Thesis (M.H.A.)--University of Michigan, 1969.

Source: Dissertation Abstracts International, Volume: 70-07, Section: B, page: 4118. Adviser: Charles L. Begley. Includes bibliographical references.

Introdução: Visando uma construção coletiva de ações educativas que privilegiem as necessidades dos trabalhadores e as condições de trabalho, com sustentação nas diretrizes da Política Nacional de Educação Permanente em Saúde e nos princípios dos Núcleos de Educação em Urgências, este estudo teve como Objetivos: Caracterizar o ambiente dos prontos socorros quanto aos insumos; conhecer o processo de educação oferecido pelas instituições à equipe de enfermagem; identificar e avaliar as necessidades de treinamento dos profissionais de Enfermagem dos prontos socorros; construir um programa de educação para estes profissionais, baseado no diagnóstico de necessidades de treinamento, considerando o ambiente de trabalho como suporte à aprendizagem contínua. Metodologia: Pesquisa quantitativa e qualitativa, com desenhos exploratório e descritivo, desenvolvida em três prontos socorros de duas instituições, uma pública e uma privada do município de São Paulo. A população constituiu-se de 31 enfermeiros, 84 técnicos ou auxiliares de enfermagem, três gestores de Enfermagem e cinco enfermeiros de Serviço de Educação. A caracterização do ambiente foi realizada por meio de entrevistas com os três gestores de enfermagem; para avaliação das necessidades de treinamento, foi aplicado um questionário a toda a equipe de enfermagem; a construção do programa de educação foi operacionalizada por meio de três encontros de grupo focal em cada pronto socorro, do qual participaram, no total, 14 profissionais; entrevistas com dois enfermeiros dos serviços de educação viabilizaram dados para caracterização do processo de educação da equipe de enfermagem. Resultados: Dentre os principais resultados, destacam-se que os treinamentos técnicos foram os mais prevalentes no levantamento de necessidades (75,6%); a maioria das sugestões de mudanças nos treinamentos foi relacionada às estratégias instrucionais (32%) e ao horário (19,7%); os treinamentos foram apontados como úteis na prática (72,7%), por possibilitarem aperfeiçoamento profissional (62,5%); participariam do planejamento dos treinamentos 77,7% dos enfermeiros e 46,3% dos profissionais de nível técnico; as unidades oferecem condições para aplicação dos conhecimentos aprendidos nos treinamentos, na opinião de 70,3%, principalmente, no que se refere ao ambiente e insumo. Os programas de educação construídos pelos grupos apresentam temas técnicos; modalidade de entrega presencial; domínios e objetivos, predominantemente, cognitivos, nos níveis do conhecimento, compreensão, aplicação e análise; estratégias participativas e práticas. Os processos de educação desenvolvidos nas instituições apresentam fragilidades nas fases de avaliação de necessidades e avaliação de resultados de treinamentos. A participação no grupo focal foi avaliada positivamente pelos participantes. Considerações Finais: Construir programas educativos baseados nas diretrizes da Política Nacional de Educação Permanente em Saúde e nos princípios dos Núcleos de Educação em Urgências é uma ação possível e promissora, pois problematiza a prática do trabalho e a transforma em necessidade de educação. É essencial, todavia, que os programas sejam executados e avaliados para os ajustes necessários para contemplar o paradigma educacional que fundamenta essa Política, pois aspectos culturais e políticos são indissociáveis da educação. Assim, este estudo tem potencialidade para ser replicado nas demais estruturas que compõem a Rede de Atenção às Urgências e a Rede de Assistência à Saúde, envolvendo a equipe de Enfermagem e as equipes multiprofissionais. / Introduction: This study aims at a collective construction of educational actions that take into account workers needs and working conditions, based on the guidelines of the National Permanent Health Education Policy and the principles of the Emergency Education Centres. Objectives: to characterize the emergency room environment according to the inputs; to know the education process provided by the institutions for nursing staff; to identify and to assess training needs of nursing professionals in emergency rooms; and to develop an education program for these professionals, based on the diagnosis of training needs, considering the work environment to support continuous learning. Methodology: Quantitative and qualitative research, with exploratory and descriptive designs, developed in three emergency rooms of two institutions, one public and one private, in São Paulo city. The population consists of 31 nurses, 84 nursing technicians or assistants, three nursing managers, and five nurses of education services. To characterize the environment, three nursing managers were interviewed; to assess the training needs, a questionnaire was applied to all nursing staff; to develop the education program, there were three focus group meetings in the three emergency rooms, attended by a total of 14 professionals; to the description of the nursing staffs education process, two nurses of education services were interviewed. Results: Among the main results, it was observed that technical training was the most prevalent in the needs assessment (75,6%); most of the suggestions of changes in training concerned instructional strategies (32%) and schedule (19,7%); training was identified as useful in practice (72,7%) because it enable professional improvement (62,5%); 77,7% of the nurses and 46,3% of the nursing technicians or assistants would take part in the planning of the trainings; the units provide conditions to apply knowledge learned in trainings (70,3%), mainly in relation to environment and input. The education programs developed by the groups contain technical topics; face-to-face delivery method; predominantly cognitive domains and objectives, at the knowledge, comprehension, application, and analysis levels; and participation strategies and practices. The education processes carried out by the institutions show signs of weaknesses in training needs and results assessment. Participants assessed positively the focus group meetings. Final Thoughts: To construct educational programs based on the guidelines of the National Permanent Health Education Policy and the principles of the Emergency Education Centres is a possible and promising action, discussing the work practice and turning it into a training need. However, it is essential that programs are implemented and assessed, considering necessary adjustments to take into account the National Policys educational paradigm, since cultural and political aspects are inseparable from education. Finally, this study has the potential to be replicated in other settings of the Emergency Care Network, involving the nursing staff and the multidisciplinary teams.

The rapid and accelerating growth of hospital Emergency Department utilization over the past twenty years has transformed a once well-defined and well bounded care setting into a highly complex and integral component of a total health care system. This increasing role complexity has created a demand by hospital decision-makers for an information system to describe, measure and evaluate Emergency Department activity within the context of broader health care issues and activities. This study is an attempt to identify and integrate the information needs of the hospital decision-makers into a meaningful whole. The evolution of emergency care in British Columbia is described in order that needs for information will not be developed in isolation from the activities of major planning, funding and professional groups in the health services. Two major issues are identified in the literature - the utilization of Emergency Departments and thrusts towards classification or categorization of Emergency Department capabilities. From this, three major policy/planning foci are selected - day to day emergency care, disaster planning, and the "mopping-up" role of Emergency Departments. Ideas about these are developed in light of six classifications of information users' needs - patient care, management, quality of care, strategic planning, research and development and policy-formulation. "Needs" were validated by two panels of major decision-makers from a representative sample of Greater Vancouver Regional Hospital District Hospitals. The results of the investigation are analyzed in light of the issues of professional power and control and political influences and recommendations made as to the appropriate components of a hospital emergency department information system. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

I och med urbaniseringen i det svenska samhället har många städer vuxit och utvecklats till storstäder. Storstäder har många utmaningar, allt ifrån att det ska finnas jobb och bostadsmöjligheter så måste även infrastrukturen i form av transportmöjligheter utvecklas i takt med befolkningsökningen. Större befolkning betyder mer människor i rörelse som lätt leder till försämrad framkomlighet i trafiken. Detta examensarbete har utförts åt Räddningstjänsten i Jönköpings kommun med syftet att bidra med ett underlag angående vad en ny brandstation skulle generera i minskade insatstider och samhällsnytta. Räddningstjänsten upplever att trafiken i Jönköpings tätort bidrar till sämre framkomlighet som i sin tur leder till att räddningstjänsten får längre insatstider än önskat. Därför planerar kommunen att en ny brandstation ska byggas. I examensarbetet har samhällsnyttan för den nya stationen undersökts genom att bygga en GIS-modell där det går att simulera och undersöka insatstiden för räddningstjänsten baserat på historiska händelser. En litteraturstudie utfördes för att ge en grundläggande kunskapsmässig förståelse för området examensarbetet behandlar. För att få förståelse och kunskap om nuläget för Räddningstjänsten i Jönköping utfördes tre olika intervjuer. Intervjuerna riktade sig till personer som är involverade i utvecklingsprocessen av Jönköpings infrastruktur. Den största delen av examensarbetet var skapandet av GIS-modellen och analysen av det resultat modellen genererade. Under hela examensarbetet har en dialog med Räddningstjänsten i Jönköping förts. Detta för att få hjälp med tolkning av den historiska data räddningstjänsten bidragit med men också för att kontrollera att GIS-modellen resulterade i svar som verkade sannolika och användbara. Examensarbetet resulterade i att en ny brandstation skulle minska medelinsatstiden för räddningstjänsten och generera samhällsnytta. Eftersom en modell aldrig kan ge samma resultat som verkligheten är det viktigt att ta andra saker än enbart GIS-modellens resultat i beaktning när det diskuteras vad samhällsnyttan och en minskning av medelinsatstiden egentligen har för betydelse. Examensarbetet anses kunna vara en del av det beslutsunderlag som används vid beslutsfattandet om en ny brandstation i Jönköpings kommun.

published_or_final_version / abstract / Community Medicine / Master / Master of Public Health

Bakgrund: Vårdskador drabbar närmare 10 procent av alla patienter. I samband med ett traumaomhändertagande kommer anestesisjuksköterskan att arbeta i en miljö som inte är dennes dagliga arbetsplats. Detta ställer höga krav på kompetens, följsamhet till riktlinjer och inövade rutiner för att kunna bibehålla ett patientsäkert och effektiv traumaomhändertagande.   Syfte: Att identifiera faktorer som kan inverka på patientsäkerheten i samband med att anestesisjuksköterskan larmas till akutrummet.   Metod: Med resilience engineering som utgångspunkt gjordes en flerfallsstudie med holistisk design. Varje fall (n=8) analyserades separat för att sammanställas med en induktiv ansats genom instrumentet Functional Resonance Analysis Method. Följsamheten mot lokala riktlinjerna kontrollerades med en deduktiv ansats.   Resultat: Anestesisjuksköterskan har till hälften av fallen den lokalkännedom som krävdes enligt gällande riktlinjer, anestesisjuksköterskan förefaller i flera fall sakna kunskap om den tekniska apparaturen som används. Detta resulterar i att anestesisjuksköterskan inte arbetade självständig utan blev beroende av traumateamet för att slutföra sina uppgifter. Förberedelserna varierade stort, i majoriteten av fallen fanns ingen större följsamhet till de riktlinjer som styrde anestesisjuksköterskans arbete i ett traumaomhändertagande. En hög patientsäkerhet bibehölls genom att arbetsfördelningen och förberedelserna delades på, ofta outtalat inom traumateamets medlemmar. Tack vare stor personalgrupp och hög kompetens inom traumateamet kunde teamets medlemmar komplettera varandra.   Slutsats: Flera aspekter som kan påverka patientsäkerhet negativt identifierades. Flertalet av dessa bl.a. lokal- och utrustningskännedom för anestesisjuksköterskor bedömdes kunna minskas eller elimineras om följsamheten till riktlinjerna skärps. I alla analyserade fall bibehålls god patientsäkerhet tack vare traumateamets höga resilience. / Background: Injuries in care occurs in approximately 10 percent of all patients. In a critical trauma care the anaesthetic nurse works in an unfamiliar workplace. This requires high competence and directive guidelines to maintain a high patient safety and effective trauma care.   Objectives: To identify factors that can have impact on the patient safety when the anaesthetic nurse is called to the ER.   Methods: Through resilience engineering, a multi-case study with a holistic design was conducted. Each case (n=8) analysed separately with an inductive approach with the instrument Functional Resonance Analysis Method. Thereafter, the compliance with guidelines was studied with a deductive approach.   Results: The anaesthetic nurse lacked the required knowledge of the ER that is required by the guidelines in half of the cases. The anaesthetic nurse also appeared to lack knowledge of technical equipment. This caused dependency in the anaesthetic nurse to fulfil its duties. Preparations varied greatly, in most of cases there was no major compliance with the guidelines for the anaesthetic nurse. High patient safety was maintained by dividing the labour within the team’s members. Thanks to large staff and level of competence within the team, the members could complement each other.   Conclusions: Several aspects that could affect patient safety negatively were identified. Most of these negative aspects could be reduced if compliance with guidelines were tightened. Throughout all cases, good patient safety is maintained thanks to the team's high resilience.

O aumento no número de atendimentos nos serviços hospitalares de urgência e emergência (SHE) resulta em superlotação desses serviços, afetando o resultado do tratamento dos pacientes e contribuindo para aumento da mortalidade. Este estudo objetivou avaliar a relação entre a gravidade clínica dos pacientes internados em um SHE e as horas de cuidados dos profissionais de enfermagem. Trata-se de um estudo de abordagem quantitativa, do tipo retrospectiva e correlacional, realizado no pronto socorro adulto (PSA) do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro em Minas Gerais (HC-UFTM) no qual foram analisados os prontuários dos pacientes internados no PSA entre os meses de janeiro a dezembro de 2017. Para avaliação da gravidade clínica foi utilizado o Acute Physiology and Chronic Health Evaluation II (APACHE II) e para avaliação das horas de cuidados de enfermagem foi utilizado o Nursing Activities Score (NAS), além disso, foi utilizado um formulário para coleta das variáveis sociodemográficas e clínicas. Foram incluídos 338 prontuários de pacientes. Os resultados mostraram mais óbitos entre os pacientes com idade mais elevada (65,3%) e nos pacientes do sexo feminino (63,3%). A maioria dos pacientes era proveniente das cidades de referência da Macrorregião Triângulo Sul (42,3%) e grande parte dos pacientes entraram no SHE por vaga zero (75,1%). Ainda, verificou-se que os diagnósticos mais frequentes no momento da admissão foram o IAM (22,2%), AVC (20,1%) e TCE (7,1%). A classificação de risco predominante entre os pacientes que internaram no SHE foi a cor laranja (68,6%), no entanto, observou-se a associação entre a classificação vermelha e a ocorrência de óbito. Em relação à gravidade clínica, a média do APACHE II para amostra foi 13,4 (DP=10,2), sendo maior nos pacientes que foram a óbito 22,0 (DP=10,0) do que nos pacientes que tiveram alta 11,3 (DP=9,1). A pontuação obtida no NAS para a amostra foi 46,9 (DP=30,3), sugerindo 11,2 horas de cuidados de enfermagem para cada paciente. A pontuação do NAS foi maior nos pacientes que foram a óbito 56,9 (DP=12,1) do que nos pacientes que tiveram alta 44,5 (DP=32,8). Foi observada correlação fraca entre o APACHE II e o NAS. Este estudo mostrou que os pacientes internados no PSA do HC-UFTM apresentam quadro clínico grave e necessitam de muitas horas de cuidados de enfermagem / The increased number of patients in urgency and emergency hospital services (EHS) leads to an overload of these services, affecting the result of patient treatment and contributing to an increased mortality. This study aimed at evaluating the relation between the severity of the clinical situation of the patients hospitalized in an EHS and the time spent by nursing professionals treating these patients. This is a quantitative study, a correlational retrospective conducted in the adult medical center (PSA) of the General Hospital at the Universidade Federal do Triângulo Mineiro, in Minas Gerais (GH-UFTMK). The study analyzed the records of patients hospitalized in the PSA from January to December 2017. The Acute Physiology and Chronic Health Evaluation II (APACHE II) was used to evaluate the clinical severity of the conditions of the patients, and the Nursing Activities Score (NAS) was used to evaluate the time under nursing care. In addition, a form was used to collect sociodemographic and clinical variables. The investigation included 338 patient records. The results showed a higher number of deaths among older (65.3%) and female (63.3%) patients. Most of them were from the cities that are references of the Macro-region Triângulo Sul (42.3%), and a high number of patients entered in the EHS through the zero vacancy method, that is, were admitted due to an emergency, despite the lack of vacancies in the hospital (75.1%). Additionally, the most commonly performed diagnoses in the moment of patient arrival were AMI (22.2%), Stroke (20.1%), and TBI (7.1%). The most common risk classification among patients entering in the EHS was orange (68.6%), while the red classification was associated to death. Regarding the clinical severity of the cases, the APACHE II mean for the sample was 13.4 (SD=10.2). The result was higher among patients who died, 22.0 (SD=10.0), than among those who were discharged 11.3 (SD=9.1). The score of the NAS in the sample was 46.9 (DP=30.3), suggesting that 11.2 hours of nursing care were needed for each patient. The NAS score was higher among patients who did not survive, 56.9 (SD=12.1) than among those who were discharged, 44.5 (SD=32.8). A weak correlation was found between APACHE II and NAS. This study showed that patients hospitalized in the GH-UFTM PSA have severe clinical conditions and require many hours of nursing care

O objetivo do presente estudo foi rever na literatura qual a definição de usuários frequentes/hiperutilizadores de serviços de urgência e emergência e conhecer as implicações destes usuários no serviço de urgência e emergência. Trata-se de um estudo realizado através Scoping Review, conforme a proposta do Joanna Briggs Institute (JBI). Resultados: Identificados 37 estudos e através da leitura do título e resumo, selecionados 27 para leitura na íntegra. Porém após a leitura detalhada foram excluídos 11 estudos que não apresentavam resultados e conclusões diretamente ligados à temática. Assim, a amostra final foi composta por 16 estudos. Entre estes, quatro eram brasileiros e escritos pelo mesmo autor. Não houve 18 consenso entre s autores quanto a definição do termo pesquisado, todavia indicaram como usuário frequente/hiperutilizador o paciente que utiliza o serviço de urgência e emergência mais de 3 vezes por ano. Conclusões: Há lacuna na literatura e não consenso sobre a temática. Há necessidade de mais estudos sobre o assunto para o delineamento de ações que possibilitem a melhora deste quadro / The purpose of this study is to review the definition done by the literature of frequent / hyper-users of immediacy and emergency services and to know the involvement of such users in the immediacy and emergency services. This is a study conducted through Scoping Review (Revisão de Alcance) as proposed by Joanna Briggs Institute (JBI). Results: 37 studies were identified and by means of reading the titles and abstracts, 27 were selected as for thorough reading. However after the itemized reading, 11 studies that did not bring forward results and conclusions directly related to the thematic, they were excluded. So the final specimen was consisted of 16 studies. Four amongst these were Brazilian and written by the same author. There was no consensus between the authors regarding definition of the searched word, nevertheless they indicated as frequent / hyper-user the patient who uses the immediacy and emergency services more than thrice a year. Conclusions: There is a vacuity in literature and no agreement on this thematic. There are needs for further studies on the topic for the delineation of actions to make improvements possible for this picture

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Emergency Medicine. Johannesburg, March, 2016 / Objectives: The aim of the current research was to determine the perception and experience of different emergency department occupational groups regarding workplace violence in the past 12 months and to determine the effect that it had on them in two government hospitals in Johannesburg, South Africa. Materials and Methods: The current research was a cross sectional, retrospective qualitative survey. Results: Eighty-six surveys (43%) out of the distributed 200 questionnaires were returned. Five surveys were unfilled leaving 81 surveys (40.5%) that are included in the analysis. Psychological violence was experienced by 73 % (n=51) of the participants while physical violence was experienced by 34.2% (n=27). Patients were the perpetrators of 61% and 67.9% of psychological and physical violence against staff members, respectively. Friends and family members who accompanied patients in the emergency department accounted for 27.4% psychological violence while this same set of people caused 17.3% of physical violence. Ninety-one percent of the participants reported that they did not receive any training courses on how to handle workplace violence incidents. Medical staff (doctors and nurses) were found to be at an increased risk to psychological violence. Conclusions: Workplace violence was commonly experienced by ED staff members. Majority of the incidents were in the form of psychological violence; however, a considerable percentage of the participants experienced physical violent incidents. Most of the violent incidents experienced were perceived to be preventable by majority of participants. This research supports the need for practical training and education of the ED staff members, on how to prevent and deal with issues related to ED WPV. / MT2016