Thesis (M.H.A.)--University of Michigan, 1972.

Bakgrund: Akutmottagningen har en hög patienttillströmning och detta leder till att patienter med lågt prioriterade skador och sjukdomar/tillstånd får ökade väntetider. Den sekretess som råder inom hälso- och sjukvården förhindrar sjuksköterskan från att ge information angående varför andra patienter prioriteras före dem. Sjuksköterskor kan med kunskap om patienters erfarenheter av vården på akutmottagningen, få en ökad förståelse och genom detta ge en mer individanpassad vård och ökad tillfredställelse hos patienterna.  Syfte: Att beskriva patienters erfarenheter av vården från sjuksköterskor på akutmottagningen. Vidare var syftet med litteraturstudien att granska de inkluderade artiklarnas datainsamlingsmetod. Metod: En litteraturstudie med deskriptiv design. De tolv inkluderade vetenskapliga artiklarna söktes fram i databaserna Cinahl och PubMed. Ansatsen på dessa är kvantitativ, kvalitativ eller mixad. Huvudresultat: Många patienter ansåg att den vård de fick av sjuksköterskan på akutmottagningen var god. Det goda bemötandet, förmågan att lyssna och den höga kompetensen hos sjuksköterskan medförde en ömsesidig respekt mellan sjuksköterska och patient. Under väntetiden förekom dock att patienterna kände sig som en börda för sjuksköterskorna samt ignorerade i vissa fall. Bristen på kontakt med sjuksköterskorna under väntetiden medförde att patienterna inte fick den information de ansåg sig behöva. Patienterna beskrev att sjuksköterskans kommunikation var adekvat samt att de använde ett lättförståeligt språk. Slutsats: De flesta patienter var nöjda med den vård de fick av sjuksköterskan på akutmottagningen. De kände att sjuksköterskan hade en hög kompetens och kommunikationen var adekvat. Dock förekom det patienter som ansåg att informationen var bristfällig. / Background: The emergency department has a high patient inflow and this results in increased waiting times for patients with low priority injuries and diseases/conditions. The confidentiality in health care prevents the nurse from giving information on why other patients are prioritized over them. Nurses can with the knowledge of patients' experiences of care in the emergency department, get a better understanding and through this provide more individualized care and increased satisfaction of patients. Aim: To describe patients' experiences of care from nurses in the emergency department. Furthermore, the aim of this study was to examine the data collection method of the included articles. Methods: A literature study with descriptive design. The twelve included scientific articles were sought out in the databases CINAHL and PubMed. The approaches of these are quantitative, qualitative or mixed. Results: Many patients felt that the treatment they received by the nurse in the emergency department was good. The good hospitality, ability to listen and the high competence of the nurse brought a mutual respect between nurse and patient. During the waiting time, however, the patients sometimes felt as a burden on nurses and in some cases even felt ignored. The lack of contact with the nurses during the waiting time meant that the patients did not receive the information they deemed necessary. Patients described that the nurse communication was adequate and that they used an easy to understand language. Conclusion: Most patients were satisfied with the care they received by the nurse in the emergency department. They felt that the nurse had a high level of competence and communication was adequate. However, there were patients who felt that the information was inadequate.

The overall aim of the present thesis was to study factors related to transfers of older people between nursing homes, emergency department and hospital care. The thesis was based on four studies and used three methods: focus group discussions, structured review of electronic healthcare records, semi-structured interviews with registered nurses and general practitioners. Study I: nursing home nurses found it difficult to decide whether older residents should be referred to hospital from the nursing home. Hospital registered nurses reported often trying to stop premature discharges or having to carry out the discharge although it had not been fully prepared. Study II: transfer rate to ED was 594 over 9 months among a total of 431 residents (M 1.37 each). 25% were caused by falls and/or injuries, 63% resulted in hospitalization (M 7.12 days). The transfer rate was 0.00-1.03 transfers/bed; it was higher for private for-profit providers than for public/private non-profit providers. Study III: nursing homes with high transfer rates had fewer updated advance care plans than did nursing homes with lower transfer rates. More nurses from nursing homes with low transfer rates had a specialist education and training in dementia care and had worked longer in eldercare. Study IV: general practitioners perceived registered nurses’ continuity, competence and collaboration with family members as important to quality of care in nursing homes; inadequate staffing, lack of medical equipment and less-than-optimal IT systems for electronic healthcare records are impediments to patient safety. The findings indicate that organizational factors could explain differences in transfer rates between nursing homes. The studies highlight the importance of advance care planning together with residents and family members in facilitating future medical decisions. Registered nurses’ continuity and competence are perceived as crucial to quality of care. To meet increasing demands for more complex medical treatment at nursing homes and to provide high-quality palliative care several changes should be made: Nursing homes should be equipped with suitable medical equipment and registered nurse staff should be matched accordingly; importantly, registered nurses and general practitioners should be able to access each other’s healthcare record systems.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Emergency Medicine Johannesburg, 2015 / Background: There has always been anecdotal reports that the ED is busier during the holidays and this increase in utilization is due to an increased incidence of trauma. Methods The retrospective data was collected from the Study Hospital’s Database and from the billing records of the doctor practice managing the ED. The data included all patients attending the Study Hospital ED during November 2011 (Non-holiday Period) and between the 10th December 2011 and 8th January 2012 (Holiday Period). Results: It was noted that the age, gender and racial profile of the patients attending the ED during the Holiday and Non-holiday Periods were similar. However there was a 39.9% increase in ED utilization during the Holiday Period. The Holiday Period was also associated with increased utilization by tourists (29.9% vs. 8.2%); with a slightly lower incidence of trauma (23.4% vs. 24.6%); with patients presenting with less urgent Triage Scores; fewer patients arriving at the ED via ambulance (3.2% vs. 7.2%) and a lower admission rate (10% vs. 17.5%). Conclusions: There was a significant increase in the utilization of the Study Hospital ED during the Holiday Period. This increased utilization was due to an increase in visitors to the Umhlanga area during the Holiday Period and was associated with an increased presentation to the ED of low acuity patients probably as a result of a lack of availability of their GP.

Introdução: Visando uma construção coletiva de ações educativas que privilegiem as necessidades dos trabalhadores e as condições de trabalho, com sustentação nas diretrizes da Política Nacional de Educação Permanente em Saúde e nos princípios dos Núcleos de Educação em Urgências, este estudo teve como Objetivos: Caracterizar o ambiente dos prontos socorros quanto aos insumos; conhecer o processo de educação oferecido pelas instituições à equipe de enfermagem; identificar e avaliar as necessidades de treinamento dos profissionais de Enfermagem dos prontos socorros; construir um programa de educação para estes profissionais, baseado no diagnóstico de necessidades de treinamento, considerando o ambiente de trabalho como suporte à aprendizagem contínua. Metodologia: Pesquisa quantitativa e qualitativa, com desenhos exploratório e descritivo, desenvolvida em três prontos socorros de duas instituições, uma pública e uma privada do município de São Paulo. A população constituiu-se de 31 enfermeiros, 84 técnicos ou auxiliares de enfermagem, três gestores de Enfermagem e cinco enfermeiros de Serviço de Educação. A caracterização do ambiente foi realizada por meio de entrevistas com os três gestores de enfermagem; para avaliação das necessidades de treinamento, foi aplicado um questionário a toda a equipe de enfermagem; a construção do programa de educação foi operacionalizada por meio de três encontros de grupo focal em cada pronto socorro, do qual participaram, no total, 14 profissionais; entrevistas com dois enfermeiros dos serviços de educação viabilizaram dados para caracterização do processo de educação da equipe de enfermagem. Resultados: Dentre os principais resultados, destacam-se que os treinamentos técnicos foram os mais prevalentes no levantamento de necessidades (75,6%); a maioria das sugestões de mudanças nos treinamentos foi relacionada às estratégias instrucionais (32%) e ao horário (19,7%); os treinamentos foram apontados como úteis na prática (72,7%), por possibilitarem aperfeiçoamento profissional (62,5%); participariam do planejamento dos treinamentos 77,7% dos enfermeiros e 46,3% dos profissionais de nível técnico; as unidades oferecem condições para aplicação dos conhecimentos aprendidos nos treinamentos, na opinião de 70,3%, principalmente, no que se refere ao ambiente e insumo. Os programas de educação construídos pelos grupos apresentam temas técnicos; modalidade de entrega presencial; domínios e objetivos, predominantemente, cognitivos, nos níveis do conhecimento, compreensão, aplicação e análise; estratégias participativas e práticas. Os processos de educação desenvolvidos nas instituições apresentam fragilidades nas fases de avaliação de necessidades e avaliação de resultados de treinamentos. A participação no grupo focal foi avaliada positivamente pelos participantes. Considerações Finais: Construir programas educativos baseados nas diretrizes da Política Nacional de Educação Permanente em Saúde e nos princípios dos Núcleos de Educação em Urgências é uma ação possível e promissora, pois problematiza a prática do trabalho e a transforma em necessidade de educação. É essencial, todavia, que os programas sejam executados e avaliados para os ajustes necessários para contemplar o paradigma educacional que fundamenta essa Política, pois aspectos culturais e políticos são indissociáveis da educação. Assim, este estudo tem potencialidade para ser replicado nas demais estruturas que compõem a Rede de Atenção às Urgências e a Rede de Assistência à Saúde, envolvendo a equipe de Enfermagem e as equipes multiprofissionais. / Introduction: This study aims at a collective construction of educational actions that take into account workers needs and working conditions, based on the guidelines of the National Permanent Health Education Policy and the principles of the Emergency Education Centres. Objectives: to characterize the emergency room environment according to the inputs; to know the education process provided by the institutions for nursing staff; to identify and to assess training needs of nursing professionals in emergency rooms; and to develop an education program for these professionals, based on the diagnosis of training needs, considering the work environment to support continuous learning. Methodology: Quantitative and qualitative research, with exploratory and descriptive designs, developed in three emergency rooms of two institutions, one public and one private, in São Paulo city. The population consists of 31 nurses, 84 nursing technicians or assistants, three nursing managers, and five nurses of education services. To characterize the environment, three nursing managers were interviewed; to assess the training needs, a questionnaire was applied to all nursing staff; to develop the education program, there were three focus group meetings in the three emergency rooms, attended by a total of 14 professionals; to the description of the nursing staffs education process, two nurses of education services were interviewed. Results: Among the main results, it was observed that technical training was the most prevalent in the needs assessment (75,6%); most of the suggestions of changes in training concerned instructional strategies (32%) and schedule (19,7%); training was identified as useful in practice (72,7%) because it enable professional improvement (62,5%); 77,7% of the nurses and 46,3% of the nursing technicians or assistants would take part in the planning of the trainings; the units provide conditions to apply knowledge learned in trainings (70,3%), mainly in relation to environment and input. The education programs developed by the groups contain technical topics; face-to-face delivery method; predominantly cognitive domains and objectives, at the knowledge, comprehension, application, and analysis levels; and participation strategies and practices. The education processes carried out by the institutions show signs of weaknesses in training needs and results assessment. Participants assessed positively the focus group meetings. Final Thoughts: To construct educational programs based on the guidelines of the National Permanent Health Education Policy and the principles of the Emergency Education Centres is a possible and promising action, discussing the work practice and turning it into a training need. However, it is essential that programs are implemented and assessed, considering necessary adjustments to take into account the National Policys educational paradigm, since cultural and political aspects are inseparable from education. Finally, this study has the potential to be replicated in other settings of the Emergency Care Network, involving the nursing staff and the multidisciplinary teams.

Thesis (M.H.A.)--University of Michigan, 1972.

Thesis (M.H.A.)--University of Michigan, 1969.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1974.

Thesis (M.H.A.)--University of Michigan, 1972.