京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20290号 / 社医博第79号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 小池 薫, 教授 佐藤 俊哉, 教授 中山 健夫 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第21031号 / 社医博第85号 / 新制||社医||10(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 小池 薫, 教授 今中 雄一, 教授 湊谷 謙司 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM

Arbetet på en akutmottagning är både komplex och oförutsägbar där patienten är ett oskrivet blad vid ankomst. Detta ställer krav på sjuksköterskans omhändertagande och ledarskap. Det förväntas att sjuksköterskan har förmåga att omhänderta och ge patienter vård på en avancerad nivå och på ett patientsäkert sätt. Sjuksköterskans kompetens och erfarenheter har en avgörande betydelse på akutmottagningen där sjuksköterskan snabbt behöver identifiera, prioritera och påbörja adekvat behandling vid livshotande tillstånd. Centralt i arbetet är att sjuksköterskan med ett ledande ansvar samverkar i team med såväl patienter och närstående som kollegor. Sjuksköterskan leder och fördelar arbetet med tydlighet för att säkra vården av patienten. Syftet med studien var att belysa sjuksköterskans erfarenheter av att leda omvårdnaden på en akutmottagning. Metoden som användes var en litteraturöversikt. Datainsamlingen utgick från sökningar i databaserna PubMed, SveMed+ och CINAHL samt manuell sökning. Tolv kvalitativa, fyra kvantitativa och tre artiklar med mixad design låg till grund för resultatet. I resultatet framkom fem teman: betydelsen av kunskap inom ledarskap och akutsjukvård, erfarenhetens betydelse av att leda i akuta situationer, intuitions betydelse vid bedömning och prioritering, kommunikationens betydelse för att uppnå en säker vård och faktorer som påverkar sjuksköterskans ledarskap. Sjuksköterskors erfarenheter visade att identifierade och beskrivna teman hade en avgörande betydelse för effekten på ledarskapet. Därigenom sågs positiva effekter på både arbetsplats, patientflöde och teamarbete och vården koordinerades väl ur ett helhetsperspektiv. Slutsatsen av resultatet visade att teoretisk kunskap inom både ledarskap och akutsjukvård samt erfarenheter hade betydelse för ledarskapet i arbetet på akutmottagningar. De mindre erfarna sjuksköterskorna behövde mera tid och träning för att kunna utveckla strategier som de erfarna sjuksköterskorna skaffat sig över tid. Emellertid visade studien att sjuksköterskor med kompetens och erfarenhet inte kunde hantera hur hög arbetsbelastning som helst.

No description available.

Bakgrund: Sjuksköterskan har ett omfattande omvårdnadsansvar, speciellt i en kontext som akutsjukvården där ett högt patientflöde, akut sjuka patienter och kritiska situationer är vanligt förekommande. Stress kan påverka en människas psykologiska funktioner, vilket kan leda till svårigheter att fungera adekvat. Sjuksköterskor måste ständigt sträva efter att upprätthålla en god vård, även i stressfyllda situationer. Denna stressfulla arbetssituation kan ställa höga krav på sjuksköterskans förmåga att erbjuda en god och säker vård. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av stress i omvårdnadsarbetet inom akutsjukvården  Metod: Denna studie är en allmän litteraturstudie med sökningar i databaserna Cinahl och PubMed. Vald analysmetod är kvalitativ innehållsanalys. Resultat: Sjuksköterskor som arbetar inom akutsjukvården upplever återkommande stress, vilket upplevs kan försämra vårdkvaliteten, leda till kommunikationsbrist och som en konsekvens, brister i patientsäkerheten. Identifierade stressorer var att känna sig otillräcklig, att upplevas behöva mer stöd och resurser och upplevelser av att inte ha tillräcklig kompetens. Slutsats: Genom utveckling av bättre arbetsförhållanden, adekvat ledningsstöd och vidare utbildning kan sjuksköterskor få bättre resurser och redskap för stresshantering. / Background: Nurses have broad and extensive responsibility, especially in emergency medical care where high patient flow, critically ill patients, and challenging situations is a common occurrence. Extensive stress can lead a negative psychological impact, and therefore a difficulty functioning adequately. Nurse must constantly strive to maintain a good care, even in stressful situations. This stressful work situation makes high demands on the nurse’s ability to offer an adequate and safe care. Aim: The aim for this study was to describe nurses’ experiences of stress in the emergency medical service. Method: This study is a general literature review with searches in two scientific databases, CINAHL and PubMed. Chosen analytical method is a qualitative content analysis.  Results: Nurses working in the emergency medical services experience recurrent stress, can affect the quality of care given, lack of adequate communication, and as consequence deficiency in patient safety. Consequences of identified stressors where to feel inadequate, to feel the need for more support and resources and feelings of having lack of competence.  Conclusion: Through the development of better working conditions, adequate management support and further education, nurses can get better resources and tools to cope with their stress.

Thesis's Topic: The Activity Analysis of Rescue of Královehradecký kraj, station Trutnov 2006-2009 Aim of the thesis: To analyze the operation of the Emergeny Medical Service in Trutnov. Method: Research of available sources, data collection and the cooperation of the members of the Emergency Medical Service coming to the patient. Results: All here listed statistics data are base on intervetion documentation of Trutnov center. Therefore the presented results can't be taken, generalled to other centers and assumed that will be comparable. Keywords: Integrated Emergency Services, Emergency Medical Service, rapid response vehicle, advanced life support vehicle, calls for the crew of the Emergency Medical Service.

O pronto socorro é uma unidade do hospital destinada à assistência a pacientes externos com ou sem risco de morte, que necessitam de atendimento imediato, cujo funcionamento se dá nas 24 horas do dia sendo fundamental a determinação do número necessário de profissionais de enfermagem para prestar assistência com qualidade satisfatória, pois a falta de profissionais de enfermagem com diferentes níveis de formação e a sobrecarga de trabalho aumentam o risco de ocorrência de falhas com prejuízo da qualidade na assistência ao paciente. Os instrumentos de classificação de pacientes são utilizados pela enfermagem em qualquer unidade assistencial e estabelecem as características da população assistida de acordo com a necessidade de cuidados requerida, sendo indispensável para a determinação das necessidades de pessoal e alocação quantitativa e qualitativa dos mesmos. Com o objetivo de caracterizar o perfil assistencial dos pacientes adultos durante a internação no pronto-socorro como um dos subsídios para o dimensionamento do pessoal de enfermagem desenvolveu-se uma pesquisa exploratória no método do estudo de caso, em um pronto-socorro, clínico e cirúrgico, de um hospital geral, público estadual que possui 24 leitos de observação e dez leitos na unidade de atendimento de emergências, localizado no extremo leste do município de São Paulo que trabalha com demanda espontânea do usuário. Os sujeitos da pesquisa foram os pacientes adultos internados na unidade de emergência e nas salas de observação durante o mês de janeiro de 2009, os dados foram coletados por meio da aplicação do instrumento de classificação de pacientes de Fugulin (2002) que avalia nove áreas de cuidado (Estado mental, Oxigenação, Sinais Vitais, Motilidade, Deambulação, Alimentação, Cuidado Corporal, Eliminação e Terapêutica). Foram realizadas 1.228 avaliações, sendo verificados 91 pacientes na categoria de cuidados intensivos, 75 na categoria de cuidados semi-intensivos, 245 com alta dependência para assistência de enfermagem, 272 com complexidade assistencial intermediária e 545 com a mínima. Houve a constatação de muitos pacientes da psiquiatria internados no pronto-socorro a espera de vagas para internação na unidade especializada requerendo da equipe de enfermagem uma assistência diferenciada para a manutenção da integridade física desses pacientes. Verificou-se por meio do número médio mensal de atendimentos realizados que a maioria dos usuários do pronto-socorro não necessitava de internação mas foram atraídos para esse serviço em busca de consultas de rotina acabando por sobrecarregar a equipe multiprofissional que atua nessa unidade que apresentou uma taxa de ocupação média acima da previsão dos leitos oficiais disponíveis tornando a planta física inadequada para pacientes e profissionais devido às internações em macas pelos corredores, reflexo da falta de um serviço de regulação. / The emergency medical service is the hospital ward designated to outpatient care with or without death risk for those who need immediate care, whose attendance is 24 hours a day, being essential the determination of a required number of nursing professionals for delivering satisfactory quality care, since the lack of nursing professionals with different levels of background and work overload increase the risk of errors, impairing the quality of patient care. The instruments of patient classification are used by nursing in any care ward and set up the characteristics of the population assisted, according to the need of care required, being vital for determining the personnel needs and its quantitative and qualitative allocation. Aiming to characterize the adult patient care profile throughout the admission at the emergency medical service, as a support for nursing personnel dimensioning, it was developed an exploratory research in a study of case method, at a clinic and surgical emergency room of a general, public state hospital that holds 24 observation beds and 10 beds at the emergency attendance ward, located at the extreme east of São Paulo city and which works with spontaneous demand of users. The subjects of research were adult patients admitted at the emergency ward and the observation rooms throughout the month of January, 2009. Data was collected through the application of an instrument of patient classification by Fugulin (2002), which evaluates nine care areas (Mental Status, Oxygenation, Vital Signs, Motility, walking, Feeding, Body Care, Elimination and Therapeutics). It was made 1228 evaluations, in which 91 patients in the intensive care category were verified, 75 in the semiintensive care, 245 with high dependence of nursing care, 272 with intermediate care complexity and 545 with minimal one. There was the evidence of many psychiatric patients admitted in the emergency room waiting for a vacancy in the specialized ward requiring from the nursing staff special care for keeping the physical integrity of those patients. It was verified by the monthly average number of attendance that most emergency room users didnt need admission, but they were attracted to this service in search for routine appointments, leading to overload the multi-professional team that works in this ward, which presented an average occupancy rate above the prediction of official beds available, making the physical space inadequate for patients and professionals, due to the admissions in beds spread in corridors, result of lack of service control.

The emergency medical services (EMS) provide the preliminary assistance and transportation for patients in need of urgent medical care in order to decrease the mortality rate and reduce the non-reversible effects of injuries. Since the objective is directly related to the human life, the value of the proposed solutions in order to improve the performance of EMS is highly welcomed. Mainly, there are three problems that EMS managers face with: location, allocation and redeployment of the EMS facilities/vehicles. Most of the studies in EMS literature focus on accurately modeling the probabilistic nature of the availability of an ambulance when it is called for. However, trivial changes in model parameters or estimates could dramatically change the optimal allocations generated by the probabilistic models and hence make the model invalid. In this study, we formulate the ambulance location problem as a deterministic multi-level maximal coverage model by which the total demand is tried to be covered as many as possible at multiple levels. Both a mathematical programming model and genetic algorithm-based heuristic approaches are proposed for the problem. The results indicate that the genetic algorithm-based solutions give reliable (near-optimal) and robust results in reasonable computational times for the problem. Moreover, the tradeoffs between the two performance measures, &lsquo / responsiveness&rsquo / and &lsquo / preparedness&rsquo / , are searched for / and our approaches with multi-level coverage are compared against the multiple coverage approaches in terms of these performance measures.

Saugos kultūra – pacientų saugos elementas nukreiptas sumažinti žalą pacientui, kuri gali būti padaryta teikiant jam sveikatos priežiūros paslaugas. Tikslas – Įvertinti Kauno regiono greitosios medicinos pagalbos tarnybų darbo vietos saugos kultūrą. Tyrimo metodas: 2012 metų kovo–gegužės mėnesiais atlikta vienmomentinė anoniminė apklausa. Tyrime dalyvavo aštuonių Kauno regiono greitosios medicinos pagalbos tarnybų darbuotojai (N=325, atsako dažnis 82,9 proc.). Tyrimui naudotas Požiūrio į saugą klausimynas (The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ). Nustatyta GMP Požiūrio į saugą klausimyno pakankamai aukštas vidinis nuoseklumas (α=0,822). Rezultatai: Kauno regiono greitosios medicinos pagalbos tarnybų specialistai, vertindami septynias saugos kultūros sritis, aukščiausiais teigiamais įverčiais vertino komandinio darbo (76,34 balai), pasitenkinimo darbu (76,49 balai) ir vadovų požiūrio į saugą sritis (75,98 balai). Žemiausiais balais darbuotojai vertino streso pripažinimo ir nepageidaujamų įvykių raiškos sritis, atitinkamai – 49,62 ir 37,24 balai. Komandinį darbą ir vadovų požiūrį į saugą dažniau teigiamai vertino slaugytojai, lyginant su GMP vairuotojais, o paramedikai labiau teigiamai vertino pasitenkinimą darbu, lyginant su gydytojais (p<0,05). Gydytojai ir paramedikai dažniau pripažino stresą, lyginant su slaugytojais ir vairuotojais (p<0,01). Daugiau kvietimų per metus atliekantys darbuotojai dažniau teigiamai vertino saugos klimato... [toliau žr. visą tekstą] / Safety culture is the element of patient safety that purposes to decrease the damage to the patient that may be done during provision of health care service. The purpose of this study was to investigate the safety culture at the workplace of emergency medical service at Kaunas region. Material and methods: Anonymous survey was conducted on March-May in 2012. The staff from eight emergency medical service institutions at Kaunas region took part in the survey (N=325 with response rate of 82.9 %). The Emergency Medical Services Safety Attitudes Questionnaire – EMS–SAQ was used after the permission by the authors was issued. The internal consistency of translated and adapted instrument was sufficiently high (Cronbach α=0,822). Results: The staff of emergency medical service of Kaunas region evaluated six dimensions of safety culture rating team work (76.34 scores), work satisfaction (76.49 scores) and perceptions of management at the highest level (75.98 scores). The lowest ratings were related to stress recognition and present of adverse events, respectively – 49.62 and 37.24 scores. Nurses scored the team work and perceptions of management more positive in comparison to drivers; paramedics have had more positive attitudes towards work satisfaction than physicians. Physicians and paramedics recognised stress more often in comparison to nurses and drivers. The attitudes towards a safety climate, perceptions of management and work satisfaction were more positive in... [to full text]

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 5 uppsatser.