Global ETD Search

21	Äldres upplevelser av att vistas på akutmottagning : En litteraturstudie / Elders' Experiences of Visiting the Emergency Department : A literature review Karlsson, Pontus, Gustafsson, Oscar January 2024 (has links) ABSTRAKT Gustafsson O & Karlsson P. Äldres upplevelser av att vistas på akutmottagning. Enlitteraturstudie. Examensarbete i omvårdnad 15 högskolepoäng. Malmö Universitet:Fakulteten för Hälsa och samhälle, Institutionen för vårdvetenskap, 2024 Bakgrund: En växande befolkning av äldre personer kommer att öka kravet påakutmottagningar Detta eftersom patientgruppen är överrepresenterad blandbesökarna samt ofta multisjuka med komplexa åkommor. Därav är det viktigt attförstå äldres upplevelser av att besöka en akutmottagning. Syfte: Syftet var att utforska äldre patienters upplevelse av att vårdas på enakutmottagning. Metod: Litteraturstudien utfördes genom att sammanställa tio stycken vetenskapligaartiklar med kvalitativ ansats. Artiklar söktes strukturerat enligt ett sökschema idatabaserna Cinahl och PubMed. Artiklar som bedömdes svara på litteraturstudienssyfte kvalitetsgranskades enligt SBU:s granskningsmall för kvalitativa studier. Resultat: Sju kategorier framkom efter analysen: behov av tydlig information,bemötande från vårdpersonal, förminskning av egna behov, känsla av oro ochosäkerhet, organisation & miljö, tilltro till personal samt upplevelsen av att vänta. Slutsats: Äldre patienter upplever en stark tilltro till sjukvårdspersonalen ochförminskar sina egna behov i förtur till andra under vistelsen på akutmottagningar. Endel patienter känner oro för att bli sjuka, för en förändrad livssituation och ävendöden. Patienterna känner ofta en tacksamhet för den vård de får och vill få begripliginformation och uppmärksamhet under väntetiden. Detta bidrar till att minskapatienternas oro och ger ökat positivt intryck av den totala upplevelsen av vistelsen. / ABSTRACT Gustafsson O & Karlsson P. Elders experiences of visiting the emergencydepartment. A literature review. Degree Project in nursing 15 credit points, MalmöUniversity: Faculty of Health and society, Department of Care Science, 2024. Background: A growing population of elderly individuals will increase the demandfor emergency departments. This patient group is overrepresented among visitors andoften presents with multiple illnesses and complex conditions. Therefore, it isimportant to understand the experiences of older adults when visiting an emergencydepartment. Aim: The aim of this study was to explore the experiences of older patients receivingcare in an emergency department. Method:The literature review was conducted by compiling ten scientific articles witha qualitative approach. Articles were systematically searched using a search protocolin the databases Cinahl and PubMed. Articles that were deemed to address thepurpose of the literature review were quality-assessed according to the SwedishAgency for Health Technology Assessment and Assessment of Social Services (SBU)guidelines for qualitative studies. Results: Seven categories emerged from the analysis: need for information,interaction with healthcare staff, minimizing needs, feelings of worry and uncertainty,trust in staff, organization and environment, and the experience of waiting. Conclusion: Older patients experienced a strong trust in staff and minimized theirneeds in favor of others during their stay in the emergency departments. Somepatients worry about getting sick, a changed life situation and even death. Patientsfeel grateful for the care and want to receive understandable information and attentionduring the waiting time. This helps to reduce patients' anxiety and gives them anincreased positive impression of the overall experience of the visit. Elders Emergency departments Experiences Nursing Patients Akutmottagning Omvårdnad Patienter Upplevelser Äldre. Nursing Omvårdnad
22	Developing guidance to inform a clinically meaningful and feasible suicide risk assessment measure for use in emergency departments McClatchey, Kirstie January 2018 (has links) Introduction: Over 800,000 people die by suicide each year, and despite being a global public health issue, limited research exists exploring suicide risk assessment practices in emergency departments. The current thesis investigated emergency department suicide risk assessment practices and clinician experiences in Scotland, to develop guidance to inform the development of a clinically meaningful and feasible suicide risk assessment for these settings which is theoretically underpinned. Methods: A mixed-method triangulation approach was utilised. Two systematic reviews were conducted to update the risk and protective factor literature. This was followed by a national survey of suicide risk assessment practices in emergency departments. Fifty-one clinicians across 17 emergency departments participated, and six clinicians participated in follow-up semi-structured interviews to investigate their experiences, which were analysed using thematic analysis. Findings of the thesis were triangulated using the ‘following-a-thread' method, to develop guidance for informing the development of future risk assessment for use in emergency departments. Results: The systematic reviews identified emerging risk and protective factors including, sexual orientation and internet usage. The survey identified substantial variation in practice between emergency department clinicians. Only 35 (68.6%) participants reported using a suicide risk assessment tool. Importantly, variation was found not only across clinicians and departments, but also within departments, with clinicians based within the same department reporting differing risk assessment practices, indicating both inter- and intra-department suicide risk assessment practice differences. The qualitative analysis of clinician experience established four major themes (current experiences; components of suicide risk assessment; clinical decision-making; suicide risk assessment needs). Triangulation of findings developed recommendations for suicide risk assessment tools and training for emergency departments. Discussion: The risk and protective factor literature has evolved due to societal changes, and there is substantial variation in suicide risk assessment practices, both across and within emergency departments. Clinicians also find suicide risk assessment challenging. There is a need for consistent training, appropriate and helpful guidelines, and the improvement of risk assessment tools to improve practice. It is recommended that suicide risk assessment tools are developed to align to clinicians' needs, while taking into account research from the health domain and from related psychological research domains. 616.8
23	Falls and Related Injuries Based on Surveillance Data: U.S. Hospital Emergency Departments Quarranttey, George K. 01 January 2016 (has links) Falls can lead to unintentional injuries and possibly death, making falls an important public health problem in terms of related health care cost, incurred disabilities, and years of life lost. Approximately 1 in every 3 Americans ages 65 years and older is at risk of falling at least once every year. Children, young adults, and middle-aged adults are also vulnerable to falls. The purpose of this study was to examine the epidemiology of falls and fall-related injuries using surveillance data from nationally representative samples of hospital emergency departments in United States. The study was guided by a social-ecological model on the premise that multiple levels of risk factors affect health. Using a cross-sectional study and archival data from NEISS-AIP between 2009 and 2011, the result of multiple logistic regression indicated that age, gender, race and body part affected were significantly associated with hospitalization due to falls (p < .001) and incident locale independently predicted hospitalization due to falls in which hospitalization due to falls was considered a proxy measure of fall severity. The odds in each of the groups for fall injuries were (a) older adults versus children, 1.07 (95% CI: 1.05-1.08); (b) males versus females, 1.23 (95% CI: 1.21-1.26); (c) Blacks versus Whites, 2.12 (95% CI: 2.11-2.13); (d) body part extremities versus head area, 0.98 (95% CI: 0.97-0.99); and (e) outside home versus inside home, 1.14 (95% CI: 1.13-1.15). The results of this study may be important in forming and implementing age-specific prevention strategies and specialized safety training programs for all age groups, thereby reducing deaths, disabilities, and considerable health care cost associated with hospitalization due to fall-related injuries. Falls Falls-related Injuries NEISS-AIP Rate of Falls Surveillance Data U.S. Hospital Emergency Departments Databases and Information Systems Health and Medical Administration Medicine and Health Sciences
24	Primärvårdspatienter på akutmottagningar / Primary care patients in emergency departments Gunnervald, Kim, Larsson, Edvin January 2015 (has links) I denna uppsats undersöks om akutmottagningarnas långa väntetider kan bero på att olämpliga teorier appliceras på vårdmarknaden. Det undersöks med en fallstudie av hälso- och sjukvården i Västra Götaland där vi har genomfört semistrukturerade intervjuer med fem anställda i kanslierna som ansvarar för att ge politikerna information till sjukvårdsbeslut och för att stödja politikerna i styrandet av hälso- och sjukvården. Det är en kvalitativ studie med en abduktiv ansats.Vår empiri indikerar att en stor orsak till akutmottagningarnas långa väntetider är att de har ett inflöde av patienter med relativt milda symptom som kunde ha omhändertagits inom primärvården. Förklaringar till det är att klienterna ofta har bristfällig kunskap om lämpliga vårdenheter och ofta antar att de får bättre vård på akutmottagningar än inom primärvården. Många av de patienter på akutmottagningarna som kommit till olämplig vårdenhet är äldre och kroniskt sjuka.Den här studien indikerar att olämpliga teorier har applicerats på Västra Götalands vårdmarknad. Inspirationen till vårdmarknaden tycks till stor del härstamma från traditionella nationalekonomiska teorier. Vi anser dock att de är olämpliga på Västra Götalands vårdmarknad på grund av bristande utbud, bristande konkurrens, irrationella klienter och risker för missgynnanden. Vi föreslår istället ett större fokus på sociologiska marknadsteorier.Den här studien begränsas av det relativt låga antalet intervjusubjekt. Vi har dock hittat tecken i vår empiri på ett samband mellan missgynnade klienter inom primärvården och det ökade inflödet till akutmottagningarna. Vår förhoppning är att detta kan bidra med uppslag till framtida, mer omfattande undersökningar. / This paper addresses long waiting times in Swedish emergency units by examining if appropriate theories are applied to the healthcare sector. This is examined with a case study of the healthcare sector in Västra Götaland County where we have conducted semi-structured interviews with five members of the staff responsible for providing the county’s politicians with information for healthcare decisions as well as supporting the politicians in managing the healthcare sector. It is a qualitative study with an abductive approach.The findings from our empirical research indicate that one major reason for the emergency units’ long waiting times is that they have an influx of patients with relatively mild illnesses that could have been handled in the primary care. Explanations for that are that clients often are ill-informed and often expect to get better care at emergency units than in the primary care. Many of the emergency units’ misplaced patients are elderly and chronically ill.This study indicates that inappropriate theories have been applied to the healthcare sector in Västra Götaland County. The inspiration for the healthcare sector seems to be from traditional economics to a large extent. We conclude, however, that traditional economics is inappropriate on the healthcare sector in Västra Götaland County because of the lacking supply, lacking competition, irrational clients and risk for disadvantages. Instead, we suggest a higher focus on sociological market theories.This study is limited by the relatively low amount of interview subjects. We have, however, found indications in our empirical material for a connection between disadvantaged clients in the primary care and the increased influx to the emergency units. We hope that this could provide ideas for future and more elaborate studies.This paper is written in Swedish. Healthcare choice long waiting times emergency departments primary care economics sociological market theory quasi-markets Vårdval långa väntetider akutmottagningar primärvården nationalekonomisk teori sociologisk marknadsteori kvasimarknader
25	Gestion des ressources humaines d'un service d'urgence en période épidémique / Human resource capacity planning of an emergence department during epidemic season El Rifai Sierra, Omar 24 November 2015 (has links) Cette thèse s'inscrit dans le cadre du projet ANR HOST (Hôpital : Optimisation, Simulation et évitement des Tensions) qui vise à étudier et résoudre le problème de tension aux urgences hospitalières. Le projet cherche premièrement à définir rigoureusement la notion de tension et puis d'utiliser des outils mathématiques pour proposer des solutions qui prennent en compte la complexité du système de santé. Malgré la récurrence des phénomènes de tension, ils sont limités dans le temps et sollicitent par conséquent des solutions à court terme. La difficulté de trouver des solutions efficaces est principalement due à l'incertitude et au dynamisme caractéristique du service des urgences. D'une année à une autre, l'intensité de l'épidémie, et donc le nombre de patients se présentant aux urgences peut varier drastiquement. De plus, pour un même nombre de patients, il est difficile d'estimer correctement la charge de travail qu'il représente. L'objectif de cette thèse est donc de proposer des solutions stratégiques, tactiques et opérationnelles de gestion des ressources en prenant en compte les aléas caractéristiques des urgences. D'un point de vue stratégique nous étudions la distribution optimale de la capacité de travail sur une période épidémique. Ensuite, nous traitons le problème de confection des postes de travail journalier en fonction de la dynamique de la demande. Nous étudions également la possibilité d'affecter des postes d'astreinte aux médecins pendant les périodes épidémiques. Finalement, nous traitons le problème d'affectation des heures supplémentaires aux ressources dans un contexte plus opérationnel. / In France, the problem of overcrowding in Emergency Departments (ED) is particularly relevant today because of increasing admissions and budget restrictions in health establishments. Formally, overcrowding can be defined as a situation where the demand surpasses the service capacity. Studies that have dealt with ED overcrowding have mostly dealt with issues of patient flow management and resource management.Our work focuses on resource management and more particularly on the impact that human resources have on ED overcrowding. In the first part of the study, we formulate the capacity allocation problem in a generic form. As such, we examine the capacity management problem and derive interesting properties for a general demand distribution and a normal demand distribution. Then, we examine the cyclic shift scheduling problem as it exists in ED. This research allows us to examine different cyclic scheduling strategies and answer the question of whether lack of flexibility in the schedules has an impact on the waiting time of patients. We propose an original stochastic linear formulation for the problem that accounts for the non-stationary work demand. After that we evaluate two scheduling mechanisms to reduce overcrowding in EDs: on-call duties and overtime hours. We study the conditions under which these mechanisms can be beneficial. The on-call duties problem is modeled as a two-stage stochastic optimization problem and the overtime management problem as a Markov decision problem. Urgences Epidémie Planification Ressources humaines Optimisation stochastique Recherche opérationnelle Optimisation combinatoire Emergency Departments Epidemics Human Ressources Stochastic Optimization Scheduling Operations Research Combinatorials optimization
26	Redesigning the Barranquilla's public emergency care network to improve the patient waiting time Ortíz Barrios, Miguel Ángel 27 November 2020 (has links) [ES] La oportunidad en la atención es uno de los críticos de mayor relevancia en la satisfacción de los pacientes que acuden a los servicios de Urgencias. Por tal motivo, las instituciones prestadoras de servicio y las organizaciones gubernamentales deben propender conjuntamente por una atención cada vez más oportuna a costos operacionales razonables. En el caso de la Red Pública en Servicios de Urgencias de Barrannquilla, compuesta por 8 puntos de atención y 2 hospitales, la tendencia marca un continuo crecimiento de la oportunidad en la atención con una tasa de 3,08 minutos/semestre y una probabilidad del 93,13% de atender a los pacientes después de una espera mayor a 30 minutos. Lo anterior se constituye en un síntoma inequívoco de la incapacidad de la Red para satisfacer los estándares de oportunidad establecidos por el Ministerio de Salud, hecho que podría desencadenar el desarrollo de sintomatologías de mayor complejidad, el incremento de la probabilidad de mortalidad, el requerimiento de servicios clínicos más complejos (hospitalización y cuidados intensivos) y el aumento de los costos asociados al servicio. En consecuencia, la presente tesis doctoral presenta el rediseño de la Red Pública en Servicios de Urgencias anteriormente mencionada a fin de otorgar a la población diana un servicio eficiente y altamente oportuno donde tanto las instituciones prestadoras del servicio como los organismos gubernamentales converjan efectivamente. Para ello, fue necesaria la ejecución de 4 grandes fases a través de las cuales se consolidó una propuesta orientada al desarrollo efectivo y sostenible de las operaciones de la Red. Primero, se caracterizó la Red Pública de Servicios de Urgencias en Salud considerando su comportamiento actual en términos de demanda y oportunidad de la atención. Luego, a través de una revisión sistemática de la literatura, se identificaron los enfoques metodológicos que se han implementado para la mejora de la oportunidad y otros indicadores de rendimiento asociados al servicio de Urgencias. Posteriormente, se diseñó una metodología para la creación de redes de Urgencias eficientes y sostenibles la cual luego se validó en la Red Pública sudamericana a fin de disminuir la oportunidad de atención promedio en Urgencias y garantizar la distribución equitativa de los beneficios financieros derivados de la colaboración. Finalmente, se construyó un modelo multicriterio que permitió evaluar el rendimiento de los departamentos de Urgencia e impulsó la creación de estrategias de mejora focalizadas en incrementar su respuesta ante la demanda cambiante, los críticos de satisfacción y las condiciones de operación estipuladas en la ley. Los resultados de esta aplicación evidenciaron que los pacientes que acceden a la Red tienden a esperar en promedio 201,6 min con desviación de estándar de 81,6 min antes de ser atendidos por urgencia. Por otro lado, de acuerdo con la revisión de literatura, la combinación de técnicas de investigación de operaciones, ingeniería de la calidad y analítica de datos es ampliamente recomendada para abordar este problema. En ese sentido, una metodología basada en modelos colaterales de pago, simulación de procesos y lean seis sigma fue propuesta y validada generando un rediseño de Red cuya oportunidad de atención promedio podría disminuir entre 6,71 min y 9,08 min con beneficios financieros promedio de US$29,980/nodo. En último lugar, un modelo compuesto por 8 criterios y 35 sub-criterios fue diseñado para evaluar el rendimiento general de los departamentos de Urgencias. Los resultados del modelo evidenciaron el rol crítico de la infraestructura (Peso global = 21,5%) en el rendimiento de los departamentos de Urgencia y la naturaleza interactiva de la Seguridad del Paciente (C + R = 12,771). / [CA] L'oportunitat en l'atenció és un dels crítics de major rellevància en la satisfacció dels pacients que acudeixen als serveis d'Urgències. Per tal motiu, les institucions prestadores de servei i les organitzacions governamentals han de propendir conjuntament per una atenció cada vegada més oportuna a costos operacionals raonables. En el cas de la Xarxa Pública en Serveis d'Urgències de Barrannquilla, composta per 8 punts d'atenció i 2 hospitals, la tendència marca un continu creixement de l'oportunitat en l'atenció amb una taxa de 3,08 minuts / semestre i una probabilitat de l' 93,13% d'atendre els pacients després d'una espera major a 30 minuts. L'anterior es constitueix en un símptoma inequívoc de la incapacitat de la Xarxa per satisfer els estàndards d'oportunitat establerts pel Ministeri de Salut, fet que podria desencadenar el desenvolupament de simptomatologies de major complexitat, l'increment de la probabilitat de mortalitat, el requeriment de serveis clínics més complexos (hospitalització i cures intensives) i l'augment dels costos associats a el servei. En conseqüència, la present tesi doctoral presenta el redisseny de la Xarxa Pública en Serveis d'Urgències anteriorment esmentada a fi d'atorgar a la població diana un servei eficient i altament oportú on tant les institucions prestadores de el servei com els organismes governamentals convergeixin efectivament. Per a això, va ser necessària l'execució de 4 grans fases a través de les quals es va consolidar una proposta orientada a el desenvolupament efectiu i sostenible de les operacions de la Xarxa. Primer, es va caracteritzar la Xarxa Pública de Serveis d'Urgències en Salut considerant el seu comportament actual en termes de demanda i oportunitat de l'atenció. Després, a través d'una revisió sistemàtica de la literatura, es van identificar els enfocaments metodològics que s'han implementat per a la millora de l'oportunitat i altres indicadors de rendiment associats a el servei d'Urgències. Posteriorment, es va dissenyar una metodologia per a la creació de xarxes d'Urgències eficients i sostenibles la qual després es va validar a la Xarxa Pública sud-americana a fi de disminuir l'oportunitat d'atenció mitjana a Urgències i garantir la distribució equitativa dels beneficis financers derivats de la col´laboració. Finalment, es va construir un model multicriteri que va permetre avaluar el rendiment dels departaments d'Urgència i va impulsar la creació d'estratègies de millora focalitzades en incrementar la seva resposta davant la demanda canviant, els crítics de satisfacció i les condicions d'operació estipulades en la llei. Els resultats d'aquesta aplicació van evidenciar que els pacients que accedeixen a la Xarxa tendeixen a esperar de mitjana 201,6 min amb desviació d'estàndard de 81,6 min abans de ser atesos per urgència. D'altra banda, d'acord amb la revisió de literatura, la combinació de tècniques d'investigació d'operacions, enginyeria de la qualitat i analítica de dades és àmpliament recomanada per abordar aquest problema. En aquest sentit, una metodologia basada en models col´laterals de pagament, simulació de processos i llegeixin 6 sigma va ser proposada i validada generant un redisseny de Xarxa la oportunitat d'atenció mitjana podria disminuir entre 6,71 min i 9,08 min amb beneficis financers mitjana d'US $ 29,980 / node. En darrer lloc, un model compost per 8 criteris i 35 sub-criteris va ser dissenyat per avaluar el rendiment general dels departaments d'Urgències. Els resultats de el model evidenciar el paper crític de la infraestructura (Pes global = 21,5%) en el rendiment dels departaments d'Urgència i la naturalesa interactiva de la Seguretat de l'Pacient (C + R = 12,771). / [EN] Waiting time is one of the most critical measures in the satisfaction of patients admitted within emergency departments. Therefore, hospitals and governmental organizations should jointly aim to provide timely attention at reasonable costs. In the case of Barranquilla's Pubic Emergency Service Network, composed by 8 Points of care (POCs) and 2 hospitals, the trend evidences a continuous growing of the waiting time with a rate of 3,08 min/semester and a 93,13% likelihood of serving patients after waiting for more than 30 minutes. This is an unmistakable symptom of the network inability for satisfying the standards established by the Ministry of Health, which may trigger the development of more complex symptoms, increase in the death rate, requirement for more complex clinical services (hospitalization and intensive care unit) and increased service costs. This doctoral dissertation then illustrates the redesign of the aforementioned Public Emergency Service Network aiming at providing the target population with an efficient and highly timely service where both hospitals and governmental institutions effectively converge. It was then necessary to implement a 4-phase methodology consolidating a proposal oriented to the effective and sustainable development of network operations. First, the Public Emergency Service Network was characterized considering its current behavior in terms of demand and waiting time. A systematic literature review was then undertaken for identifying the methodological approaches that have been implementing for improving the waiting time and other performance indicators associated with the emergency care service. Following this, a methodology for the creation of efficient and sustainable emergency care networks was designed and later validated in the Southamerican Public network for lessening the average waiting time and ensuring the equitable distribution of profits derived from the collaboration. Ultimately, a multicriteria decision-making model was created for assessing the performance of the emergency departments and propelling the design of improvement strategies focused on bettering the response against the changing demand conditions, critical to satisfaction and operational conditions. The results evidenced that the patients accessing to the network tend to wait 201,6 min on average with a standard deviation of 81,6 min before being served by the emergency care unit. On the other hand, based on the reported literature, it is highly suggested to combine Operations Research (OR) methods, quality-based techniques, and data-driven approaches for addressing this problem. In this sense, a methodology based on collateral payment models, Discrete-event simulation, and Lean Six Sigma was proposed and validated resulting in a redesigned network whose average waiting time may diminish between 6,71 min and 9,08 min with an average profit US$29,980/node. Lately, a model comprising of 8 criteria and 35 sub-criteria was designed for evaluating the overall performance of emergency departments. The model outcomes revealed the critical role of Infrastructure (Global weight = 21,5%) in ED performance and the interactive nature of Patient Safety (C + R = 12,771). / Ortíz Barrios, MÁ. (2020). Redesigning the Barranquilla's public emergency care network to improve the patient waiting time [Tesis doctoral]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/156215 / TESIS Emergency departments (EDs) Fuzzy AHP (FAHP) Fuzzy DEMATEL (FDEMATEL) TOPSIS Performance evaluation Discrete-event Simulation (DES) Lean Six Sigma (LSS) Emergency Care Networks (ECNs) Healthcare Process improvement ORGANIZACION DE EMPRESAS
27	Patienten betraktas som ett nummer och inte som en människa : En integrerad litteraturstudie om crowding / Patienten ses som ett nummer och inte som en person : En integrerad litteraturstudie om trängsel Martinez, Camilla, Thern, Suzanne January 2022 (has links) Bakgrund: Crowding är ett fenomen som innebär en stor ansamling av personer på en och samma plats. På akutmottagningar blir crowding en utmaning då antalet patienter överskrider antalet sjuksköterskor. Under sitt arbetspass träffar sjuksköterskan många patienter men för patienterna är besöket på en akutmottagning något utöver det vardagliga. Därför är det viktigt att sjuksköterskan sätter den enskilda patienten i centrum. Syfte: Att undersöka vilka erfarenheter sjuksköterskor och patienter har av crowding på akutmottagningar. Metod: Magisterarbetet är en integrativ litteraturstudie. Databaserna Cinahl och Pubmed har använts i studien. Totalt omfattar resultatet 16 artiklar och både patienter och sjuksköterskor har inkluderats i undersökningen. Resultat: Sex huvudkategorier framkom i resultatet. "Svårt att upprätta patientsäkerhet", "stressig arbetsmiljö påverkar arbetstillfredsställelsen", "att känna sig otillräcklig", "ökad teamkänsla vid samarbete", "påverkan på vårdrelationen" och "när omgivningen blir icke-vårdande". Slutsats: Crowding medför en påverkan på vårdrelationen, patientsäkerheten, sjuksköterskors arbetsmiljö och patienternas vårdmiljö. Vidare forskning av erfarenheter av crowding behövs för att belysa problemet och minska dess negativa konsekvenser för sjuksköterskor och patienter. / Background: Crowding is a phenomenon that involves a large gathering of people in one place. In emergency departments, crowding becomes a challenge as the number of patients exceeds the number of nurses. During the work shift, the nurse meets many patients. But for the patients the visit to an emergency department is something out of the ordinary. Therefore, it is important that the nurse puts the individual patient at the center. Aim: To investigate what experiences nurses and patients have of crowding in emergency rooms. Method: An integrative literature study. The Cinahl and Pubmed databases were used in this study. A total of 16 articles were included in the survey. Experiences of both patients and nurses have been included in the study. Result: Six main categories were identified in the result. "Difficult to establish patient safety", "stressful work environment affects job satisfaction", "feeling inadequate", "increased team spirit in collaboration", "impact on the care relationship", and "when the environment becomes non-caring". Conclusion: Crowding has an impact on the care relationship, patient safety, nurses´ work environment and patients´ care environment. Further research on crowding experiences is needed to shed light on the problem and reduce its negative consequences for nurses and patients. crowding emergency departments nurses' experiences patients' experiences caring-relation environment patient safety crowding akutmottagningar sjuksköterskors erfarenheter patienters erfarenheter vårdrelation miljö patientsäkerhet Nursing Omvårdnad
28	Optimisation des opérations dans les services d’urgence / Operations optimization in emergency departments Ghanes, Karim 29 April 2016 (has links) Un Service d’urgence (SU) est le service hospitalier ayant comme responsabilité de fournir des soins non programmés à une grande variété de patients, 24 heures sur 24, 7 jours sur 7. Les SU sont actuellement confrontés à un problème international et récurrent, à savoir la saturation des urgences qui résulte de l’actuelle inadéquation entre les capacités médicales et la demande des patients. L'objectif est de développer des solutions internes et économiques permettant d’atténuer le phénomène de saturation des urgences et d’améliorer leur performance, à l'aide de méthodes issues de la Recherche Opérationnelle/Gestion des Opérations (RO/GO). Ces solutions sont d'un grand intérêt pour les gestionnaires. Afin d'atteindre cet objectif, nous abordons trois ensembles de questions de recherche.La première catégorie comprend des questions prospectives portant sur les indicateurs clés de performance (ICP) ainsi que sur les différents facteurs contribuant à l’encombrement des urgences. La deuxième catégorie est constituée de questions liées au dimensionnement de la capacité des ressources humaines dans un SU. Un modèle réaliste de simulation à événements discrets des urgences est élaboré. En utilisant l'optimisation basée sur la simulation, la durée moyenne de séjour des patients (LOS) est minimisée, en intégrant une contrainte budgétaire ainsi qu’une contrainte assurant que les patients les plus critiques accèderont à un médecin dans un délai déterminé. Les résultats obtenus permettent de fournir aux gestionnaires des urgences des indications utiles sur l'impact du budget sur la performance et sur la manière dont les investissements devraient être priorisés et répartis entre les ressources, ainsi que sur l'effet de la prise en compte de deux principaux ICP différents. Nous proposons également une heuristique pour l'optimisation de la structure des shifts (roulements) du personnel dans la journée. La méthode combine l'optimisation basée sur la simulation avec de la programmation linéaire. La troisième catégorie de questions porte sur le processus de soins des patients. Nous analysons des modifications et des alternatives innovantes dans le parcours du patient (à budget fixe). Typiquement, dans les pratiques actuelles, chaque patient dans un SU est affecté à un seul médecin qui en sera exclusivement responsable pendant toutes les étapes du processus (règle du "Même Patient Même Médecin", MPMM). Dans un premier temps, nous menons une enquête auprès des praticiens qui confirme que MPMM représente la pratique standard dans la plupart des SU à travers le monde. L’enquête révèle également que la suppression de cette règle est très controversée parmi les urgentistes. Nous utilisons ensuite une modélisation en réseau de files d’attente Erlang-R contenant une complexité additionnelle. Nous montrons et quantifions les avantages potentiels de la suppression de la restriction MPMM en fonction des paramètres du système. Une seconde étude portant sur le processus est menée, à savoir la prescription des examens par l’infirmière chargée du tri (PIT) avant la consultation initiale. Nous comparons le fait d’autoriser l’infirmière à prescrire certains examens complémentaires, avec la procédure standard consistant à attendre que le médecin examine le patient et lui prescrive des examens. Nous démontrons l'efficacité de PIT sur la performance du SU en fonction de paramètres clés, tels que le niveau de compétence de l’infirmière, la charge du système et l'extension de la durée du tri.De manière générale, cette thèse aborde d’innovantes questions de recherche dans la gestion des opérations des SU. Elle fournit aux décideurs des recommandations et des outils permettant d’améliorer la performance des urgences. Cette thèse ouvre également la voie pour de futurs axes de recherche liés à l'optimisation des opérations dans les SU. / Emergency Department (ED) is the service within hospitals responsible for providing unscheduled care to a wide variety of patients over 24 hours a day, 7 days a week. As a result to the existing mismatch between available caring capacity and patients demand, EDs are currently facing a recurrent worldwide problem, namely overcrowding. The objective of this thesis is to develop internal and cost-effective solutions to alleviate overcrowding in EDs and improve their performance, using Operations Research/Operations Management (OR/OM) methods. Such solutions are of great interest for managers. In order to achieve this objective, we address a series of research questions.The first category of research questions include prospective questions about ED Key Performance Indicators (KPIs) and about the diverse factors contributing to overcrowding. We first conduct a detailed literature review on the commonly used KPIs from an OR/OM perspective. The review summarizes the advantages and drawbacks of each KPI and provides several useful insights. In addition, a series of statistical analysis are performed in the purpose of identifying the main influencing factors of performance.The second category consists in resource-related questions that are associated to the dimensioning of ED resource capacity. A realistic ED discrete-event simulation model is thus proposed. The model accounts for the most essential structural and functional characteristics of EDs thanks to a close collaboration with practitioners. Using simulation optimization, we minimize the patient average length of stay (LOS), by integrating a staffing budget constraint and a constraint securing that the most severe incidents will see a doctor within a specified time limit. The obtained results allow us to provide useful insights to managers about the impact of the budget on performance and how investments priorities should be allocated among resources, as well as the effect of combining two different major KPIs. Furthermore, we propose a heuristic for the optimization of the shifts of human resources. The method combines simulation optimization and linear programming.The third category of questions deals with process-related issues. We investigate potential alternative and innovative ED patient flow designs (with fixed budget). Typically in current ED practices, each patient is assigned to a single physician who will be exclusively responsible of him/her during all stages of the process (“Same Patient Same Physician”, SPSP rule). We conduct a survey which confirms that SPSP stands as the standard practice in most EDs worldwide, and that removing SPSP rule is very controversial among practitioners. We next use a complexity-augmented Erlang-R queueing network modeling. We show and quantify the potential benefits of removing the SPSP restriction as a function of the system parameters. For a second process-related issue, we compare the Triage Nurse ordering (TNO) diagnostic tests against the standard procedure, i.e., waiting for the physician to examine the patient and order tests. We demonstrate the efficiency of TNO on ED performance as a function of key parameters, such as triage nurse ability, system load and triage time extension.In summary, this thesis addresses innovative OM research questions for EDs. It provides decision makers with recommendations and tools in order to improve ED performance. It also highlights various avenues for future research related to the optimization of ED operations. Services d’urgence Opérations Évaluation de la performance Optimisation Indicateurs clés de performance Simulation Files d'attente Emergency departments Operations Performance evaluation Optimization Key performance indicators Simulation Queuing systems
29	Violences et souffrances en milieu hospitalier : le cas des infirmiers du gouvernorat de Tunis / Violence and suffering in hospitals : the case of the nurses of the governorate of Tunis Remili, Donia 15 April 2019 (has links) Des études récentes confirment que la violence au travail dans le secteur de la santé est universelle, malgré certaines différences locales, et qu’elle impacte aussi bien les hommes que les femmes, (Di Martino, 2002). Cette recherche, s’attache à décrire les perceptions de la violence et de la souffrance chez ces professionnels de santé, à travers l’évaluation de la perception des risques psychosociaux, par les infirmiers et ce, dans les services des urgences, et d’hospitalisation à Tunis.Il s’agit de souffrances délétères multiples, qui se teintent du stress, et du burn out, s’alimentent de l’anxiété, s’amplifient par un système organisationnel défaillant et une qualité relationnelle inconsistante Il s’agit d’une étude, descriptive, transversale, prospective, portant sur une population d’infirmiers, exerçant dans trois hôpitaux répartis sur des services d’urgence et des services d’hospitalisation. L’étude est divisée, en parties ; exploratoire, quantitative et qualitative. Le cadre de référence général, étant l’approche systémique, notamment par Brondenfenbrenner (1979), ainsi que ; dans le domaine de l’organisation, par Mintzberg et en communication par l’école Palo Alto…, associée, essentiellement, à L’approche transactionnelle, sur le stress et le coping ; ainsi que l’approche humaniste en sciences infirmières (en matière de la relation soignant-soigné). / Recent studies, confirm that workplace violence in the health sector is universal, despite some local differences. It affects both men and women. (Di Martino, 2002). This research attempts to describe the perceptions of violence and suffering within these health professionals through the evaluation of perception of psychosocial risks by nurses in the emergency and hospitalization departments in the governorate of Tunis. It is about multiple deleterious sufferings, which are tinged with stress, and burn out. Fed with anxiety, and amplified by a faulty organizational system, and an inconsistent relational quality. It is a descriptive cross-sectional prospective study of a nursing population working in three hospitals distributed over emergency and hospitalization departments. The study isdivided into exploratory, quantitative and qualitative parts. The general frame of reference, being the systemic approach, notably by Brondenfenbrenner (1979), as well as; in the field of organization, by Mintzberg, and in communication, by the school Palo Alto ..., associated essentially with the transactional approach, on stress and coping as well as the humanistic approach to nursing (Healer-healed relationship). Violence externe Risques psychosociaux Infirmiers Communication Services des urgences Services d'hospitalisation Patient Accompagnant Relation d’aide External violence Psychosocial risks Nurses Communication Emergency departments Hospitalization departments Patient Accompanying person Helping relationship 158.720 886 1
30	From the "rising tide" to solidarity: disrupting dominant crisis discourses in dementia social policy in neoliberal times MacLeod, Suzanne 26 March 2014 (has links) As a social worker practising in long-term residential care for people living with dementia, I am alarmed by discourses in the media and health policy that construct persons living with dementia and their health care needs as a threatening “rising tide” or crisis. I am particularly concerned about the material effects such dominant discourses, and the values they uphold, might have on the collective provision of care and support for our elderly citizens in the present neoliberal economic and political context of health care. To better understand how dominant discourses about dementia work at this time when Canada’s population is aging and the number of persons living with dementia is anticipated to increase, I have rooted my thesis in poststructural methodology. My research method is a discourse analysis, which draws on Foucault’s archaeological and genealogical concepts, to examine two contemporary health policy documents related to dementia care – one national and one provincial. I also incorporate some poetic representation – or found poetry – to write up my findings. While deconstructing and disrupting taken for granted dominant crisis discourses on dementia in health policy, my research also makes space for alternative constructions to support discursive and health policy possibilities in solidarity with persons living with dementia so that they may thrive. / Graduate / 0452 / 0680 / 0351 / macsuz@shaw.ca social determinants of health social exclusion crisis discourse Alzheimer's Alzheimer Society of Canada Suzanne MacLeod Susan Strega Donna Jeffery poststructural poststructuralism admission to long-term care funding for long-term care acute care aging demographic BC Psychogeriatric Association biomedical British Columbia Canada Health Act collective social responsibility competition corporate profit corporatization deresponsibilization elder friendly elderly citizens family caregivers Foucault found poetry genealogy of power knowledge incompetent Ministry of Health moral economics pharmaceutical bed blocker stigmatized tsunami absent-person action plan aging population alternative discourse apocalyptic demography appropriate archaeology archaeology of knowledge archaeological British Columbia burden Canada caregiver charity charitable collective collective car community community care condition of possibility conditions of possibility corporate counter-discourse dementia dementia care dementia policy dementia social policy dependent depoliticize discourse discourse analysis disruptive discourse economic burden economics economy elder emergency epidemic exclusion fear-monger Foucauldian found poem genealogy genealogical health authority health care health care staff health care system health policy document healthy lifestyle home and community care homogenization homogenize hospital imaginaries imaginary incapable individual responsibility individualism knowledge long-term care material effect materiality of discourse media moral panic national strategy neoliberal neoliberalism neoliberal rationality not prepared object objectification other person-centered people living with dementia person living with dementia persons living with dementia person with dementia poem poetic representation poetry policy policies political politics power power knowledge power relations private privatize privatization productivity of dominant discourse public health care residential care resistance responsibility responsibilization rising tide safety net shift costs to caregivers responsibility social policy imaginary social well-being social work social worker solidarity specialized stakeholder state stigma subject matter expert taxpayer threat unprepared unproductive voluntary volunteer wait time wave social policy

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