Aging population is becoming a problem in a lot of countries, being Swedenone of them, and that is leading society to a lack of the necessary peopleto take care of all the elderly people. The CareIP device, an alarm systemfor the elderly people, with which they are able to ask for assistive help incase they need it, has been used all over Sweden for a while now. In thisthesis, a simulation model has been built in order to study how this caregiving system works in the specic case of Vaxjo. This model can be usedto simulate real situations and prevent certain problems as it could be thelack or excess of resources, long waiting times or unexpected increase on thenumber of alarms, which could lead to critical situations on a emergencyhealthcare system.

Bakgrund: Suicid är ett globalt förekommande fenomen. Orsakerna till suicid är ofta flera och komplexa, men den största riskfaktorn är tidigare genomfört suicidförsök. På akutmottagningen vårdar sjuksköterskor suicidbenägna människor som vanligtvis intoxikerat eller medvetet skärskadat sig. Sjuksköterskor spelar en huvudroll i det suicidpreventiva arbetet, då de jobbar patientnära. De har i uppgift att lindra lidande i form av exempelvis psykisk smärta. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda suicidbenägna patienter inom akutsjukvården. Metod: Uppsatsen genomfördes i form av en litteraturbaserad studie. Tio kvalitativa artiklar valdes ut och analyserades enligt Fribergs (2022) fem steg. Resultat: Resultatet mynnade ut i tre teman med tillhörande subteman. Teman var: Bristande kunskaper, Skiftande attityder och värderingar och Arbetsmiljö och organisatorisk inverkan på vården. Det framkom att akutsjukvårdens stressiga arbetsmiljö, bristande suicidkompetens och personliga värderingar är faktorer som påverkar eller försvårar sjuksköterskors arbete. Sjuksköterskor önskar att få ytterligare utbildning i suicid och suicidhjälp. Konklusion: Att vårda suicidbenägna patienter är komplext för sjuksköterskor. Det är viktigt att sjuksköterskor besitter kompetens om suicid oavsett arbetsplats. Detta för att kunna göra adekvata suicidriskbedömningar samt förhindra suicid i tid. / Background: Suicide is a global phenomenon. The reasons behind suicide are often many and complex, but the biggest risk is an earlier attempt. Nurses at the emergency department meet suicidal individuals that usually are intoxicated or have slice-wounds. Nurses play a leading role in suicide prevention work, as they work close to patients. They are tasked with alleviating suffering, as for example psychical pain. Aim: To describe nurses’ experiences of caring for suicidal patients within emergency healthcare. Method: A literature-based study was made. Ten qualitative articles were selected and analyzed according to Friberg’s (2022) five steps. Findings: The result became three themes with belonging subthemes. The themes were: Lack of knowledge, Various attitudes and values, Work environment and organizational impact on the care. It appeared that the stressful work environment of emergency healthcare, lack of suicide competence and personal values affects or complicates nurses’ work. Nurses want further education about suicide and suicide help. Conclusion: Caring for suicidal patients is complex for nurses. It is important that nurses have competence in suicide, regardless of workplace. This because they must be able to do adequate suicide risk assessments and prevent suicide in time.

Syftet med denna uppsats var att genomföra en litteraturstudie för att undersöka hur patienter upplever bemötandet i akutsjukvården. För att uppnå detta syfte användes en metod där tidigare forskning och vetenskapliga artiklar granskades och analyserades.  Begreppet bemötande är ett uttryck för hur någon uppför sig eller uppträder gentemot en annan person, genom mänskligt samspel och inställningen till varandra i form av gester och ord. Begreppet bemötande är inget nytt i sig, dock ökar brukandet av ordet i vårdsammanhang. I begreppet bemötande ingår information samt kommunikation och dessa begrepp kan inte separeras från varandra då alla tre samspelar. En grund för gott bemötande ingår även inom människovärdesprincipen som är en etisk plattform som belyser begreppet som respekt för självbestämmande, integritet, värdighet och trygghet. Detta arbete ämnar ta reda på hur patienten upplever bemötandet från vårdpersonalen i akutsjukvården. Mycket forskning, både artiklar och litteratur beskriver och undersöker vikten av att ställa patienten i fokus. Resultatet av litteraturstudien visade att patienternas upplevelse av bemötande i akutsjukvård är en komplex fråga. I resultatet framgick det att empati, information och kommunikation spelade en avgörande roll för patienternas upplevelse av vården. Studien visade också på vikten av att skapa en trygg och inkluderande miljö för patienterna, särskilt i situationer där stress är vanligt förekommande. Slutsatsen visar att det finns utrymme för förbättring inom akutsjukvården för att möta patienternas behov av ett respektfullt bemötande. Det är av vikt att fortsätta undersöka och implementera metoder för att säkerställa att patienter får tillgång till och tar till sig information. Detta för att förbättra patienternas upplevelse och skapa en mer patientcentrerad akutsjukvård. / The aim of this thesis was to conduct a literature review to explore how patients perceive the treatment they receive in emergency healthcare. To achieve this aim, a method was employed where previous research and scientific articles were examined and analyzed. The concept of interaction refers to how someone behaves or acts towards another person, through human approach and attitudes towards each other in the form of gestures and words. The concept of interaction is not new in itself, however, the use of the word is increasing in healthcare contexts. Within the concept of interaction, information and communication are included, and these concepts cannot be separated from interaction as all three interact. A foundation for a good interaction also includes the principle of human dignity, which is an ethical platform highlighting concepts such as respect for self-determination, integrity, dignity, and security. This work aims to find out how the patient experiences the interaction from healthcare professionals in emergency healthcare. Much research, both articles and literature, describes and examines the importance of putting the patient at the center. The result of the literature review revealed that patients' experiences of treatment are a complex issue. The results indicated that empathy, information, and communication played a crucial role in shaping patients' perceptions of healthcare. The study also highlighted the importance of creating a safe and inclusive environment for patients, especially in situations where stress is prevalent. The conclusion suggests that there is room for improvement in emergency healthcare to meet patients' needs for respectful treatment. It is crucial to continue researching and implementing methods to ensure that patients have access to and comprehend information. This is necessary to enhance patients' experiences and establish a more patient-centered approach to emergency healthcare.

The overall aim of this thesis is to obtain an understanding of Emergency Healthcare Work (EHW) at the Emergency Department (ED), including the competencies required by EHW, and based on practitioners' and managers' perspectives. Methods: In study I, a quantitative method was employed. A questionnaire was sent to all Swedish EDs and data was analysed using descriptive statistics and content analysis. In studies II- IV, qualitative methods were used. In study II, participant observations and individual and group interviews were conducted. In studies III-IV individual and group interviews were conducted. In studies II-IV, data was analysed using qualitative content analysis. Results: According to head nurses, basic nursing education does not lead to sufficient competence for working at an ED and thus supplementary formal education is needed. A minority of head nurses perceive that they are completely responsible for creating preconditions for competence development (study I). The EHW is characterized by rapid, brief and standardized encounters with limited scope for providing individualized care. Practitioners strive to be adaptable by structuring EHW and they cooperate to achieve a good workflow (study II). Management is characterized by a command and control approach. Managers experience EHW as lifesaving work and they experience difficulties in meeting the expectations of their staff (study III). There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the possibilities to develop competencies in EHW. The focus on competence in EHW is on account of the emergency and lifesaving nature of its actions. Purely medical competencies are valued and caring competencies are subsequently downgraded. A medical competence approach consolidates the current view of competencies necessary in everyday work in EDs (study IV). Conclusions: EHW and the competencies required by EHW are defined from a purely medicalized and result-driven viewpoint. Patients' medical needs are given greater importance than their caring needs. Medicalized and result-driven EHW makes it difficult to provide individualized care. This difficulty is a hindrance to the implementation of a holistic view in EHW. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet kommer att offentligt försvaras Fredagen den 12 december, kl. 09.00 i hörsalen 2119 Institutionen för vårdvetenskap och hälsa, Arvid Wallgens Backe, Hus 2, Göteborg</p><p>I. Andersson, H. &amp; Nilsson, K. (2009). Questioning Nursing Competences in Emergency Health Care. Journal of Emergency Nursing, 35, 305-311. II. Andersson, H., Jakobsson, E., Furåker, C. &amp; Nilsson, K. (2012). The everyday work at a Swedish emergency department - The practitioners' perspective. International Emergency Nursing. 20, 58-68. III. Andersson, H., Wireklint Sundström, B., Nilsson, K. &amp; Jakobsson Ung, E. (2014). Management of everyday work in Emergency Departments – An exploratory study with Swedish Manager. International Emergency Nursing. 22, 190-196. IV. Andersson, H., Wireklint Sundström, B., Nilsson, K. &amp; Jakobsson Ung, E. (2014). Competencies in Swedish emergency departments - The practitioners' and managers' perspective. International Emergency Nursing. 22, 81-87.</p>

Healthcare waste (HCW) incineration practices in the global South countries are among the major sources of black carbon (BC) emissions or smoke. This study analyzes HCW incineration trends during emergency situations and smoke from HCW incineration processes in Haiti. The study was prompted by the current arguments about the climate change and the growing health effects associated with BC emissions. The conceptual framework was based on both adverse health effects from BC emissions exposure and climate change potential of BC emissions. Therefore, the goal was to determine whether cardboard HCW sharps containers emit lower BC emissions to the atmosphere during the incineration process, relative to the plastic sharps containers, and the pattern of emergency HCW incineration before and after the 2010 earthquake and cholera emergencies in Haiti. This was an observational study conducted with secondary data on HCW incinerated weights from January 2009 to December 2013 and primary data on average smoke densities. Linear regression analysis of the pattern of HCW incinerated weights revealed a relatively linear pattern (R2 = 0.164) with fluctuating scenarios (peak sharp rise in 2012). Independent samples t-tests demonstrated significantly lower smoke emission during the incineration processes of cardboard sharps HCW containers as compared to plastic containers (95 % CI, p = 0.003). Implications for positive social change include provision of quantitative evidence of the benefits of cardboard sharps HCW containers in reducing smoke during incineration activities, potential data for policy formulation, suggestions for review of existing HCW guidelines, and additional research on potential health impacts of emergency HCW disposal and BC emissions.

With an increasing migrant population there is a growing need to organize interpreting practices in healthcare in order to deliver equitable high-quality care. This thesis focuses on healthcare institutions’ organization of interpreting services. The aim of the study was to explore interpreting practices in a healthcare context by comparing two different healthcare areas – elderly and emergency healthcare. The study aimed to highlight the impact of the organizational and institutional context. This study was designed as an explorative and descriptive qualitative study including 79 healthcare professionals with experience of interpreting practices recruited via purposeful sampling in elderly and emergency healthcare. Data were collected through individual and focus-group interviews and analysed with inductive qualitative content analysis. The main findings show that the processes and structures around interpreting practices were complex and mainly linked to individual and interpersonal levels and, to a limited extent, to the institutional level. On the institutional level the Public Procurement Act was the only formal policy to follow. On individual and interpersonal level interpreting practices were structured by self-established informal workplace routines developed by the professional groups. The norms and routines used was determined by access to interpreters, time aspects, characteristics of the care given, health conditions and the person’s problem, expectations and requests from the person and also from healthcare professionals. There were wishes for improvement, with better flexibility in access to professional interpreters, training for users and interpreters, and also better technical solutions and equipment. In conclusion, the use of interpreters was rooted in the organizational environment of interpreting practice, including the availability of laws, policy and guidelines, and closely related to individuals’ language skills, cultural values and social factors. The use of professional interpreters was based on the nature of care in context and access to interpreters and determined by health professionals’ estimation of the person’s current health status in order to deliver fast and individualized care based on humanistic values. Thus, it is important to consider organizational framework and cultural awareness when formulating interpreting practices adapted to the context, and formal guidelines in order to achieve the aim of personcentered and equal health care.

Bakgrund: Det är väl känt att personcentrerad vård, både internationellt och nationellt, definieras som framställning av god omvårdnad. I sjuksköterskans kompetensbeskrivning ingår det att sjuksköterskan ska kunna tillämpa ett personcentrerat förhållningssätt. Den personcentrerade vården förutsätter att vårdpersonal inom akutsjukvård har förmågan att förstå patientens perspektiv, visa intresse och hänsyn för den enskilde samt för vården. Syfte: Syftet var att undersöka sjuksköterskors erfarenheter av att arbeta med ett personcentrerat förhållningssätt inom akutsjukvård. Metod: En strukturerad litteraturöversikt har genomförts. I databaserna Cinahl och Pubmed har 15 kvalitativa vårdvetenskapliga artiklar valts ut och ligger till grund för resultatet. Analysen utfördes utifrån Thomas och Hardens tematiska syntes. Resultat: Resultatet redovisas utifrån fem analytiska kategorier: Personcentrerad vård innebär att sjuksköterskan inom akutsjukvård ser hela människan och inte enbart sjukdomen, sjuksköterskans förmåga att göra patienten och deras anhöriga delaktiga i vårdprocessen anses vara väsentligt för vårdrelationen, sjuksköterskans samverkan med vårdpersonal är betydelsefull för den personcentrerade vården och för patientsäkerheten, sjuksköterskans kompetens och egna intresse har betydelse för hur väl utförd den personcentrerade vården blir och akutmottagningens arbetsmiljö kan vara ett hinder för sjuksköterskan att arbeta personcentrerat. Slutsats: Att etablera en god vårdrelation och att ge kontinuerlig information till patienterna anses vara en fördel för att för att ge patienterna möjlighet att kunna ta ett beslut och vara delaktiga i vårdprocessen. Sjuksköterskor inom akutsjukvård behöver mer kunskap om ämnet personcentrerad vård, men även möjlighet till mer tid i mötet med patienterna för att få så goda förutsättningar som möjligt att kunna utföra personcentrerad vård. / Background: It is well known that person-centered care, both internationally and nationally, is defined as the production of good nursing care. The nurse's competency description includes that the nurse must be able to apply a personcentered approach. Person-centered care requires that the emergency care staff can understand the patient's perspective, show interest and consideration for the individual as well as for the care. Aim: The aim was to investigate nurses' experiences of working with a personcentered approach within emergency healthcare. Method: A structured literature review has been used. In the databases Cinahl and Pubmed, 15 qualitative health science articles have been selected and form the basis of the results. The analysis was carried out based on Thomas and Harden's thematic synthesis. Results: The results are reported based on five analytical categories: Personcentered care means that the nurse in emergency care sees the whole person and not just the disease, the nurse's ability to involve the patient and their relatives in the care process is considered essential for the care relationship, the nurse's collaboration with care staff is significant for the person-centered care and for patient safety, the nurse's competence and self-interest are important for how well the person-centered care is carried out and the emergency department's work environment can be an obstacle for the nurse to work person-centered. Conclusion: By establishing a good care relationship and providing continuous information to the patients is important in order to give the patients the opportunity to be able to make a decision and be involved in the care process. Nurses within emergency healthcare need more knowledge about person-centered care, but also the opportunity to spend more time in the encounter with the patient to have the best possible conditions to perform person-centered care.