No / Many accident and emergency clinicians regard the radiographic image as an extension of the clinical examination, as a provisional diagnosis, based on clinical signs and symptoms, can be confirmed or refuted by inspection of X-rays. However, the value of radiography in this context is not determined by the actual presence of trauma or pathology on the radiograph, but is dependent on the ability of a clinician to identify any trauma or pathology present. Traditionally, the responsibility for interpreting radiographic images within the accident and emergency environment in the United Kingdom (UK) has been with medical clinicians. However, expansion of the nursing role has begun to change the boundaries of professional practice and now many nurses are both requesting and interpreting trauma radiographs. To ascertain the ability of accident and emergency doctors and nurses to interpret trauma radiographs, and identify whether there is a consistent standard of interpretive accuracy that could be used as a measure of competence. Methods: A literature review was conducted using the Cochrane Library, Medline and CINAHL databases and the keywords radiographic interpretation, radiographic reporting, accident and emergency and emergency/nurse practitioner. Findings: The ability of accident and nursing doctors and nurses to interpret trauma radiographs accurately varies markedly, and no identified published study has established an appropriate level of accuracy that should be achieved in order to demonstrate satisfactory competence in the interpretation of radiographic images. Conclusions: Determining a measure of interpretive accuracy that can be used to assess ability to interpret radiographic trauma images is fraught with difficulties. Consequently, nurses may attempt to prove their skills by directly comparing their abilities to those of their medical colleagues. However, as a result of marked variation in the ability of senior house officers to interpret trauma radiographs, a similar ability does not automatically imply that a satisfactory level of ability has been achieved.

Emergency nursing is an evolving field in Kenya with the Nursing Council of Kenya (NCK) yet to list it as a speciality area. This study wished to identify and describe the core competencies that should be included in an emergency nurse training programme based on the views of nurses and doctors who work in emergency units in a level 1 hospital in Nairobi, Kenya. The researcher used qualitative explorative and quantitative descriptive designs in phases 1 and 2, respectively, and convenience and purposive sampling. The study found that the respondents emphasised the inclusion of 137 (93.2%) of the 147 skills in the questionnaire as core competencies and disagreed with 10 (6.8%). Concomitantly, the vast majority of the respondents (93.6%) supported the inclusion of the skills compared to those (6.3%) that did not. Based on the findings, the researcher made recommendations of the core competencies to be included in the programme. / Health Studies / M.A. (Health studies)

Emergency nursing is an evolving field in Kenya with the Nursing Council of Kenya (NCK) yet to list it as a speciality area. This study wished to identify and describe the core competencies that should be included in an emergency nurse training programme based on the views of nurses and doctors who work in emergency units in a level 1 hospital in Nairobi, Kenya. The researcher used qualitative explorative and quantitative descriptive designs in phases 1 and 2, respectively, and convenience and purposive sampling. The study found that the respondents emphasised the inclusion of 137 (93.2%) of the 147 skills in the questionnaire as core competencies and disagreed with 10 (6.8%). Concomitantly, the vast majority of the respondents (93.6%) supported the inclusion of the skills compared to those (6.3%) that did not. Based on the findings, the researcher made recommendations of the core competencies to be included in the programme. / Health Studies / M.A. (Health studies)

Bakgrund: Den prehospitala vården bedrivs utanför sjukhusets trygga väggar när en patient är i akut behov av sjukvård. Av patienten kan den prehospitala vården upplevas skrämmande och kan leda till en känsla av maktlöshet. Ambulanssjuksköterskan ska i mötet med patienten kunna genomföra ett systematiskt, stödjande och reflekterat omhändertagande. För att kunna genomföra detta omhändertagande är det av stor vikt att kunna skapa tillit i den vårdande relationen. Tidigare forskning visar att patienten såg tillit som en betydelsefull faktor i samspelet med sjuksköterskan. Syfte: Syftet är att belysa hur patienten upplever att tillit skapas i mötet med ambulanssjuksköterskan i den prehospitala vården. Metod: Tre systematiska artikelsökningar genomfördes. Tolv stycken kvalitativa artiklar granskades och inkluderades i litteraturstudien. Analysen genomfördes i nio steg enligt en stegmodell framtagen för kvalitativa litteraturstudier. Meningsbärande enheter skapades och öppen kodning av materialet gjordes. Därefter skapades teman och subteman som utgjorde resultatet. Resultat: Tillit skapades enligt patienten genom verbal och icke verbal kommunikation. Relevant information samt en ambulanssjuksköterska som var närvarande och hade ett lugnt bemötande skapade tillit. Resultatet presenteras enligt följande teman: Dialog med subteman; verbal och icke verbal kommunikation skapade tillit samt informationsöverföring skapade tillit. Professionalism med subteman; kompetens och kliniska färdigheter skapade tillit, lugn skapade tillit, en helhetssyn skapade tillit, förmåga att generera delaktighet skapade tillit samt närvaro skapade tillit. Slutsats: Tillit är en avgörande faktor för att patienten ska lita på ambulanssjuksköterskans kunskap och kompetens. Litteraturstudien bidrar med kunskap om hur tillit skapas och vilka förutsättningar som skapar en tillitsfull relation i det korta prehospitala mötet. / Background: Prehospital care is performed outside the safe environment of the hospital when a patient needs emergency care. The patient can feel powerless and experience the prehospital care as frightening. In the meeting with the patient the prehospital emergency nurse should be able to perform care that is systematic, supportive and deliberate. To be able to accomplish this care it is important to create trust. Previous research has shown that trust is an essential factor in the meeting with the nurse. Aim:The aim is to illustrate how the patient experiences trust in the prehospital setting with the prehospital emergency nurse. Method: Three systematic article researches have been conducted. Twelve qualitative articles were rated based on quality and included in the literature review. The articles were analysed based on a step-by-step guide. The guide is made for qualitative systematic reviews. Sentences that applied to the aim of the study were selected and open coding was conducted. Themes and subthemes constituted the result. Result: Trust was created by verbal and nonverbal communication. It was also important that the prehospital nurse provided relevant information, was calm and present in order for the patient to feel trust. The result was presented as follows: dialogue with subthemes: verbal and nonverbal communication created trust and information created trust. Professionalism with subthemes: competence and clinical skills created trust, calm created trust, a lifeworld perspective created trust, ability to create participation created trust and presence created trust. Conclusion: Trust was a vital factor for the patient to be able to trust the knowledge and competence the prehospital emergency nurse possesses. The literature review gave immersed knowledge regarding how to create trust and which parts that create a trustful relationship in the short prehospital care relationship.

På akutmottagningen vårdas sårbara patienter, barn som utsätts för fysiskt våld. Akutsjuksköterskan har ett ansvar i att kunna identifiera den sårbara patiente, för fysiskt våld leder till flertalet hälsorisker och varje missat fall kan leda till dödlighet. Alla barn har rätt till att skyddas mot alla former av våld. Syftet med studien var att utforska tillgänglig evidens gällande akutsjuksköterskans utgångspunkter för att identifiera barn där det misstänks att barnet utsatts för fysiskt våld. Metoden var en systematisk och integrativ litteraturstudie. Studien resulterade i två huvudteman: Förmågan att redogöra berättelsens och Konsten att känna igen. De två huvudteman delas in i fyra subteman, skildra barnets vardagliga liv, genomföra en riskbedömning, verifierbara skador och upptäcka det som inte syns. För att akutsjuksköterskan skall kunna identifiera barn som misstänks utsatts för fysiskt våld krävs det utbildning på arbetsplatserna samt dokument som kan användas som stöd vid bedömning. / At the emergency room, vulnerable patients are cared for, children who are exposed to physical violence. The emergency nurse has a responsibility in identifying the vulnerable patient. Being exposed to physical violence leads to several health risks and each missed case can lead to mortality. All children have the right to be protected from all forms of violence. The purpose of the study was to explore available evidence regarding the emergency nurse's starting point for identifying children who are suspected to have been subjected to physical violence. The method is a systematic and integrative literature study. The study resulted in two main themes: the ability to tell the story and the art of recognizing. The two main themes are divided into four subthemes, describing the child's everyday life, carrying out a risk assessment, verifiable injuries and discovering what is not visible. In order for the emergency nurse to be able to identify children who are suspected of being subjected to physical violence, training is required in the workplace as well as documents that can be used as support in assessment.

Access to health care in rural communities is challenged by workforce shortages. Nurse practitioners (NPs) have been filling the gap created by physician migration into specialty areas. Flex hospital legislation allows critical access hospitals (CAHs) to staff the emergency department with NPs or physician assistants without on-site physicians. NP education often lacks emergency and trauma curriculum, resulting in gaps in education and practice expectations and leading to significant role transition stress and turnover. The purpose of this project was to construct an evidence-based transition-to-practice residency program to support NPs providing emergency department care in the CAH. Theoretical frameworks used to guide the project include rural health theory, novice to expert, and from limbo to legitimacy frameworks. Global outcomes include increased quality of care, patient safety, NP job satisfaction, and decreased turnover. The quality improvement initiative engaged an interprofessional team of institutional and community stakeholders (n = 10) to develop primary products including the residency program, curriculum modules, and the secondary products necessary to implement and evaluate the project. Implementation will consist of a pilot followed by expansion throughout the rural health network. Evaluation will involve the CAH dashboard to monitor patient outcomes, Misener NP job satisfaction scale, and employee turnover rates. The project expands understanding of the on-boarding needs of rural NPs. The results of this project will serve as a guide to publish outcome data and collaborate with higher education to develop programs to award academic credit for paid clinical experiences leading to academic degrees.

Sveriges akutmottagningar har ett årligt genomflöde av cirka 2,5 miljoner patienter. Personalomsättningen är hög för de sjuksköterskor vilka arbetar där och arbetssituationen är ofta ansträngd, både vad gäller tider, arbetsbörda och kritiskt sjuka patienter. För att på ett kvalitativt sätt ta hand om dessa patienter och uppnå tillit krävs, förutom de sex kärnkompetenserna, även empati, medkänsla och engagemang. Compassion fatigue är det tillstånd av negativism hos sjuksköterskan med minskad medkänsla för patienterna samt engagemangslöshet, som orsakats av kumulativ sekundär utsatthet vid omhändertagande av patienter utsatta för trauma och svåra händelser. Syftet var att beskriva symtom och åtgärder för att förebygga och minska den utmattning kallad compassion fatigue hos sjuksköterskor inom akutsjukvård. Som metod valdes litteraturöversikt. Sammanlagt 17 stycken vetenskapliga artiklar med publikationsdatum 2009–2016 ingick. Databaserna de valdes från var CINAHL, Medline, PsykINFO, PubMed och Web of Science. I resultatet framkom symtom upplevda som psykologiska och fysiologiska. Akutsjuksköterskorna upplevde återupplevande, undvikande och överspändhet som en konsekvens av compassion fatigue. Åtgärder för att förebygga problematiken var, från sjuksköterskans håll, att själv först skaffa kunskap och att börja sträva mot balans i tillvaron. Relationer på och utanför akutmottagningen var skyddande mekanismer och den rekommenderade strategin var problemfokuserad hanteringen. Arbetsgivarens ansvar låg på att delge medarbetare kunskap, organisera regelbundet stöd samt tillse att arbetsmiljön gynnade akutsjuksköterskorna både i form av ledarskap samt möjlighet till återhämtning och stabilitet i arbetsgruppen. Sammanfattningsvis kan sägas att tecknen för pågående eller begynnande compassion fatigue är mångskiftande även om de inte alltid knutits ihop med själva fenomenet. Genom förbättringskunskap kan kvalitetsutveckling på ett framgångsrikt sätt bedrivas. För att på ett långsiktigt sätt få sjuksköterskor arbetande inom akutsjukvård att både orka stanna kvar på akutmottagningen och att där göra ett bra arbete med patienterna, krävs åtskilliga åtgärder från flera håll. Resultatet visar på att med kunskap kan symtom på compassion fatigue och utmattning upptäckas och även åtgärdas. Flera aktörer krävs för att få sjuksköterskor arbetande på en akutmottagning, att genom strategier och förmågor skapa en resiliens, där de långsiktigt orkar ta hand om sina patienter på ett övertygande och tillförlitligt sätt. Det verkar centralt att hitta en rimlig nivå, där tillräckligt mycket närhet och engagemang ges ut, för att god vård ska kunna uppnås, utan att för den skull bränna ut akutsjuksköterskan. / Sweden's emergency departments have an annual throughput of 2,5 million patients. Staff turnover is high for the nurses who work there and the work situation is often strained due to long shifts, time constraints, workload and critically ill patients. In order to maintain a high level of care and earn the trust of patients with acute needs, in addition to the six core skills, empathy, compassion and commitment are required. Compassion fatigue is the condition of negativism in the nurse with reduced patient compassion as well as decreased commitment, caused by cumulative secondary vulnerability in the treatment of patients exposed to trauma and severe events. The aim of this study was to describe the symptoms of compassion fatigue, and measures to prevent and reduce this condition among emergency care nurses. The method chosen was a literature review. A total of 17 scientific articles with publication dates from 2009 to 2016 were included. The databases that were selected were CINAHL, Medline, Psych Info, PubMed and Web of Science. The results indicated that symptoms are experienced psychologically and physiologically. Emergency nurses felt re-experiencing, avoidance, and arousal as consequences of compassion fatigue. Measures to prevent the problem were (from the nurse’s perspective) to first acquire knowledge and then begin to strive for balance in your existence. Relationships inside and outside the emergency department were protective mechanisms, and the recommended strategy was problem-focused management. The employer's responsibilities were to educate their employees appropriately, organize regular support and ensure that the working environment favored emergency nurses both in terms of leadership and the opportunity for recovery and stability in the working group. In conclusion, the signs of ongoing or incipient compassion fatigue are diverse, although they are not always linked with the phenomenon. By improving knowledge and awareness of this condition among emergency-care providers, the work of quality improvement can be conducted successfully. The literature suggests that convincing nurses to work long-term in emergency care and ensuring that they are able to continue providing quality care to their patients requires several strategies from several sources. Results show that emergency nurses equipped with the proper knowledge of this condition, symptoms of compassion fatigue and exhaustion can be detected and the condition corrected. It takes several parties to create resilience through strategies and abilities at nurses working in an emergency care department, in order to take care of their patients in a convincing and reliable manner in the long-term. It seems crucial to find a reasonable level, with enough intimacy and commitment, for good health to be achieved, without burning out the emergency nurse.Keywords: Compassion fatigue, burnout, turnover, emergency nurse

Bakgrund: Akut Koronart Syndrom (AKS) är ett samlingsnamn för tre olika kliniska tillstånd som förorsakas av en ruptur på ett ateromatösa plack vilket leder till en trombosbildning som okluderar hjärtats kranskärl helt eller delvis. Den äldre populationen utgör en stor andel av patienterna som drabbas av AKS sjukdom. AKS är en diagnos som påverkar patienten både fysiskt och psykiskt och Akutsjuksköterskor ska bemöta och vårda dessa patienter under hela dygnets timmar oavsett om det är ett stort eller lågt inflöde på akutmottagningen. Enligt statistik från Socialstyrelsen ökar antalet patienter på akutmottagningarna och tiden för den erbjudna vården minskar vilket gör att vårdbehov måste tidigt kunna identifieras för att kunna sätta in rätt omvårdnadsåtgärder för dessa. Syfte:  Att belysa upplevelser av att som patient bli vårdad för akut koronart syndrom på akutmottagning.   Metod: Metoden som valts är en systematisk integrativ litteraturöversikt. Datainsamlingen har gjorts med hjälp av den femstegsprocess som beskrivits av Oermann och Knafl (2021) där analysfasen bytts ut mot en tematisk innehållsanalys enligt Braun och Clarkes (2008).  Resultat: Resultatet presenteras som tre övergripande teman (Fysiska upplevelser, Psykiska upplevelser och Vårdupplevelser) respektive åtta subteman (Smärtlindring vid koronar bröstsmärta. Rädsla, ångest och en osäkerhet över situationen. Upplevelse av hotad hälsa. Utsatthet vid hög belastning på akutmottagningen. Effekter av psykisk belastning vid AKS. Orsaker till upplevelsen av god vård. Bristande information och kommunikation. Självbestämmande och beslutstagande under vården.).  Slutsatser: Patienter som vårdas för AKS på akutmottagning har komplexa upplevelser med stor variation som alla behöver sin vård där akutsjuksköterskans kompetens är av stor vikt. Behov för information beskrevs i stora delar av resultatet. / Background: Acute coronary syndrome (ACS) is a collective name for three different clinical conditions which are caused by a rupture on a atherosclerothic plaque. This situation leads to the creation of a thrombos that occludes a coronary artery in the heart partially or completely. The older generation makes up for a greater part of the patients treated for ACS. ACS is a condition that affects the patient both physically and psychologically and emergency nurses care for these patients during every hour of the day no matter if the patient flow is high or low at the emergency department. According to statistics from Socialstyrelsen, the number of patients at the emergency department is increasing and the time for care decreasing which further notes the importance of being able to early identify care-needs to be able to provide the correct care for these.    Aim: To enlighten the experiences of patients getting care for acute coronary syndrome at the emergency department  Method: The method that was chosen was a systematic integrative literature review.  Datacollection has been done with the assistance of the five-step process described by Oermann och Knafl (2021) where the data analytic step has been replaced by a thematic content analysis described by Braun och Clarkes (2008).  Results: The result section presents three general themes (Physical experiences, Psychological experiences and care-experiences) together with eight sub-themes (Painrelief during coronary chest pain.  Fear, anxiety and uncertainty over the situation. An experience of threat towards health. Vulnerability during crowding at the emergency department. Effects of psychological burden during ACS. Reasons for experiencing good care. Lack of information and communication. Self-determination and decisionmaking during care.). Conclusions: Patients receiving care for AKS at the emergency department inhibit complex experiences with great variation which all need their own personal caring where the competence of the emergency nurse is of great importance. A need for information was described in greater parts of the result.

På akutmottagningen möter akutsjuksköterskor dagligen utmaningen att bedöma och vårda patienter med tidskritiska tillstånd, en central kompetens för deras yrkesroll. Forskning pekar på flera förutsättningar som hämmar deras förmåga att göra vårdande bedömningar, där hela människans behov tillgodoses. Syftet med denna studie var att undersöka tillgänglig vetenskaplig litteratur om förutsättningar som påverkar akutsjuksköterskans vårdande bedömning av patienter med tidskritiska tillstånd på akutmottagning. Genom en systematisk och integrativ analys av fjorton vetenskapliga artiklar med varierande forskningsmetoder, inklusive kvantitativa, kvalitativa och mixad metod med ursprung från olika delar av världen, identifierades flera förutsättningar som påverkar akutsjuksköterskans förmåga att göra vårdande bedömningar. Dessa förutsättningar presenterades i två huvudkategorier: “Förutsättningar för en balanserad bedömning” och "Förutsättningar för en korrekt bedömning", med ytterligare fyra underkategorier, vars innehåll består av bland annat förutsättningar som stress, emotionella påfrestningar, vilja, engagemang, erfarenhet och vårdmiljö. Studiens resultat understryker behovet av att förhålla sig till dessa förutsättningar för att förbättra akutsjuksköterskors bedömningsförmåga. Trots vetskapen om akutmottagningens behov av förändring saknas effektiva insatser till förbättring som kan underlätta akutsjuksköterskans arbete. För att säkerställa patienternas välbefinnande och att upprätthålla hög vårdkvalitet är det avgörande att akutsjuksköterskor gör både balanserade och korrekta bedömningar. / At the emergency department, emergency nurses face the daily challenge of assessing and caring patients with time-critical conditions, a central competency for their professional role. Research indicates several conditions that inhibits their ability to make caring assessments, addressing the holistic needs of individuals. The aim of this study was to review existing scientific literature on conditions influencing emergency nurses' caring assessment of patient with time-critical conditions in emergency departments. Through a systematic and integrative analysis of fourteen scientific articles employing various research methods, including quantitative, qualitative, and mixed methods from different parts of the world, several conditions affecting emergency nurses' ability to make caring assessments were identified. These conditions were categorized into two main categories: "Prerequisites for a balanced assessment" and "Prerequisites for an accurate assessment", with an additional four subcategories, including conditions such as stress, emotional strain, will, commitment, experience, and the healthcare environment. The study's findings emphasize the need to address these conditions to improve emergency nurses' assessment capabilities. Despite awareness of the need for change in emergency departments, effective improvement interventions to facilitate emergency nurses' work are lacking. To ensure patient well-being and maintain high-quality care, it is crucial for emergency nurses to make both balanced and accurate assessments.

Introduction : Trauma is the leading cause of death in patients between the ages of 1-44 years in South Africa. Taking these statistics into consideration it is essential to better resuscitation strategies in order to improve outcome of trauma patients. Compensated and uncompensated haemorrhagic shock is frequently under diagnosed in trauma patients, which has a definitive effect on mortality. Concerns about inadequate monitoring of patients through the use of only physiological end points are raised. Methods : A comprehensive literature review was conducted on resuscitation strategies for patients presenting with haemorrhagic shock. Physiological and metabolic end points of resuscitation were identified to guide resuscitation strategies. A quantitative, retrospective, non-experimental, descriptive, correlational and crosssectional research design was chosen for this study. Data was collected by using biophysical measures, namely clinical audit checklists. Results : Lactate was identified as a good indicator to predicting mortality in patients presenting with shock caused by haemorrhage. Special consideration to patients’ age and physiological status should be made during resuscitation. The consequence of delayed resuscitation in haemorrhagic shock patients is associated with an increase in mortality that can be prevented. It is found that serum blood lactate levels taken over time are good predictors of patient survival rates. Patients presenting with a raised serum blood lactate level for more than 24-hours has an increase in mortality rate. Conclusion : Emergency nurse practitioners are responsible for the monitoring of patients admitted to the emergency unit with haemorrhagic shock. The use of serum lactate levels during the first 24-hours of the resuscitation of patients with haemorrhage can assist with the implementation of strategies to reverse the effect haemorrhagic shock on cellular level in these patients. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted