Thesis (MTech (Business Administration))--Cape Technikon, Cape Town, 2000 / The current rationalisation of health care in the Western Cape may result in a decrease in the number of patients attending the Trauma Unit at Groote Schuur Hospital (GSH), one of the two large tertiary care hospitals in the Western Cape. This in turn may result in cuts in staff allocations to this unit. The nursing staff need to be proactive in preventing potential cuts which may compromise the services that they offer. Current statistics collected by nursing managers in the trauma unit at GSH provide an indication of the volume of work handled, but do not necessarily capture the intensity of that work. The purpose of this research project will determine the extent to which nursing care required by patients attending the trauma unit at GSH has increased and to establish appropriate staff workload scheduling. The existing classification systems available for assessing patient acuity levels are no longer suitable as they use patient numbers to describe workload. By using a classification system specifically developed for the use by nurse managers in high care units (trauma units), the appropriate staffing norms based on the acuity level of patients can be determined. Finally, this research project will determine a suitable model for measuring the intensity of workload specific to a trauma unit environment for the effective and efficient allocation of staff.

nÃo hà / Os serviÃos de urgÃncia e emergÃncia constituem importantes componentes do sistema nacional de saÃde, destinados ao atendimento de pacientes com afecÃÃes agudas, com ou sem risco de morte, exigindo profissionais preparados para oferecer assistÃncia imediata aos clientes. Deste modo, os profissionais que atuam nessas unidades deveriam receber treinamento especÃfico. Objetivou-se avaliar o efeito do treinamento no conhecimento dos enfermeiros sobre acolhimento com classificaÃÃo de risco em unidade de urgÃncia e emergÃncia. Trata-se de um estudo de delineamento prÃ- experimental, modelo prÃ- teste / pÃs-teste com um Ãnico grupo, enfocando o efeito de um treinamento em acolhimento com classificaÃÃo de risco. A pesquisa foi realizada em um hospital pÃblico municipal de urgÃncia e emergÃncia, situado na cidade de Fortaleza-CE. A populaÃÃo foi composta por enfermeiros com escala de plantÃo na unidade de emergÃncia e seguindo os critÃrios de inclusÃo e exclusÃo a amostra ficou constituÃda por 30 enfermeiros. Como instrumento utilizou-se um questionÃrio autoaplicativo (prà e pÃs-treinamento). Os dados foram digitados em uma base de dados no Microsoft Access 2002 e, apÃs digitaÃÃo, foram exportados para o programa estatÃstico STATA v.8 para tratamento e geraÃÃo dos resultados. A pesquisa foi aprovada pelo Comità de Ãtica da Universidade Federal do Cearà - COMEPE sob o Protocolo n 108/11. Os resultados apontam que o grupo foi constituÃdo em sua totalidade pelo sexo feminino onde a maioria (66,6%) tinha idade superior a 40 anos e eram casadas ou em uniÃo estÃvel (56,6%). Quanto ao tempo de graduaÃÃo em Enfermagem, 73,3% computaram perÃodo igual ou superior a dezesseis anos e 90% tinham concluÃdo uma especializaÃÃo. O grupo apresentava atuaÃÃo em Enfermagem igual e superior a dezesseis anos (66,7%), com tempo de serviÃo em emergÃncia de atà cinco anos (53,3%). Identificou-se que 76,6% das enfermeiras trabalham em outra (s) instituiÃÃo (Ães). Deste modo, encontrou-se uma Carga HorÃria (CH) semanal de trabalho igual ou superior a quarenta horas em 63,6%. Na anÃlise relacionada à prÃtica do acolhimento com classificaÃÃo de risco houve um aumento significativo da primeira para a segunda etapa quanto aos acertos, ficando essa mudanÃa mais perceptÃvel nas questÃes: C1 (de 63,3% para 90%); C2 (de 50% para 83,3%); C4 (de 43,3% para 73,3%); C5 (de 46,7% para 73,3%); C6 (de 3,3% para 40%) e C12 (de 16,7% para 56,7%). Nas questÃes associadas Ãs situaÃÃes de urgÃncia e emergÃncia nÃo foram identificadas mudanÃas expressivas. Somente em alguns casos as mudanÃas foram positivas na avaliaÃÃo do conhecimento: C3 (de 66,7% para 80%); C15 (de 33,3% para 50%); C16 (de 83,3% para 96,7%); C17 (de 46,7% para 76,7%) e C25 (de 53,3% para 66,7%). Nas quinze questÃes que abordaram a classificaÃÃo de risco observou-se que na primeira etapa somente uma questÃo (6,6%) teve percentual de acerto igual ou superior a 50% (D10 â 83,3%). Na segunda etapa esse quantitativo cresceu para cinco questÃes (33,3%): D1 (66,7%); D3 (60%); D10 (90%); D11 (56,7%) e D14 (50%). à possÃvel inferir que o treinamento contribuiu para mudar o nÃvel de conhecimento dos enfermeiros, contudo ainda hà necessidade de a instituiÃÃo implementar programas de educaÃÃo continuada, favorecendo a qualificaÃÃo de seus profissionais, proporcionando aos seus clientes um atendimento eficiente e de qualidade.

The purpose of this exploratory descriptive study was to determine orthopedic patients' perceptions of satisfying and/or dissatisfying nursing care behaviours during their emergency room experience. The conceptual framework selected for this study was based on Risser's (1975) criterion to evaluate patient satisfaction with nursing care. Risser's evaluative criterion consists of four dimensions which include: technical-professional behaviour, trusting relationship, inter-intrapersonal relationship, and educational relationship. The study was conducted in a large metropolitan hospital in the Vancouver area. The sample consisted of seven men and three women. Their ages ranged from 23 to 81 years. All subjects were admitted to the emergency room and subsequently transferred to an orthopedic ward as a result of an orthopedic injury and/or illness. An interview guide was designed by the researcher to collect retrospective data of subjects' perceptions of their emergency room experience. Data were collected through taped semi-structured interviews with all the subjects during their stay on the orthopedic ward. Data were analyzed by categorizing the identified nursing care behaviours under the four dimensions of Risser's (1975) evaluative criterion. The findings indicated that subjects were able to recall satisfying or dissatisfying nursing care behaviours. They appraised and/or commented on the nursing care behaviours which met their basic physical and psychosocial needs. The nursing care behaviours related to the trusting relationship dimension were an integral component of patient satisfaction. The role of the triage nurse was significant in influencing subjects' perceptions of satisfaction or dissatisfaction with nursing care. Overall, subjects expressed satisfaction with the nursing care behaviours in each of the four dimensions. / Applied Science, Faculty of / Nursing, School of / Graduate

This qualitative descriptive research study was undertaken to describe the experiences of emergency nurses with critical incidents and identify strategies used to manage these situations in the emergency department setting. Critical incidents are events, such as death or serious injury, that cause a strong emotional reaction and may overwhelm a nurse‘s usual coping skills. Nineteen nurses who worked in one of two community-based emergency departments in Central Massachusetts were interviewed and asked to describe a critical incident they had experienced in their nursing career. Qualitative content analysis revealed two major themes: (1) critical incident experiences; and (2) aftermath; and five subthemes: (a) connections; (b) workplace culture; (c) responses; (d) lasting effects; and (e) strategies. Critical incidents were limited to events with children, patient deaths, and interactions with family; this differed from prior research in that no incidents were identified involving multiple casualties, violence, or mutilating injuries. Connections occurred when the patient was known to the nurse or reminded the nurse of self or family. Responses were the reactions of the participants to the critical incident and were physical, psychological, and spiritual in nature. The majority of study participants cried in response to a critical incident. Workplace culture, a subtheme not found in other studies, involved their perceptions of expected behavior in the emergency department and emphasized the influence of workplace culture on newer or inexperienced nurses. The theme of aftermath described the time period following critical incident. Lasting effects occurred in the form of vivid memories that were triggered by different stimuli. The subtheme, strategies, revealed that nurses desired, but lacked formal strategies to manage their reactions following a critical incident. Thus, they described the use of informal strategies such as talking to co-workers and family members. Implications of this study support the need for educational preparation and support of emergency nurses who deal with critical incidents in the workplace. Intervening during the critical incident experience and having follow-up strategies in place to prevent distress and enhance coping in the aftermath are important for well-being, practice, and patient care in the emergency setting.

Background: Family members often accompany patients to the emergency department and play an important role in caring for the patient. Communication between nurses and family members has long been identified as a priority of care and an area needing improvement due to the increasingly busy nature of the emergency department. Good communication can improve patient outcomes, satisfaction with care and decrease patient and family anxiety. Objective: To determine and describe what interventions exist to improve nurse-family communication during the waiting period of an emergency department visit. Methods: A scoping review was completed following the Joanna Briggs Institution methodology: (1) identify the research question, (2) define the inclusion criteria, (3) use a search strategy to identify relevant studies using a three-step approach, (4) select studies using a team approach, (5) data extraction, (6) data analysis, and (7) presentation of results. Results: The search yielded 1,771 articles of which 20 were included in the review. An additional 7 articles were found in the grey literature search. Results were analyzed using basic content analysis, reported using tables, figures, descriptive statistics and narrative synthesis and organized based on Peplau's Theory of Interpersonal Relations. A variety of pediatric and adult interventions were found targeting staff members and family members and took place worldwide. Two models were developed based on the results of this review: a communication model for triage nurses and one for all emergency department nurses. Conclusion: Communication plays an essential role in emergency department nursing care. Communication skills training should be built into nursing curriculum, nursing orientation, triage training, and continuing education. Future research should focus on evaluating the effectiveness of interventions using a standardized scale, understanding the specific needs of family members and effectively teaching communication skills to emergency department nurses.

Yau, Ching Ying. / Thesis (D.Nurs.)--Chinese University of Hong Kong, 2013. / Includes bibliographical references (leaves 180-194). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese; appendixes includes Chinese.

Background Trauma is the leading cause of death in the young (ages 1-44) and the current life situation is responsible for producing emergency injuries from motor vehicle accidents, violence and from acute life threatening illnesses. The training of emergency nurses is therefore of priority based on the increasing demands on the entire emergency health care system. The study evaluates the education and training of emergency nursing programme that has been offered for the past seven (7) years at a Nursing Education Institution (NEI) in the Limpopo province. The programme has not has not been formally evaluated. Aim The overall aim of the study is to explore and describe the views of students pertaining to the emergency nursing programme offered at the NEI in the Limpopo province and to make recommendations for the refinement of the emergency nursing programme, based on the views of the nursing students. Methods A qualitative design working from an Appreciative Inquiry approach was employed. Purposive sampling was used and focus group interviews were conducted with 20 Professional nurses who are trained as emergency nurses at the NEI from 2007 to 2013. Two main themes emerged: theoretical aspects and clinical aspects, which included both positive and negative views. The findings were used to make recommendations to refine the programme / Health Studies / M.A. (Health Studies)

Bakgrund: Akutmottagningar är överrepresenterade när det gäller förekomsten av våld inom vården. Våldet påverkar sjuksköterskans förmåga att ge god vård negativt och riskerar både patientsäkerheten och arbetsmiljön på akutmottagningen. Syfte: Att undersöka vilka riskfaktorer som kan öka risken för att en patient uppvisar ett våldsamt beteende på akutmottagningen samt hur personalen bemöter dessa patienter. Metod: Arbetet är designat som en integrativ litteraturstudie där 12 artiklar inkluderades. Resultat: Ett flertal faktorer identifierades som betydelsefulla för risken att en patient uppvisar ett våldsamt beteende på akutmottagningen. Utifrån dem identifierades fyra faktorer som särskilt viktiga; väntetider under “strukturella faktorer”, alkohol eller drogpåverkade patienter under “substansrelaterade faktorer” samt patienter med psykiatrisk sjukdom under “medicinska faktorer”. Deltagarna i de olika studierna identifierade ofta samma faktorer, även om de lade olika mycket tyngd vid olika faktorer. Hur akutvårdspersonalen hanterade kontakten med de patienter som uppvisade ett våldsamt beteende var olika bland annat beroende på erfarenhet. Bättre kommunikation, information och ett empatiskt bemötande kunde minska risken för våldsamt beteende och avvärja ett våldsamt beteende. Slutsats: Förekomsten av våld på akutmottagningen kan sällan förklaras av en enskild faktor, utan oftast spelar många separata faktorer in. De riskfaktorerna som identifierats som enskilt största för risken för våld på akutmottagning är väntetider, alkohol och/eller drogpåverkade patienter samt patienter med psykiatrisk sjukdom. God kommunikation, information och empati kan minska risk för våld eller kan minska eller förebygga att våld uppstår. / Background: Emergency departments are over-represented in the incidence of violence in health care. Violence affects nurses' ability to provide good care in a negative way and increases the risks to both patient safety and workplace environment. Purpose: To investigate the risk factors that can increase the risk of a patient exhibiting violent behavior in the emergency department and how the staff treats these patients. Method: The thesis is designed as an integrative literature review in which 12 articles were included. Results: Several factors were identified as important to the risk of patients exhibiting violent behavior when visiting the emergency department. Four factors amongst them were identified as especially important: waiting times under “structural factors”, patients under the influence of alcohol or narcotics under “factors related to substances”, as well as patients with psychiatric disorders under “medicinal factors”. The participants in the different studies often identified the same factors, even though they had differing opinions on the importance of the factors. The emergency department staff handled the contact with patients exhibiting violent behavior differently based on several factors such as experience. Better communication, information and an empathic treatment of could lessen the risk of violent behavior and help stave off violent behavior. Conclusion: The most common risk factors for violence in the emergency department are waiting times, alcohol and / or drug affected patients and patients with psychiatric illness. Good communication, information and empathy can reduce the risk of violence or averting violence.

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

Bakgrund: Akutmottagningar behöver vara utformade för att kunna erbjuda en varierad patientgrupp akut vård. Arbetet på en akutmottagning karakteriseras av teamwork där sjuksköterskan förväntas kunna handla snabbt och kombinera omvårdnadsarbetet med medicinska och administrativa arbetsuppgifter. För att kunna uppleva en god arbetsmiljö krävs ett socialt kapital på arbetsplatsen, förmågan att uppleva mening och tillfredsställelse i arbetet samt ett gott stöd från organisationens olika skikt.  Syfte: Belysa sjuksköterskans arbetsmiljö på en akutmottagning.  Metod: Metoden som använts är en litteraturöversikt enligt Fribergs metod med syftet att skapa en överblick över det aktuella kunskapsläget inom ämnesområdet. Översikten utformades på tio vetenskapliga artiklar hämtade från CINAHL Complete och PubMed. Artiklarna analyserades enligt Fribergs modell för en litteraturöversikt, likheter och skillnader identifierades och tematiserades. Som teoretisk utgångspunkt användes Watsons omvårdnadsteori.  Resultat: Resultatet presenteras i form av tre huvudteman; fysiska, psykologiska och sociala aspekter av arbetsmiljön. De fysiska aspekterna utgjordes av undertemana Lokaler och säkerhet samt Bemanning och patienttäthet. De psykologiska aspekterna behandlade ämnena Att arbeta under tidspress samt Förekomst av utmattning, ångest och arbetsrelaterad stress. De sociala aspekterna inkluderade Teamwork och Konflikthantering.  Diskussion: Resultatet diskuterades med utgångspunkt i Watsons omvårdnadsteori och analyserades i relation till hur organisationen och ledningen såväl som sjuksköterskans inställning till omvårdnad kunde påverka arbetsmiljön. Resultatet tolkades även utifrån arbetsmiljöns påverkan på sjuksköterskans patientbemötande.