Sjuksköterskor som arbetar på akutmottagningar utsätts regelbundet för stress. Det medför psykiska och fysiska besvär för sjuksköterskor och försämrad omvårdnad för patienten. Studien avser att utifrån vetenskaplig litteratur sammanställa de faktorer som leder till stress för sjuksköterskor som arbetar på akutmottagningar och hur vården påverkas av stressade sjuksköteskor. Syfte Syftet med litteraturstudien var att beskriva vilka faktorer på akutmottagningen som upplevdes bidra till stress för sjuksköterskor som arbetar på en akutmottagning och hur stressen påverkar sjuksköterskors möjligheter att erbjuda en god vård för patienter på akutmottagningen. Metod Studien har genomförts som en litteraturstudie. I studien användes 15 artiklar som bestod av både kvalitativ och kvantitativ ansats. Materialet hämtades i databaserna CINAHL och PubMed. Resultat Resultatet visar att det finns flera olika faktorer som bidrar till stress för sjuksköterskor på akutmottagningen. Stressande faktorer visade sig utifrån studierna i resultatet vara; hög arbetsbelastning och låg bemanning, avsaknad av tid för reflektion för sjuksköterskan, att vårda barn i stressade situationer, hot och våld på akutmottagningen, kommunikation samt smärta och lidande. Hur vården påverkas av sjuksköterskors stress på akutmottagningen var utifrån studierna att patientsäkerheten blev försämrad och att vårdrelationen påverkades. Slutsats Författarna drar slutsatsen att stress påverkar sjuksköteskors arbetsuppgifter på akutmottagningen. Patienters möjlighet till patientsäker och god vård på akutmottagningen påverkas negativt av stressade sjuksköterskor. För att komma till rätta med sjuksköterskebristen på akutmottagningar så är det av betydelse för sjukhusledningen att arbeta preventivt mot stressade sjuksköterskor. / Nurses working in emergency rooms are exposed to stress on a regular basis. This may affect them with physical and psychological problems which consecutively can be seen as one of the reasons of a lowered quality within patient's care. This thesis, based on scientific literature, shall collect facts that lead nurses into stress as well as its consequences within caretaking. Purpose The purpose of this study was to describe the factors in the emergency department experienced contribute to stress for nurses working in an emergency department and how stress affects nurses' ability to provide quality care for patients in the emergency department. Method The study was conducted as a literature review. The study used 15 articles that consisted of both qualitative and quantitative approach. The material was downloaded from the databases CINAHL and PubMed. Results The results show that there are several factors which contribute to a high(er) stress level for nurses working in emergency rooms. The thesis shows that stress factors such as: high work intensity, understaffing , too little time for the nurses to reflect their on work, caretaking of children in stress filled times, threats and violence in the emergency area, insufficient communication as well as pain and suffering in general. Based on the studies, it could be concluded that this stress, influencing the nurses, is also causing effects on the actual caretaking by the means of a substandard patient safety and an affected nurse-patient-relation. Conclusion The authors conclude that stress affects the nurse's work in the emergency department. Patient’s opportunity for patient safety and good care in the emergency department is adversely affected by stressed nurses. In order to deal with the nursing shortage in emergency departments, it is important for the hospital management to prevent stress among nurses

Objective: This study aims to examine the relationship between emergency department patient encounter characteristics and narcotic analgesic prescribing practices in order to determine what patient characteristics, if any, influence the decision to prescribe narcotics.Methods: Cross sectional data on patients presenting to U.S. emergency departments from the 2003 and 2004 National Hospital Ambulatory Medical Care Survey were analyzed. Patients reporting moderate to severe pain were included in the sample and analysis. Chi square tests of significance were used to assess the association between individual demographic and encounter characteristics to narcotic prescription or administration. Separate multiple logistic regressions were then performed on patients presenting with one of the three most common diagnosis categories or reasons for visit, since this was thought to also influence the decision to prescribe narcotics or not. Multivariate analysis produced adjusted odds ratios and 95% confidence intervals in order to determine the independent associations between each predictor variable and narcotic medication prescription or administration.Results: Our sample included 26,248 individuals presenting to U.S. emergency departments with moderate to severe pain as recorded by the NHMCS survey. Various patient and encounter characteristics appeared to influence narcotic administration in the univariate analysis including age, race, ethnicity, alcohol use, method of payment, geographic location and whether or not visit was related to a work injury or illness. No gender differences were found. Combining the top 3 reasons for visit, we found that race, patient alcohol use, age, geographic location and ethnicity all had significant bearing on the prescription of narcotics. Much of this was true when looking at top three diagnoses. Age, race, patient alcohol use, and geographic location were all associated with significantly different rates of narcotic administration, while ethnicity dropped out of significance. Black race, in both subcategories of analysis, showed the greatest association with decreased odds of receiving narcotic drugs in the ED.Conclusion: While initiatives like Healthy People 2010 are aimed at improving health and eliminating health care disparities, it appears that disparities still do exist on many levels. As it has been concluded through various other studies, it appears that race does influence health care providers' decisions to prescribe or administer narcotics. In January of 2001 JAHCO revised their standards to better address pain management of patients in the United States. While pain may be better-evaluated and recorded and overall rates or pain medication administration or prescription may have improved, it appears that the common disparities have not.

O suicídio é um fenômeno complexo, considerado problema de saúde pública devido às altas taxas de tentativas e consequentes óbitos. O contato inicial com o paciente que tentou o suicídio, na maioria das vezes, ocorre no pronto-socorro do hospital geral, sendo, fundamental analisar o relacionamento entre os membros da equipe de saúde e o paciente com comportamento suicida para entender como o cuidado está sendo oferecido. Este estudo teve como objetivo compreender como profissionais de saúde, que atuam no pronto-socorro, vivenciam a assistência prestada ao paciente que tentou suicídio. A pesquisa teve caráter qualitativo e a coleta de dados foi realizada por meio de entrevistas abertas. O material obtido a partir dos depoimentos foi avaliado por meio da técnica da análise temática. As respostas dadas pelos colaboradores foram agrupadas em temas comuns: conceituação do suicídio; importância do atendimento multiprofissional; diferenças entre o SUS e o sistema privado; as distintas posturas dos profissionais de saúde; relação família-paciente; medicamentos como forma de cuidado e tentativa de suicídio; sofrimento psíquico entre os profissionais. A presente investigação apontou que a assistência ao paciente que tentou o suicídio no pronto-socorro é inadequada, marcada pela falta de preparo e fragmentação do cuidado. Evita-se o contato com o sofrimento intenso relacionado com o ato suicida e o cuidado a esse paciente é redirecionado aos profissionais da saúde mental. Os fatores que influenciam na assistência precisam ser reconhecidos e reformulados para que haja melhoria na qualidade dos atendimentos possibilitando um cuidado integral à pessoa com ideação e tentativa de suicídio / Suicide is a complex phenomenon, considered a public health problem given high resultant mortality rates. In the majority of cases, initial contact with patients who attempted suicide occurs in the emergency room of a general hospital. As a result, analyzing the relationship between members of the healthcare team and the patient with suicidal behavior is paramount to understanding how care is being provided. The objective of this study was to understand health care professionals experiences in treating attempted suicide patients while working in the E.R. The study was qualitative in nature and data were collected via open interviews. The data obtained from the depositions were analyzed using thematic analysis. The responses given by the interviewees were grouped into topics: the concept of suicide; the importance of multidisciplinary care; differences between the public and private health systems; the different postures of health care professionals; the patient-family relationship; medication as both a form of treatment and a manner for attempted suicide; and psychic suffering among health care professionals. The present study found that care for patients provided in the E.R. after attempting suicide is inadequate, defined by a lack of preparation on part of the health care professionals and fragmented care. Health care professionals avoid contact with the intense suffering related with the act of suicide and these patients are redirected to mental health professionals. The diverse factors that influence care should be recognized and reconsidered so that the quality of care is improved, which would provide for holistic care of the patient with suicidal thoughts or attempted suicide

The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed.

Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.

Sjuksköterskor inom akutsjukvården har ett varierande yrke. Ingen dag är den andra lik och av sjuksköterskor krävs snabba beslut och ett lugnande arbetssätt. I ett rum kan en patient vårdas för en fiskekrok i fingret medan patienten i rummet bredvid är döende. Detta kan göra att personalen mår dålig och blir stressad vilket kan leda till brister i omvårdnaden mot patienterna. Syftet med studien var att undersöka och beskriva sjuksköterskors upplevelser av avlastningssamtal. För att nå syftet gjordes en intervjustudie. Sju sjuksköterskor från tre olika akutmottagningar intervjuades. Graneheim och Lundmans (2004) analysmetod användes och intervjuerna resulterade i sex kategorier: Tillhörighet i arbetsgruppen, trivsel, stimulans, enkelhet, att växa i sin yrkesroll, tidslig och rumslig uppfattning. Avlastningssamtalen sker både informellt och formellt bland personalen. Arbetsgruppen har stor betydelse och ett bra klimat på arbetsplatsen bidrar till att underlätta spontana avlastningssamtal. För personal som varit med om samma händelser kan samtalet ge en ökad förståelse för var och ens insats och det bidrar till att sjusköterskor mognar och växer i sin yrkesroll. Det upplevs också som en trygghet och lättnad att känna förtroende för kollegorna och kunna prata om sådant som känns tungt. Det behövs mer forskning inom det här området särskilt vad sjuksköterskor har för behov av avlastande samtal. / Nurses in acute care have a vary profession. No days are the same and from  nurses needs quick decisions and a composed approach. In a room is a patient sitting with a fishing hook in his finger while the patient in the next room is dying. This can make the staff feel bad and become stressed which can lead to deficiencies in nursing care to patients. The aim of the study was to explore and describe nurses' experiences of relief calls. An interview study was made. Seven nurses from three different acute care were interviewed. The analysis of Graneheim and Lundman (2004) was used and the interviews resulted in six categories: Membership of the working group, comfort, stimulation, simplicity, to grow in their professional, time and spatial perception. Relief calls is both informally and formally among staff. The working group is of great importance and a good climate in the workplace helps to facilitate spontaneous relief calls. For staff who have been through the same events can call give a better understanding of everyone's effort and it helps nurses to mature and grow in their professional capacity. It is seen also as a security and relief to have confidence in their colleagues and to talk about things that feel heavy. Further research is needed in this area particularly what nurses have a need for relief calls.

Syfte: Undersöka sjuksköterskors och undersköterskors erfarenheter, upplevelser och syn påanhörigas närvaro i akutrummet i samband med omhändertagandet av en kritiskt sjuk ellerskadad patient. Metod: Empirisk studie med kvalitativ ansats. 16 semi-struktureradeintervjuer genomfördes. Resultat: Vårdpersonalen har delade meningar om anhörigas närvaropå akutrummet. Generellt tycks anhörigas närvaro upplevas som positivt så länge det handlarom en kritiskt sjuk eller skadad patient. När patientens tillstånd inte är lika kritiskt kananhörigas närvaro leda till en försämrad sekretess, till viss del också beroende på det aktuellaakutrummets planlösning. Patientsäkerhet och arbetsmiljö kan också påverkas av anhörigasnärvaro. Slutsats: Bland vårdpersonal finns en önskan om tydligare riktlinjer i gällandepolicy om anhörigas närvaro på akutrummet för att förbättra sekretess, arbetsmiljö ochpatientsäkerhet. / Objective: To examine the experiences and views of nurses and assistant nurses regardingrelatives being present in the emergency room during the care of a critically ill or woundedpatient. Method: Empirical study with a qualitative approach. Sixteen semi-structuredinterviews were performed. Results: The nursing staff had different views on relatives beingpresent in the emergency room. Generally, the presence of relatives was regarded assomething positive, if the patient was critically ill or badly wounded. If the patient’s conditionisn’t critical, the presence of relatives can impair the patient’s confidentiality, partly based onhow the emergency room is built. Patient’s safety and the working environment can also beaffected by the presence of relatives. Conclusion: There is a wish among nursing staff formore distinct guidelines in the current policy about the presence of relatives in the emergencyroom, in order to improve the patient confidentiality, working environment and the patients’safety.

Syftet med denna studie var att beskriva patientens upplevelse av besöket på akutmottagningen samt vilka faktorer som påverkade upplevelsen. Syftet var även att beskriva vilka faktorer som möjliggör och hindrar sjuksköterskan att arbeta utifrån ett omvårdnadsperspektiv. Studien genomfördes som en systematisk litteraturstudie där 10 artiklar granskades och låg till grund för resultatet vilket visade att patientens upplevelse och faktorer som påverkade upplevelsen av besöket på akutmottagningen var sjuksköterskans omvårdnad, väntetider, akutmottagningens miljö samt vårdpersonalens information och kommunikation. För att sjuksköterskan skulle ha möjlighet att arbeta utifrån ett omvårdnadsperspektiv krävdes vissa kunskaper hos sjuksköterskan, bland annat att ha bred kunskap inte bara i omvårdnad utan även inom medicinska sjukdomar, för att bättre förstå patientens situation. Att vara emotionellt involverad, känna ansvar, ta egna initiativ, vara öppen och lyhörd, genuint intresserad och involverad av patienten och göra det där "lilla extra" gjorde att sjuksköterskan kunde arbeta utifrån ett omvårdnadsperspektiv. Det som hindrade omvårdnad var tidsbrist, att läkaren tog tid på sig för beslut, prioritering av medicinska och praktiska göromål, brist på specifik kunskap gällande geriatrik och demenssjukdomar samt svåra situationer och dödsfall alldeles innan sjuksköterskan skulle gå in till nästa patient.

The objectives of this research study are: 1. To probe into the widespread period of severe acute respiratory syndrome. 2. To study on this highly contagious and rapid spread of this new kind of disease At the time when nearby emergency department of medical center breaks out a suspicion of nasocomial infection. First, our emergency department immediately formed a strict fever screening station. After comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever station between the central and southern medical institution. The research period was from May 15, 2003to July 15, 2003. Our research targets made by the emergency fever station were around 3730 patients with a random selection of 300 cases. This research uses the structure of fever screening measurement questionnaires to gather information and then adapted the EP1-INFO 10.0 version of statistical analysis. The results of the research are as follows: 1. Chief complaint of sore throat (38.3%) and fever (17%) fitted to the clinical symptoms of SARS. In relation to SARS before and after the spread of the disease, there are still other complaints such as the gastrointestinal system (18.7%) and cardiovascular disease (16.7%) that showed no obvious difference. 2. During the period of emergency fever screening station, an additional 50% of manpower are being arranged to screen probable or non-probable affected cases. (from the 300 randomly selected cases) 3. There are no obvious difference showed after comparing the outcome of the prevention and spreading of this disease by the set-up of the emergency fever center between the central and southern medical institution. 4. After tallying the number of doctors and nurses participated in screening procedure and number of non-medical staff developed similar symptoms to SARS, we can see the result of total number of medical staff from the emergency fever screening station that can successfully control the spread and prevention of the disease, making it the standard and model in the prevention and control of other communicable disease in the future. Key words: Severe acute respiratory syndrome, fever screening station, emergency room, emergency task force

<p>Sjuksköterskor inom akutsjukvården har ett varierande yrke. Ingen dag är den andra lik och av sjuksköterskor krävs snabba beslut och ett lugnande arbetssätt. I ett rum kan en patient vårdas för en fiskekrok i fingret medan patienten i rummet bredvid är döende. Detta kan göra att personalen mår dålig och blir stressad vilket kan leda till brister i omvårdnaden mot patienterna. Syftet med studien var att undersöka och beskriva sjuksköterskors upplevelser av avlastningssamtal. För att nå syftet gjordes en intervjustudie. Sju sjuksköterskor från tre olika akutmottagningar intervjuades. Graneheim och Lundmans (2004) analysmetod användes och intervjuerna resulterade i sex kategorier: Tillhörighet i arbetsgruppen, trivsel, stimulans, enkelhet, att växa i sin yrkesroll, tidslig och rumslig uppfattning. Avlastningssamtalen sker både informellt och formellt bland personalen. Arbetsgruppen har stor betydelse och ett bra klimat på arbetsplatsen bidrar till att underlätta spontana avlastningssamtal. För personal som varit med om samma händelser kan samtalet ge en ökad förståelse för var och ens insats och det bidrar till att sjusköterskor mognar och växer i sin yrkesroll. Det upplevs också som en trygghet och lättnad att känna förtroende för kollegorna och kunna prata om sådant som känns tungt. Det behövs mer forskning inom det här området särskilt vad sjuksköterskor har för behov av avlastande samtal.</p> / <p>Nurses in acute care have a vary profession. No days are the same and from  nurses needs quick decisions and a composed approach. In a room is a patient sitting with a fishing hook in his finger while the patient in the next room is dying. This can make the staff feel bad and become stressed which can lead to deficiencies in nursing care to patients. The aim of the study was to explore and describe nurses' experiences of relief calls. An interview study was made. Seven nurses from three different acute care were interviewed. The analysis of Graneheim and Lundman (2004) was used and the interviews resulted in six categories: Membership of the working group, comfort, stimulation, simplicity, to grow in their professional, time and spatial perception. Relief calls is both informally and formally among staff. The working group is of great importance and a good climate in the workplace helps to facilitate spontaneous relief calls. For staff who have been through the same events can call give a better understanding of everyone's effort and it helps nurses to mature and grow in their professional capacity. It is seen also as a security and relief to have confidence in their colleagues and to talk about things that feel heavy. Further research is needed in this area particularly what nurses have a need for relief calls.</p>