30 years, good educational level, with more than 20% with third degree and no illiterate; all declared any occupation, emphasizing trade and administrative jobs, good housing satisfaction and noting that all patients have health care insure, by the company where they work, or because they pay in parallel. Among the most common clinical complaints appeared headache as prevalent symptom and digestive system problems. More than 12% have had previous diagnosis of depression. Majority practices physical activity. More than 23% had mild, moderate or severe hypertension during care. More than 77% reported sleeping between 6 and 8 hours a day, but nearly half claims sleep problems. Stress at work and problems related to it appeared with some frequency. Alcohol also drew attention because 45.2% claimed to use, even if socially, while alcohol or drugs problems in the family were reported to almost 20%. The depression appeared in 21% of interviewees, with 8.1% moderate, 12.9% mild and no severe depression. Beck Inventory proved to be effective and drew attention negatively on items pleasure, self-criticism, irritability, sleep, tiredness and health concern. Data showed negative correlation for items smoking habit (p = 0021), insomnia (p = 0005) and economic problems (p <0000). It is concluded that depressive symptoms were increased when compared to the undiagnosed and unsuspected sample, but in accordance with data of depression associated with other clinical diseases in general hospital, any pathology can increase the prevalence of depressive symptoms and vice versa. This information allows to better know the client attended at this health care service and demonstrates that nursing actions in Emergency and First Aid can and must be designed in order to ensure the integrity of the person who suffers psychically and physically, facing that it is up to the general hospital to attend the decompensations once exclusively designated to asylum services. More detailed studies are suggested to better clarify the relationship between \"stress at work,\" clinical and/or somatic manifestation and depressive symptoms, and the factor \"economic problems\" in economic impact, in order to arouse the interest of large health care private companies in the mental health issue and to encourage the improvement in caring of patients, are they insured or not.

O conhecimento do trabalho em equipe de assistência ao paciente, em unidade hospitalar de atendimento ao trauma, tanto no que se refere aos aspectos facilitadores quanto aos dificultadores desse processo, é imprescindível, diante da importância desse tipo de atendimento no contexto de atenção à saúde. Este estudo teve como objetivo analisar os aspectos que facilitam e dificultam o trabalho em equipe de assistência ao paciente em unidade hospitalar de urgências traumáticas. Trata-se de estudo descritivo, de abordagem quantitativa, utilizando a Técnica do Incidente Crítico. O estudo foi realizado em um hospital de ensino no interior do Estado de São Paulo, SP. Utilizou-se como técnica de coleta de dados a entrevista. Participaram 64 profissionais da equipe de assistência ao paciente da unidade. Os resultados evidenciaram 107 situações, sendo 56 positivas e 51 negativas, que envolveram 614 comportamentos e 267 consequências vinculadas ao trabalho em equipe na unidade. A análise dos incidentes relatados destacou que a dinâmica do trabalho em equipe é percebida como positiva no cenário. Os resultados evidenciam a necessidade de diferentes agentes dessa equipe realizarem ações integradas/articuladas e compartilhadas, nas quais sejam claras a noção de complementariedade de saberes em busca de objetivos comuns que atendam as necessidades imediatas de saúde do paciente politraumatizado. Os resultados também revelam que atendimentos aos pacientes, vítimas de trauma grave/moderado, facilitam a dinâmica do trabalho em equipe na unidade. Entende-se que isso pode decorrer de investimentos de políticas públicas e pelas diretrizes do Advanced Trauma Life Support, nos quais têm sido envidados esforços, capacitando profissionais, os quais reconhecem a finalidade que orienta o processo de trabalho e o atendimento de casos de alta gravidade com demanda imprevisível, que exigem alta tecnologia, pessoal com formação e competência técnica especializada para assistir, de forma integrada, articulada e assertiva, os casos. A integração, interação, articulação e comunicação entre a própria equipe e entre os diversos setores intra e extra-hospitalares favorecem a continuidade e integralidade do cuidado, bem como o produto final do processo de trabalho. É inegável a relevância e a clareza que os participantes dão ao trabalho em equipe nessa unidade, em especial as ações articuladas e integradas durante os atendimentos a politraumatizados graves/moderados. Fragilidades na articulação, integração e comunicação, bem como na imprevisibilidade da demanda e no despreparo de alguns profissionais foram destacados como dificultadores do trabalho em equipe no contexto da sala de trauma / The knowledge of work in patient care team, in a hospital trauma care unit, both regarding the facilitating aspects as well as the constraints of this process, is crucial, given the importance of this type of assistance in the health care context. This descriptive and quantitative study aimed to analyze the aspects that facilitate and hinder the work in patient care team in hospital emergency trauma unit, using the Critical Incident Technique. The study was conducted in a teaching hospital in the interior of the state of São Paulo, Brazil. Interview was used as data collection technique. In total, 64 professionals from the patient care team of the unit participated in study. Results evidenced 107 cases, of which 56 positive and 51 negative, involving 614 behaviors and 267 consequences linked to team work in the unit. The analysis of the reported incidents highlighted that the dynamics of team work is perceived as positive in the scenario. Results evidenced the need for different agents of the team to perform integrated/shared and coordinated actions, in which the concept of complementarity of knowledge in pursuit of common goals that meet the immediate health needs of polytrauma patients, is clear. Results also reveal that care provided to patients, victims of severe/moderate trauma, facilitate the dynamics of the team work in the unit. This may occur due to public policies\' investments and due to the guidelines of the Advanced Trauma Life Support, in which efforts have been made to train professionals, who recognize the aim that guides the work process and the provision of care in high-severity cases with unpredictable demand, which require high technology, trained staff with specialized technical competence to assist cases in an integrated, coordinated and assertive way. The integration, interaction, coordination and communication among the team itself and among the various intra and extra-hospital sectors favor the continuity and comprehensiveness of care, as well as the final product of the work process. The relevance and clarity that participants give to the team work in this unit is undeniable, especially as to coordinated and integrated actions during care to severe/moderate polytrauma patients. Weaknesses in coordination, integration and communication, as well as demand unpredictability and the unpreparedness of some professionals were highlighted as constraints of the team work in the context of trauma center