Embora o tema Segurança do Paciente esteja em crescente evidência, não pode ser considerado novo. Mais recentemente, temos acompanhado na mídia a veiculação de notícias envolvendo erros durante o cuidado em saúde, com a conotação de que estão sempre associados a descuido ou despreparo, assim como a más práticas profissionais. Embora erros sejam indesejáveis, não há como negar que ocorrem e têm repercussões ao paciente, ao profissional e à instituição. Contextualizar segurança do paciente no cenário das instituições de saúde é um desafio, e abordar esta temática no contexto dos serviços de urgência e emergência é tarefa ainda mais complexa, tendo em vista a dinâmica de atendimento, a carência quantitativa e qualitativa de recursos, imprevisibilidade da demanda e as características próprias destes serviços, que os tornam locais de alto risco para ocorrência de erros durante o cuidado em saúde. Nesse sentido, este estudo tem como objetivo desenvolver ações relacionadas à segurança do paciente no contexto de um serviço de urgência e emergência. Trata-se de uma pesquisa qualitativa, do tipo pesquisa-ação, desenvolvida em um serviço não hospitalar de pronto atendimento de urgência e emergência do interior do Estado de São Paulo. Para a construção dos dados, foram utilizados grupo focal e entrevistas semiestruturadas. Participaram deste estudo 33 trabalhadores de enfermagem. Os dados foram interpretados por meio da técnica de Análise de Conteúdo, na modalidade temática. O presente estudo possibilitou conhecer as vivências dos trabalhadores diante de riscos e ocorrências de erros no ambiente de trabalho, bem como as ações passíveis de serem implementadas para melhorar a segurança do paciente. Evidenciaram-se situações envolvendo riscos aos quais os pacientes estão expostos durante o atendimento em um serviço de emergência, tais como falhas na identificação dos pacientes, no processo de terapia medicamentosa, quedas durante a prestação do cuidado e risco de infecção e contaminação por exposição a material biológico, atribuíveis a diversos fatores que permeiam o processo do cuidado em saúde. Como parte das ações prioritárias, destacou-se a necessidade tanto de identificação e avaliação dos riscos apresentados pelos pacientes quanto de fortalecimento da adoção de práticas seguras, com foco na identificação dos pacientes, na terapia medicamentosa, no risco para quedas e na implantação de pulseiras de identificação e com alertas de risco de queda e alergias. Na perspectiva dos participantes, são também medidas importantes: informatização da prescrição médica; ampliação do olhar para o ambiente e as condições de trabalho como fatores de risco para ocorrências de incidentes; e ações de educação em serviço com foco na adesão às ações a serem implementadas. A divulgação desta experiência poderá contribuir para reflexão e expansão de estratégias em segurança do paciente e subsidiar futuros estudos / Although the issue of Patient Safety is on growing evidence, it cannot be considered as a novelty. More recently, we have followed the disclosure of news involving errors during health care in the media, with the connotation that they are always associated with neglect or lack of preparation, as well as with bad professional practices. Although errors are undesirable, there is no denying that they occur and have an impact on patients, professionals and institutions. Contextualizing patient safety in the scenario of health institutions is a challenge, and addressing this issue in the context of urgency and emergency services is an even more complex task, bearing in mind the dynamics of care, the quantitative and qualitative shortage of resources, the unpredictable demand and the typical characteristics of these services, which transform them into high-risk places for the occurrence of errors during health care. Accordingly, this study intends to develop actions related to patient safety in the context of an urgency and emergency service. This is a qualitative research, typified as research-action, developed in a non-hospital emergency care service in the State of São Paulo. In order to produce data, we used focus groups and semi-structured interviews. This study was attended by 33 nursing workers. Data were interpreted through the Content Analysis technique, in its thematic modality. This study has enabled us to know the experiences of workers in the face of risks and occurrences of errors in the work environment, as well as the actions likely to be implemented to improve patient safety. We have found situations involving risks to which patients are exposed during health care procedures in an emergency service, such as failure to identify users, flaws during the drug therapy process, falls during the provision of care, and risk of infection and contamination by exposure to biological material, which may be attributable to several factors that permeate the health care process. As part of the priority actions, we should highlight the need both to identify and assess the risks shown by patients and to strengthen the adoption of safe practices, with an emphasis on the identification of users, drug therapy and risk of falls, and on the implementation of identification bracelets, besides risk alerts related to falls and allergies. From the perspective of the participants, the following measures are also relevant: computerization of the medical prescription; expansion of the gaze towards the environment and the work conditions as risk factors for incidental occurrences; and in-service educational actions, with an emphasis on the adherence to the actions to be implemented. The disclosure of this experience may contribute to the reflection and expansion of patient safety strategies and subsidize future studies

Bakgrund: Tidigare forskning har visat på vikten av information för patienters vårdupplevelse och säkerhet. Ändå finns tydliga belägg för att informationen brister på akutmottagningar. Det är därför viktigt att sammanställa patienters upplevelser inom området. Syfte: Att undersöka patienters upplevelser av information på akutmottagningar. Metod: Deskriptiv design med litteraturöversikt som metod där 16 vetenskapliga kvalitativa originalartiklar analyserades. Resultat: Fem teman skapades: Initial vård på akutmottagningen; efterföljande väntetid; tillstånd och behandling; förståelse och minnesförmåga; samt avslutande vård på akutmottagningen. Både positiva och negativa upplevelser framkom. Mest framträdande var negativa upplevelser angående bristande information om saker som väntetider, tillstånd och behandling. Slutsats: Information är en viktig del av vården på en akutmottagning och denna studie belyser dess betydelse ur ett patientperspektiv. I resultatet framkom en mängd olika upplevelser som visar på problemområdets relevans. Behov av mer forskning specifikt gällande patienters upplevelser av information anses behövas. Genom att belysa patienters upplevelser har brister och även möjligheter till förbättringar synliggjorts, vilket kan vara av nytta för sjuksköterskor i sin profession. / Background: Previous research has shown the importance of information for the patients care experience and safety. Still there is clear evidence that information is lacking at emergency departments [ED]. It is therefore important to gather patient experiences on the subject. Purpose: To investigate patient experiences of information in emergency departments. Method: Descriptive design with a literature review as method where 16 scientific qualitative original articles was analyzed. Results: Five themes was created: Initial care at the ED; following waiting time; condition and treatment; understanding and ability to remember; and final care at the ED. Both positive and negative experiences emerged. Most prominently was negative experiences regarding lack of information about subjects such as waiting times, condition and treatment. Conclusion: Information is a crucial part of the care at the ED and this study highlights its importance from the patient perspective. A lot of different experiences emerged in the result that displays the relevance of the problem area. The need of further research regarding patient experiences of information is considered needed. Flaws and opportunities for improvement has also been revealed by highlighting patient experiences, which may be of use for nurses in their profession.

Bakgrund: Akutmottagningar använder sig av triagering för att prioritera inom vilket tidsspann som patienter borde få vård. Sjuksköterskornas bemötande i triageprocessen är bland det första en patient möter på akutmottagningen, vilket kan påverka patienters erfarenhet av vårdtillfället. Peplau beskriver i sin teori vikten av sjuksköterskorna och patienternas mellanmänskliga relation.  Syfte: Att sammanställa kunskap om patientens erfarenhet av bemötande från sjuksköterska på akutmottagning. Metod: Genom att samla artiklar från Europa, Nordamerika och Australien, kvalitetsgranska och bearbeta dem utifrån en metod beskriven av Friberg (2017) ska litteraturöversiktens syfte uppnås.  Resultat: Resultatet visade blandade erfarenheter av bemötande på akutmottagning. Sjuksköterskornas kommunikationsförmåga skattades högt enligt flertal studier. Att få chansen att ställa frågor och att få dem besvarade ansågs vara ytterligare en viktig aspekt av bemötandet. Nästan samtliga patienter ansåg att sjuksköterskorna var lyhörda, lyssnade på dem och såg till att de fick sina frågor besvarade. Många deltagare var missnöjda med sjuksköterskans förmåga att visa empati medan majoriteten ansåg att de blev bemötta med respekt. Patienternas uppfattningar om akutsjukvårdens uppbyggnad ledde till förväntningar på sjuksköterskorna och deras bemötande. Dessa förväntningar kunde inte alltid uppfyllas vilket medförde en negativ upplevelse av bemötandet.  Slutsats: Genom att ge ut mer information om triage, sjukvårdssystemets uppbyggnad och väntetider kan patienternas erfarenhet av akutmottagningen förbättras. Bättre informerade patienter kan dessutom leda till att patientflödet och arbetsbelastningen för sjuksköterskorna på akutmottagningen minskar. Detta kan i sin tur leda till ett förbättrat bemötande där varje patient kan ses som en person och inte som ett medicinskt problem. / Background: When the patients arrive at the Emergency Department the interaction with the nurse is one of the first things they encounter. Peplau describes the nurse-patient relations in her theory of interpersonal relations and its importance to the patients experience.  Aim: To compile the patients experience in the nurse-patient encounter at emergency departments. Method: By reviewing articles from Europe, USA and Australia and processing them through a quality template and then analysing them by a method described by Friberg (2017) the aim of this study should be met.  Result: The nurses communication abilities were scored highly. Their ability to answer questions and giving the patient room in the discussion was described as an important aspect of the nurse-patient relationship. The majority of patients experienced compassion and care and that the nurses listened and made sure that their questions were answered. Many of the participants were dissatisfied with the nurse’s ability to show empathy while the majority thought they had been treated with respect. The patients’ understanding of the emergency department and the triage process led to expectations on the nurses and their treatment. These expectations could not always be met, which resulted in negative experiences.  Conclusion: By giving out more information about the triage process, the emergency department and waiting times the patients’ experience can be improved. Giving patients better knowledge of where to turn for medical advice could lead to a lesser workload for the nurses and in turn improvements in the treatment of patients and their experience.

A presente pesquisa caracteriza-se como estudo qualitativo, de cunho descritivo exploratório realizado numa Unidade Básica Distrital de Saúde (UBDS) da região Oeste da cidade de Ribeirão Preto, interior do Estado de São Paulo. Tal local é um Centro de Saúde Escola vinculado à Faculdade de Medicina da Universidade de São Paulo. Objetivou-se com o estudo conhecer o cotidiano de atendimento das demandas de saúde mental realizadas no pronto atendimento deste serviço. O estudo justifica-se por, após início do processo de Reforma Psiquiátrica, os serviços emergenciais, tanto os que funcionam dentro de hospitais gerais quanto os alocados em unidades de pronto atendimento nas Unidades de Saúde, importantes pontos da rede de atendimento em saúde mental. Como instrumento de coleta de dados utilizou-se a observação participante e entrevista semiestruturada com 17 participantes. Foram realizadas cerca de 90 horas de observação participante registradas em diário de campo. Os participantes da pesquisa foram interrogados sobre o atendimento dos usuários com demandas em saúde mental no serviço. Os dados das entrevistas foram analisados quanto ao conteúdo, sendo realizada análise do tipo temática. A discussão apoiou-se nos preceitos atuais de atendimento aos usuários de saúde mental. Do processo de análise emergiram quatro categorias: No pronto atendimento o atendimento ao paciente psiquiátrico é rotina...; O atendimento depende muito do médico que está atendendo...; A grande maioria é dependente químico... E aí?; A gente não tem uma preparação para lidar com paciente psiquiátrico... A partir da análise pudemos entender que a demanda em saúde mental é constante no serviço e que essa vem, quase sempre, acompanhada de uma angústia por parte dos profissionais que não se sentem capazes de atender usuários com essa demanda de saúde. Através da observação e da entrevista constatou-se ainda que, no serviço, o modelo de atendimento é ainda o médico-centrado, sendo que os demais profissionais da equipe, quase sempre, se limitam apenas executar prescrições médicas como, por exemplo, medicação e, quando necessário, contenção. No que se refere ao atendimento ao usuário de substâncias psicoativas, não nos pareceu que esses são vistos como usuários com demandas em saúde mental. Tais usuários são atendidos com condutas guiadas por pré-conceitos e julgamentos morais, ações pouco adequadas aos atendimentos em saúde. As dificuldades encontradas no serviço, no que se refere ao atendimento a usuários com demanda em saúde mental, parecem ser principalmente advindas de uma formação profissional pouco adequada. Diante disto, torna-se necessário, neste serviço, que haja investimento no sentido de melhorar formação para o atendimento a usuários com esse tipo de demanda. Mesmo com as dificuldades encontradas no serviço estudado, acreditamos que por meio de um trabalho de educação permanente possam surgir novas potencialidades na atenção em saúde mental e, assim, um fortalecimento da rede de saúde local. / This research is characterized as a qualitative study, descriptive exploratory held in a District Health Unit Basic (UBDS) the region west of the city of Ribeirao Preto, interior of São Paulo. This service is also a Health Center linked to the Faculty of Medicine, University of Sao Paulo. The goal this research was to study the day-to-day of care of the demands of mental health conducted in the emergency room of this service. The study is justified because, after initiation of the Psychiatric Reform, emergency services, both those who work within general hospitals as allocated in the emergency units in the health units, are important to point in the network of mental health care. As an instrument of data collection used the participant observation and semistructured interviews with 17 participants. Were performed about 90 hours of participant observation, which was recorded in a field diary. Survey participants were questioned about the service demands of users with mental health service. The interview data were analyzed as contents, and performed analysis of the thematic type. The discussion is supported in current concepts of care for mental health users. The process of analysis four categories: In the emergency room care to psychiatric patients is routine...; The service relies heavily on the physician who is answering...; The vast majority are dependent of drugs... What\'s make?; We do not have a preparedness to deal with psychiatric patients... Thus, from the analysis we understand that the demand for mental health service is constant and that, almost always, is accompanied by an anxiety on the part of professionals who do not feel able to meet this demand users with health. Through observation and interview it was found that, in the service studied, the service model is still the physician-centered, and the remaining team members limited to just execute medication. With regard to the users of drugs the service, did not seem that these are seen as people with demands on mental health. Such users are assisted with postures guided by prejudices and moral judgments, actions inadequate to health care. The difficulties encountered in service, in relation people with mental health demand, appear to be due to an unsuitable formation. Given this, it becomes necessary, this service, investment in improving training to meet this demand. Even with the difficulties encountered in the service studied, we believe that through a continuing education may arise new possibilities and thus a strengthening of local mental health network.

Embora o tema Segurança do Paciente esteja em crescente evidência, não pode ser considerado novo. Mais recentemente, temos acompanhado na mídia a veiculação de notícias envolvendo erros durante o cuidado em saúde, com a conotação de que estão sempre associados a descuido ou despreparo, assim como a más práticas profissionais. Embora erros sejam indesejáveis, não há como negar que ocorrem e têm repercussões ao paciente, ao profissional e à instituição. Contextualizar segurança do paciente no cenário das instituições de saúde é um desafio, e abordar esta temática no contexto dos serviços de urgência e emergência é tarefa ainda mais complexa, tendo em vista a dinâmica de atendimento, a carência quantitativa e qualitativa de recursos, imprevisibilidade da demanda e as características próprias destes serviços, que os tornam locais de alto risco para ocorrência de erros durante o cuidado em saúde. Nesse sentido, este estudo tem como objetivo desenvolver ações relacionadas à segurança do paciente no contexto de um serviço de urgência e emergência. Trata-se de uma pesquisa qualitativa, do tipo pesquisa-ação, desenvolvida em um serviço não hospitalar de pronto atendimento de urgência e emergência do interior do Estado de São Paulo. Para a construção dos dados, foram utilizados grupo focal e entrevistas semiestruturadas. Participaram deste estudo 33 trabalhadores de enfermagem. Os dados foram interpretados por meio da técnica de Análise de Conteúdo, na modalidade temática. O presente estudo possibilitou conhecer as vivências dos trabalhadores diante de riscos e ocorrências de erros no ambiente de trabalho, bem como as ações passíveis de serem implementadas para melhorar a segurança do paciente. Evidenciaram-se situações envolvendo riscos aos quais os pacientes estão expostos durante o atendimento em um serviço de emergência, tais como falhas na identificação dos pacientes, no processo de terapia medicamentosa, quedas durante a prestação do cuidado e risco de infecção e contaminação por exposição a material biológico, atribuíveis a diversos fatores que permeiam o processo do cuidado em saúde. Como parte das ações prioritárias, destacou-se a necessidade tanto de identificação e avaliação dos riscos apresentados pelos pacientes quanto de fortalecimento da adoção de práticas seguras, com foco na identificação dos pacientes, na terapia medicamentosa, no risco para quedas e na implantação de pulseiras de identificação e com alertas de risco de queda e alergias. Na perspectiva dos participantes, são também medidas importantes: informatização da prescrição médica; ampliação do olhar para o ambiente e as condições de trabalho como fatores de risco para ocorrências de incidentes; e ações de educação em serviço com foco na adesão às ações a serem implementadas. A divulgação desta experiência poderá contribuir para reflexão e expansão de estratégias em segurança do paciente e subsidiar futuros estudos / Although the issue of Patient Safety is on growing evidence, it cannot be considered as a novelty. More recently, we have followed the disclosure of news involving errors during health care in the media, with the connotation that they are always associated with neglect or lack of preparation, as well as with bad professional practices. Although errors are undesirable, there is no denying that they occur and have an impact on patients, professionals and institutions. Contextualizing patient safety in the scenario of health institutions is a challenge, and addressing this issue in the context of urgency and emergency services is an even more complex task, bearing in mind the dynamics of care, the quantitative and qualitative shortage of resources, the unpredictable demand and the typical characteristics of these services, which transform them into high-risk places for the occurrence of errors during health care. Accordingly, this study intends to develop actions related to patient safety in the context of an urgency and emergency service. This is a qualitative research, typified as research-action, developed in a non-hospital emergency care service in the State of São Paulo. In order to produce data, we used focus groups and semi-structured interviews. This study was attended by 33 nursing workers. Data were interpreted through the Content Analysis technique, in its thematic modality. This study has enabled us to know the experiences of workers in the face of risks and occurrences of errors in the work environment, as well as the actions likely to be implemented to improve patient safety. We have found situations involving risks to which patients are exposed during health care procedures in an emergency service, such as failure to identify users, flaws during the drug therapy process, falls during the provision of care, and risk of infection and contamination by exposure to biological material, which may be attributable to several factors that permeate the health care process. As part of the priority actions, we should highlight the need both to identify and assess the risks shown by patients and to strengthen the adoption of safe practices, with an emphasis on the identification of users, drug therapy and risk of falls, and on the implementation of identification bracelets, besides risk alerts related to falls and allergies. From the perspective of the participants, the following measures are also relevant: computerization of the medical prescription; expansion of the gaze towards the environment and the work conditions as risk factors for incidental occurrences; and in-service educational actions, with an emphasis on the adherence to the actions to be implemented. The disclosure of this experience may contribute to the reflection and expansion of patient safety strategies and subsidize future studies

<p>Syftet med föreliggande litteraturstudie var att beskriva hur sjuksköterskan upplever sitt bemötande av alkoholpåverkade ungdomar och sin kunskap om alkoholprevention. Studien belyser även påverkande faktorer till ungdomars alkoholkonsumtion. Metoden var en beskrivande litteraturstudie. Två undergrupper identifierades och 16 artiklar granskades sammanlagt. Resultatet visade att sjuksköterskor ansåg sig vara i behov av mer alkoholrelaterad utbildning för att kunna bemöta patienter på ett tillfredsställande sätt. Studier visar att för att minska den ökade belastningen på allmänna sjukhus på grund av alkoholanvändning behövs utbildning och strategier för intervention. Den vanligaste orsaken för ungdomar att uppsöka en akutmottagning i samband med alkoholkonsumtion är mindre skador som fall. Andelen patienter inlagda på sjukhus på grund av alkoholförgiftning har ökat under de senaste åren. Att dokumentera en uppföljningsplan för ungdomar som kommer in till akutmottagningen missas i de flesta fall. Majoriteten av alla barn och ungdomar gick hem från akutmottagningen utan rådgivning i samband med alkoholförgiftning. Att sjuksköterskan inte känner sig ha tillräcklig kunskap inom alkoholprevention visade sig vara den vanligaste orsaken till att inte ge råd till patienter om alkoholkonsumtion. Föräldrars inverkan och regler har en betydande roll för ungdomars alkoholkonsumtion. Studier visade att tydliga regler kan skjuta upp ungdomars alkoholdebut med flera år. Under varma årstider och under helger visade sig ungdomars alkoholkonsumtion vara som störst.</p> / <p>The purpose of the following study was to describe how the nurse experience the treatment of intoxicated adolescents and their knowledge of alcohol prevention. The study also describes the influences of alcohol by adolescents. The method was a descriptive literature study. Two subgroups were identified and in total, 16 articles were examined. The results show that nurses believe themselves to be in need of more alcohol-related education to respond to patients in a satisfactory manner. Studies show that to reduce the increasing burden on public hospitals because of alcohol use, nurses need education and strategies for intervention. The most common reason for young people to seek an ER in relation to alcohol consumption is small damage cases. The proportion of patients to hospital because of alcohol intoxication has increased. To document a follow-up plan for young people entering the emergency room is missed in most cases. The majority of children and adolescents who enter the ER with alcoholintoxication goes home without any guidence of the subject. The nurse feel insufficient knowledge in alcoholprevention , which proved to be the most common reason for not advising patients concerning alcohol consumption. Parental influence and rules have a significant role in young people's alcohol consumption. Studies with clear rules can defer youth alcohol debut with a number of years. During the warm seasons and during the weekends turned out that most young people's alcohol consumption.</p>

Syftet med studien var att belysa hur sjuksköterskor som arbetar på en akutmottagning upplever mötet med patienter som är påverkade av alkohol och droger. En kvalitativ intervjustudie med semistrukturerad intervjuguide genomfördes. Materialet transkriberades och analyserades genom kvalitativ innehållsanalys. Sju sjuksköterskor som arbetar på en akutmottagning i Mellansverige deltog i studien. Det framkom att informanterna känner empati för påverkade patienter vilka samtidigt beskrivs som opålitliga. Sjuksköterskorna är på sin vakt då patienterna snabbt kan bli aggressiva och hotfulla om de upplever sig bli provocerade. Sjuksköterskorna behöver ibland värja sig mot påverkade patienter som utsätter dem för oönskad fysisk kontakt och de upplever det som en trygghet att ta hjälp av väktare eller polis vid behov. Känslor som osäkerhet, frustration, irritation, olust och ilska väcks hos sjuksköterskorna i mötet med patientgruppen men de eftersträvar att bemöta alla lika. Trots detta uppges påverkade patienter behandlas annorlunda, prioriteras lägre och tas inte riktigt på allvar. Trots att sjuksköterskorna upplever att påverkade patienter är oberäkneliga och framkallar osäkerhetskänslor känner de empati för dessa individer. Ett professionellt bemötande eftersträvas men trots det antyds att toleransen är låg gentemot påverkade patienter. Vidare utbildning välkomnas och tros kunna bidra till bättre omvårdnad av en komplex patientgrupp. / The aim of this study was to illustrate how nurses working in an emergency department experience meeting with patients under the influence of alcohol and drugs. A qualitative study was undertaken with a semi-structured interview guide. Data was transcribed and analyzed by qualitative content analysis. Seven nurses who work in an emergency department in central Sweden participated in the study. It was found that nurses feel empathy for patients under the influence of substances, although they also described them as unreliable. Several nurses described themselves as being on guard as patients can become aggressive and threatening, and that situations can quickly turn when the patients perceive themselves to be provoked. When nurses are exposed to unwanted physical contact they sometimes need to defend themselves. When it is warranted, the help of security or the police can offer some degree of comfort. The nurses are experiencing feelings of insecurity, frustration, irritation, unease and anger in the encounter with this group of patients, but retain their professionalism and strive to treat everyone equally. Despite this it is indicated that patients under the influence of substances are treated differently from other patients, are a lower priority and are not taken as seriously. Although patients under the influence of substances may appear volatile and threatening nurses feel much empathy. A professional approach is sought but despite that it is suggested that the tolerance is low in relation to patients under the influence of substances. Further education is welcomed and is believed to contribute to better care for a complex population of patients.

Nyckelord: Akutmottagning, sjuksköterska, tidsfaktorer, stress, välmående   Bakgrund: Stress och tidsbrist är vanligt förekommande inom sjukvården, och arbetet som sjuksköterska på akutmottagning genererar höga nivåer av stress.   Syfte: Att undersöka hur sjuksköterskor på en akutmottagning upplever att tidsbrist och stress påverkar deras välmående.   Metod: Kvalitativ studie där tolv stycken semistrukturerade intervjuer utfördes med sjuksköterskor på akutmottagningen på Akademiska sjukhuset. Intervjuerna analyserades med latent innehållanalys enligt Graneheim och Lundman samt Aaron Antonovskys hälsomodell.   Huvudresultat: Sjuksköterskornas intervjuer resulterade i fyra kategorier och tio underkategorier vilka tillsammans bildade två domäner och ett tema. Kategorier som erhölls var hanterbarhet, meningsfullhet, begriplighet samt brist på hanterbarhet. Sjuksköterskornas välmående påverkades positivt av stress som upplevdes som hanterbar, meningsfull och begriplig, medan välmåendet påverkades negativt av brist på hanterbarhet. Tidsbrist påverkade sjuksköterskornas välmående endast negativt.   Slutsats: Tidsbrist påverkade sjuksköterskornas välmående negativt, medan sjuksköterskorna upplevde att stress kunde ha både positiv och negativ inverkan på deras välmående. / Keywords: Emergency Service, Hospital, Nurse, Occupational stress, Time factors, Mental health.   Background: Stress and lack of time often occur in medical care treatment, and working as a nurse at the hospital´s emergency service generates high levels of stress.   Aim: To explore nurses´ perceptions about how lack of time and occupational stress at a hospital´s emergency service affect their mental health. Method: A qualitative study with twelve semi structured interviews with nurses were carried out at Uppsala University Hospital´s emergency service. The interviews were analysed with latent content analysis according to Graneheim and Lundman, and Aaron Antonovsky`s health model.   Main results: The interviews with the nurses lead to four categories and ten sub categories which altogether made two domains and one theme. The categories that were derived were manageability, meaningfulness, comprehensibility and lack of manageability. The nurses’ mental health was affected in a positive way by stress which was perceived as manageable, meaningful and comprehensable, while a lack of manageability affected the mental health in a negative way. Lack of time affected the nurses’ mental health only in a negative way. Conclusions: Lack of time affected the nurses´ mental health in a negative way, while the nurses experienced that stress could affect their mental health both in a positive and a negative way.

Syftet med föreliggande litteraturstudie var att beskriva hur sjuksköterskan upplever sitt bemötande av alkoholpåverkade ungdomar och sin kunskap om alkoholprevention. Studien belyser även påverkande faktorer till ungdomars alkoholkonsumtion. Metoden var en beskrivande litteraturstudie. Två undergrupper identifierades och 16 artiklar granskades sammanlagt. Resultatet visade att sjuksköterskor ansåg sig vara i behov av mer alkoholrelaterad utbildning för att kunna bemöta patienter på ett tillfredsställande sätt. Studier visar att för att minska den ökade belastningen på allmänna sjukhus på grund av alkoholanvändning behövs utbildning och strategier för intervention. Den vanligaste orsaken för ungdomar att uppsöka en akutmottagning i samband med alkoholkonsumtion är mindre skador som fall. Andelen patienter inlagda på sjukhus på grund av alkoholförgiftning har ökat under de senaste åren. Att dokumentera en uppföljningsplan för ungdomar som kommer in till akutmottagningen missas i de flesta fall. Majoriteten av alla barn och ungdomar gick hem från akutmottagningen utan rådgivning i samband med alkoholförgiftning. Att sjuksköterskan inte känner sig ha tillräcklig kunskap inom alkoholprevention visade sig vara den vanligaste orsaken till att inte ge råd till patienter om alkoholkonsumtion. Föräldrars inverkan och regler har en betydande roll för ungdomars alkoholkonsumtion. Studier visade att tydliga regler kan skjuta upp ungdomars alkoholdebut med flera år. Under varma årstider och under helger visade sig ungdomars alkoholkonsumtion vara som störst. / The purpose of the following study was to describe how the nurse experience the treatment of intoxicated adolescents and their knowledge of alcohol prevention. The study also describes the influences of alcohol by adolescents. The method was a descriptive literature study. Two subgroups were identified and in total, 16 articles were examined. The results show that nurses believe themselves to be in need of more alcohol-related education to respond to patients in a satisfactory manner. Studies show that to reduce the increasing burden on public hospitals because of alcohol use, nurses need education and strategies for intervention. The most common reason for young people to seek an ER in relation to alcohol consumption is small damage cases. The proportion of patients to hospital because of alcohol intoxication has increased. To document a follow-up plan for young people entering the emergency room is missed in most cases. The majority of children and adolescents who enter the ER with alcoholintoxication goes home without any guidence of the subject. The nurse feel insufficient knowledge in alcoholprevention , which proved to be the most common reason for not advising patients concerning alcohol consumption. Parental influence and rules have a significant role in young people's alcohol consumption. Studies with clear rules can defer youth alcohol debut with a number of years. During the warm seasons and during the weekends turned out that most young people's alcohol consumption.

Emergency departments (EDs) are the only source of medical care for many adults and have been found to be feasible venues for vaccinating high-risk patients against seasonal influenza. Since the CDC guidelines expanded in 2008 to include any adults wishing to protect themselves and those around them from the flu, the vaccination of low-risk patients in the ED has not been evaluated. This study sought to assess the acceptability among adult patients of all ages for vaccinating against seasonal influenza in the Urgent Care area of an urban ED, which treats primarily healthy adults. A convenience sample of adult patients in the Urgent Care area was surveyed in November 2009. Subjects were asked about their vaccination history, as well as their perceived need and potential acceptance of a vaccine in the ED. Demographic data obtained included age, race, education, insurance status, medical history, access to primary care and contact with high-risk individuals. 381 patients were approached, of whom 352 completed the survey (92.4%; 56% male, 44% female; mean age 36 years, Standard Deviation 12.4), and 349 were vaccine-eligible. 250 (72%) denied any significant medical history. While 169 patients (48.4%) had an influenza vaccination history, only 69 (20%) were vaccinated in 2009. Of the 280 not vaccinated this year, 179 (64%) would have accepted the vaccine in the ED. Factors associated with increased odds of vaccine acceptance in the ED included: age younger than 50 years (Odds Ratio [OR] 3.28, 95% Confidence Interval [CI] = 1.74 to 6.21, p<0.01), Latino/Hispanic ethnicity (OR 2.89, 95% CI = 1.52 to 5.51, p<0.01), and close contact with high-risk individuals (OR 2.28, 95% CI = 1.33 to 3.92, p<0.01). These results suggest that the majority of relatively healthy adult patients would accept the seasonal influenza vaccine in the ED. Although a shortage of vaccines and increased vigilance during a concurrent H1N1 outbreak may have influenced overall acceptability, we conclude that influenza vaccinations during the ED patient encounter would generally be acceptable to patients as a means to improve their overall health, and indirectly the health of their high-risk close contacts.