This thesis examines the responses of one hundred and seventy three nurses who work in emergency departments in New South Wales to the psychological tenets of stress, support and burnout. Several tools were utilised the Maslach Burnout Inventory, the Jalowiec Coping Scale and the Bailey Stress Scale. The respondents were grouped according to their place of work and numerous variables were analysed for both similarities and significant differences. Overall nurses who work in emergency departments in NSW reported that the lack of in-patient beds or exit block was the most significant stressor in their work, followed by interruptions by telephones and uncontrolled volumes of patients. Although a variety of formal support systems available to emergency nurses were identified in this study a there was not universal agreement about their usefulness. Support from colleagues however was identified as sustaining and helpful. Reported coping styles of the respondents in this study were constructive, self reliant and professional. There was a very small number of respondents who can be classified as burnt out. / Master of Science (Hons.) Health

Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Responses were individually reviewed and coded by the research team.Results: Major obstacles relating to ED design identified by emergency nurses included (1) many issues related to limited space, (2) poor department layout and design features, and (3) the lack of privacy. Despite EDs being a challenging place to provide EOL care, positive ED design characteristics impacted EOL care for dying patients and families.Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed due to the immediate need for a second trauma patient and family. Nurses can evaluate existing facilities and identify areas where potential change and remodeling would improve patient care, increase patient privacy, or further utilize space. Conclusion: Understanding ED designs impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new EDs or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.

Introduction: Death occurs frequently in emergency departments (EDs). Obstacles present in EDs can make providing end-of-life (EOL) care stressful and challenging for emergency nurses. Although death is common in EDs, there is a paucity of research regarding ED design as an obstacle to EOL care. The purpose of this study was to identify emergency nurses experiences and recommendations regarding ways ED designs negatively or positively impacted EOL care for dying patients and their families. Methods: At 25-item questionnaire regarding ED design and EOL care was sent to a geographically dispersed, national random sample of 500 emergency nurses. Inclusion criteria were nurses who could read English, worked in an emergency department, and had cared for at least one patient at the EOL. Responses were individually reviewed and coded by the research team.Results: Major obstacles relating to ED design identified by emergency nurses included (1) many issues related to limited space, (2) poor department layout and design features, and (3) the lack of privacy. Despite EDs being a challenging place to provide EOL care, positive ED design characteristics impacted EOL care for dying patients and families.Discussion: Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed due to the immediate need for a second trauma patient and family. Nurses can evaluate existing facilities and identify areas where potential change and remodeling would improve patient care, increase patient privacy, or further utilize space. Conclusion: Understanding ED designs impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new EDs or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.

Incidence of injury is currently the third leading cause of death in the Czech Republic. A good link between pre-hospital emergency care and hospital care becomes a priority. Nurses play an important role during an acute admission of patients with trauma to in-hospital care, they are the connecting link of all members of the multidisciplinary team, whose common mission is the patient and saturation of his /her needs. With the changing role of nurses in the modern concept of nursing, nurses become equal partners of physicians and other health care professionals. To be accepted by other members of the team and to be able to work with the full extent of her sphere of action in the acute phase of a trauma patient admission, she has to know perfectly her competencies under the applicable legislation. In the theoretical part the roles and responsibilities of nurses under the applicable legislation are defined. There are also chapters dealing with individual injuries and the organization of care for patients with trauma. In the final section of the theoretical part there is a chapter dealing with the holistic care for patients, including ethical care issues, the role of a patient and the importance of cooperation with the family of the trauma patient who is acutely admitted into the hospital. In the empirical part of the thesis three objectives were stated. To determine the cooperation of nurses with other members of the multidisciplinary team, as well as to find out whether the nurses involved in the admission of a trauma patient into hospital know their own competencies under the Decree No. 424/2004 Coll. The third objective was to determine how trauma patients perceive the process of admission to the hospital. Based on these objectives two hypotheses and two research questions were established. The objectives were successfully met, both hypotheses were confirmed and the questions answered. The research was conducted on the basis of a quantitative qualitative survey at departments of selected hospitals where the patients with acute trauma emergency were directed by emergency medical services. For the quantitative research the interviewing method using questionnaires was selected. Interviews with patients were conducted by the qualitative research method. The respondents were 117 nurses and 5 patients.

Bakgrund: Sjuksköterskor som arbetar på akutmottagningar förväntas ha en hög kompetens inom traumavård. Med hög kompetens menas att de utför ett komplext och avancerat arbete och har ett stort ansvar i det initiala omhändertagandet av traumapatienter. Syfte: Syftet med studien var att beskriva sjuksköterskors självskattade kompetens inom traumavård på en akutmottagning Metod: Studien är empirisk suveystudie med kvantitativ data som samlades in genom att en enkät delades ut till sjuksköterskor på en akutmottagning. Sjuksköterskorna fick skatta sin kompetens inom traumavård utifrån svensk sjuksköterskeförenings sex kärnkompetenser samt efter deras formella och kliniska kompetens. Resultat: Huvudresultatet är att nästan alla (94%) av sjuksköterskorna vårdar traumapatienter oavsett erfarenhet och formell utbildning. 30% av sjuksköterskorna har arbetat i mindre än ett år på akutmottagningen. De flesta (85%) anser sig vara effektiva i vården med traumapatienter och nästan alla (87%) är motiverade för arbetet de utför. Sjuksköterskorna anser att de har kompetens för att arbeta med patientcentrerad vård, men inte för att arbeta med säker vård. Slutsats: Motivation och engagemang finns för att vårda traumapatienter. Men frågan är om det räcker till för ett adekvat omhändertagande av traumapatienter då 30% av sjuksköterskorna inte arbetat länge nog för att ha tillräckligt kompetens inom traumavård? / Background: Nurses working in emergency departments are expected to have a high level of competence. High level of competence means that they carry out a complex and advanced work and have a great responsibility in the initial care of trauma patients. Aim: The aim of this study was to describe nurses' self-rated competence in trauma care at an emergency ward. Method: The study is an empirical surveystudy with quantitative data collected through a questionnaire that was distributed to nurses at a hospital emergency department. The nurses had to rate their competence in trauma care by the Swedish Society of Nursing six core competencies as well as their formal and clinical skills. Results: The main result is that almost all (94%) of the nurses is caring for trauma patients regardless of experience and formal training. 30% of nurses have worked in less than a year in the emergency department. Most (85%) consider themselves to be effective in the care of trauma patients and almost all (87%) are motivated for the work they perform. The nurses believe that they have the skills to work with patient-centered care, but not to work with safe care. Conclusion: There are motivation and commitment to care for trauma patients. But the question is whether it is sufficient for an adequate treatment of trauma patients when 30% of nurses have not worked long enough to have formal competence in trauma care?

Bakgrund: Psykisk ohälsa och självskadebeteenden ökar i samhället och är ett oroväckande folkhälsoproblem. Självskadebeteende utgörs av allt från ett icke-suicidalt självskadebeteende till avsiktliga självskador som kan resultera i suicid. Självskadebeteenden kan vara en följd av psykiskt och känslomässigt lidande. Akutsjuksköterskan har en central och betydelsefull roll i mötet, när patienter med självskadebeteenden söker vård på somatisk akutmottagning. Syftetvar att beskriva faktorer som påverkar akutsjuksköterskors möte av patienter med självskadebeteenden på somatisk akutmottagning. Metod: Studien utgörs av en litteraturstudiemed systematisk metod. Föreliggande studie resulterade i 17 vetenskapliga artiklar och bearbetades utifrån en integrerad analys. Resultat: I resultatet framkom två huvudkategoriersom beskrev positiva och negativa faktorer som påverkade mötet av patienter med självskadebeteenden. De underkategorier som visades ha den främsta påverkan i akutsjuksköterskans möte med patienter med ett självskadebeteende var utbildning, erfarenhet och personcentrad vård. Akutsjuksköterskor som hade erfarenhet, kunskap och utbildninghade en större acceptans och helhetsperspektiv i mötet, vilket minskade negativa attityder till patienter med självskadebeteenden. Slutsats: En förutsättning för att se patienten bakom ett självskadebeteende på en somatisk akutmottagning och utifrån det kunna arbeta personcentrerat var att specialistsjuksköterskor inom akutsjukvård får utbildning kring självskadebeteenden. Specialistsjuksköterskan bör ha ett helhetsperspektiv i bemötandet och omvårdnaden av patienten för att främja hälsa och minska lidande hos denna sårbara patientgrupp. / Background: Mental illness and self-harm are increasing in society and are a worrying public health problem. Self-harm ranges from non-suicidal self-harm to intentional self-harm that can result in suicide. Self-harm can be a consequence of psychological and emotional suffering. The emergency nurse has a central and important role in the meeting when patients with self-harm seek treatment in a somatic emergency department. The aim was to describe factors that affect the meeting of patients with self-harm in somatic emergency departments.Method: The study consists of a literature study with a systematic method. The present study resulted in 17 scientific articles and was processed based on an integrated analysis. Results: The results revealed two main categories that described positive and negative factors that influenced the meeting of patients with self-harm behaviors. The subcategories that were shown to have the main impact in the emergency nurse's encounter with patients with selfharm were education, experience, and person-centered care. Emergency nurses who had experience, knowledge and training had a greater acceptance and holistic perspective in the meeting, which reduced negative attitudes towards patients with self-harm behaviors. Conclusion: A prerequisite for seeing the patient behind self-harm in a somatic emergency department and from that being able to work person-centered was that specialist nurses in emergency care receive training on self-harm behaviors. The specialist nurse should have a holistic approach to the treatment and care of the patient in order to promote health and reduce the suffering of this vulnerable patient group.

Introduction: Death is not an uncommon outcome for patients who seek immediate care in an emergency department. Although death is common in the emergency department there is little literature regarding end-of-life care in the emergency department. The purpose of this research study is to determine what changes emergency nurses would suggest to improve end-of-life care for dying patients and their families in emergency departments. Background: A national, geographically dispersed, random sample of 1000 emergency nurses were sent a questionnaire entitled, "Emergency Nurses' Perceptions of End-of-Life Care." Inclusion criteria included nurses who were members of the Emergency Nurses Association, could read English, worked in an emergency department, and had cared for at least one emergency patient at the end-of-life. Results: There was an overwhelming consistency in recommended changes to improve care of the dying emergency department patient by the nurses participating in the study. Five major themes were identified: 1) increasing the amount of time emergency nurses have to care for dying patients and their families; 2) consistently allowing family presence during resuscitation; 3) providing a comfortable patient room; 4) providing for more privacy at the end-of-life; and 5) providing a family grief room. Conclusion: The emergency department will continue to be the primary access point for dying patients to receive medical and nursing care. Implementing changes based on emergency nurse recommendations may dramatically improve the experience for the dying patient as well as their family members.

Occupational stress is a major concern in Canadian society, and nurses have been identified as a high-risk population. In this study, levels of occupational stress (vicarious trauma, secondary traumatic stress, and burnout) were examined in Sexual Assault Nurse Examiners (SANEs) and Emergency nurses. Our objectives were: 1) to compare levels of occupational stress between groups, 2) examine the relationship between occupational stress and job satisfaction, and 3) examine the relationship between job satisfaction, intention to leave, and absenteeism. Results showed no significant group differences on vicarious trauma and secondary traumatic stress, but significantly higher levels of burnout in Emergency nurses, and intention to leave one’s job significantly predicted job satisfaction in Emergency nurses. Although SANEs did not experience greater occupational stress, open-ended data indicated negative consequences to this work. However, both groups also spoke to the positive rewards of helping those in need. Implications for nursing practice are also discussed.

Occupational stress is a major concern in Canadian society, and nurses have been identified as a high-risk population. In this study, levels of occupational stress (vicarious trauma, secondary traumatic stress, and burnout) were examined in Sexual Assault Nurse Examiners (SANEs) and Emergency nurses. Our objectives were: 1) to compare levels of occupational stress between groups, 2) examine the relationship between occupational stress and job satisfaction, and 3) examine the relationship between job satisfaction, intention to leave, and absenteeism. Results showed no significant group differences on vicarious trauma and secondary traumatic stress, but significantly higher levels of burnout in Emergency nurses, and intention to leave one’s job significantly predicted job satisfaction in Emergency nurses. Although SANEs did not experience greater occupational stress, open-ended data indicated negative consequences to this work. However, both groups also spoke to the positive rewards of helping those in need. Implications for nursing practice are also discussed.

The aim of this study was to determine Accident and Emergency (A&E) nurses’ perceptions of a structured debriefing programme based on the model of SP Hattingh. Objectives of the research were to train A&E nurses as peer debriefers to be able to implement a structured debriefing programme, to then implement it and finally to determine the debriefed A&E nurses and debriefers’ perceptions of the structured debriefing programme. A contextual, explorative, descriptive research design, using qualitative methodology, was adopted. The population for this study was all registered nurses working in an A&E unit in a private hospital in Gauteng. Three main themes were identified, namely: positive aspects, negative aspects and recommendations for implementation. Recommendations were made to optimise the use of this programme in the future. / Dissertation (MCur (Clinical))--University of Pretoria, 2007. / Nursing Science / MCur / unrestricted