Objectives: This study has been conducted to determine the levels of inappropriate use of the A&E for conditions that could be treated by GPs, the nature of the morbidity pattern of those conditions, the reasons why primary care services were not being utilized, and also examined the validity (i.e. sensitivity and specificity) of patient classifications undertaken by nurses at the time of admission within this local context. Study design and setting: A cross sectional study was conducted over a one year period and subjects were randomly selected from four A&E departments located across the four principle geographic regions of Hong Kong by stratified, two-stage sampling. Main outcome measure: The gold standard in differentiating true emergency cases and GP cases was based on a retrospective record review conducted independently by a panel of emergency physicians. A random sub-sample of those classified as GP cases was interviewed and compared to a matched (via morbidity status) sample of primary care patients who had attended a hospitals' GOPC in order to determine factors distinguishing these two patient groups. Multiple Logistic Regression was used to distinguish the difference between GP cases and matched GOPC primary care patients on significance and odds ratios of the variables. The morbidity pattern according to ICPC was tabulated and analysed for the 'true' A&E cases and non-urgent cases. Sensitivity, specificity and positive predictive values were computed for both non-weighted and weighted conditions. Results: The level of GP cases was found to be 57% with a significant higher proportion of patients in younger age group, and late evening. The morbidity pattern of those top 10 diagnoses of non-urgent cases was very similar to the Hong Kong general practice morbidity pattern for self limiting conditions. Closure of the clinic was the main reason for GP cases attending A&E. Other major reasons were deterioration of symptoms, GPs' inability to diagnose efficiently and patients' wish to continue medical treatment in the same hospital. Affordability was the most pronounced reason for utilising the GOPC, but did not apply to the A&E GP patients. The most accurate weighted nurses' triage classification had the average sensitivity of 75%, specificity of 65.7%, and positive predictive value of 54%. The most accurate weighted patients' self-triage classification yielded a sensitivity of 43.3%, specificity of 49.2%, and a positive predictive value of 38.6%. Conclusion: The reasons for high level of utilisation of A&E services are complex and reflect problems of delivery of GP services. There is an urgent need for the GPs to set up a network system to provide out of hours services, and also for a better interfacing between primary and secondary care, and between public and private sectors, so that patients can be referred back to GPs. The design and measures chosen for this study will help provide A&E policy makers and planners with relevant information for better addressing practical solutions. / Albert Lee. / Source: Dissertation Abstracts International, Volume: 73-01, Section: B, page: . / Thesis (M.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 137-151). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Appendix 4 in Chinese.

Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population. In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands. We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable. We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models. In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group. In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).

published_or_final_version / Business Administration / Master / Master of Business Administration

A grande procura pelo Serviço de Emergência e a conseqüente permanência dos pacientes em repetidas admissões representam entraves para os enfermeiros, os quais são responsáveis pelo gerenciamento desses serviços. Objetivos: Caracterizar o perfil dos pacientes readmitidos em um Serviço de Emergência de um hospital filantrópico; identificar o perfil sócio-demográfico e de morbidade dos pacientes readmitidos; caracterizar a utilização do Serviço de Emergência e identificar os fatores relacionados às readmissões. Casuística e Método: estudo transversal, descritivo e exploratório realizado em um Serviço de Emergência de um hospital filantrópico de ensino, de atenção terciária, na cidade de São Paulo. A amostra foi composta por pacientes maiores de 14 anos considerados internados no Serviço de Emergência, com mais de uma admissão, nos seis meses anteriores ao dia da coleta de dados. A coleta de dados foi realizada por meio de instrumento estruturado com questões abertas e fechadas, e as informações foram obtidas do prontuário do paciente e por entrevista direta ao paciente ou familiares, durante todo o mês de maio de 2004. Resultados: a incidência de readmissões foi de 23,3%. Houve predomínio de pacientes do sexo masculino (61,9%), idade de 40 a 90 anos (85,9%), baixa escolaridade (57,8%) e 46,7% pertenciam à área de regionalização do SUS para o serviço estudado. Quase a totalidade (92,8%) não era cadastrada no PSF, sendo que grande parte (45,4%) referiu desconhecer o programa. As principais hipóteses diagnósticas foram as doenças do aparelho circulatório (33,7%) seguidas pelas neoplasias (24,1%). A maioria dos pacientes (57,6%) foi readmitido com o mesmo diagnóstico e 23,9% devido a complicações. Na visão dos entrevistados, como fatores desencadeantes da readmissão, 40,9% referiram causas potencialmente evitáveis. A maioria dos entrevistados referiu que seu problema não foi resolvido na internação anterior, sendo o principal motivo a continuidade dos sintomas. Conclusões: A incidência de readmissões foi elevada, podendo ter sido ocasionada por evolução da doença crônico-degenerativa, idade avançada, baixo seguimento das orientações recebidas, complicações pós-operatórias, necessidade de cuidado domiciliar e não resolução do problema na admissão anterior / The great need for the Emergency Department and the resultant length of stay of the patients in repeated admissions become a hard situation for nurses, who are responsible for the administration on this units. Objectives: characterize the readmitted patients at the Emergency Department in a philanthropyc hospital; identify the socialdemographic and morbity profile of the readmitted patients; characterize the use of the Emergency Department; identify factors associated with readmissions. Methods: transversal, descriptive and exploratory study, at the Emergency Department on a tertiary health service of a philanthropic teaching hospital in São Paulo city, the sample was made by patients over fourteen years old that became inpatient at the Emergency Department, with over than one admission until six months before the data collection day. It was used an instrument with opened and closed questions for the data collection. Data were obtained from patient records and by interview to the patient or responsible, during May 2004. Results: the readmission incidence was 23,3%. The patients were predominantly males (61,9%), age 40 to 90 years old (85,9%), low level education (57,8%); 46,7% lived at areas regarding the regionalization of the health service. Almost of all (92,8%) wasn’t registered at Family Health Program, and a high proportion of patients (45,4%) were unaware of this program. The main diagnosis were circulatory disease (33,7%) followed by cancer (24,1%). Most of patients (57,6%) was readmitted with the same diagnosis and 23,9% due to complications. On the perception of 40,9% of the patients, the related factors to readmissions were classified as potentially avoidable causes. Conclusions: The readmission incidence was raised, it was can be caused by problems in adherence to treatment, gravity of chronic disease, not enough orientation, or by complications

Made available in DSpace on 2016-08-10T10:54:02Z (GMT). No. of bitstreams: 1 SOLANGE MARIA SEIXAS MARTINS.pdf: 6696788 bytes, checksum: 209fdfa09ac23f069a02890863dae15d (MD5) Previous issue date: 2012-03-05 / The growing demand and insufficiently structured health care network for emergency hospital care has contributed to the overload of these services, making them one of the most problematic areas in the Brazilian health system. A caring and welcoming triage protocol in the hospital emergency room, stands out among the guidelines proposed in Brazilian public policies to address this issue. In this context, we developed a qualitative case study aiming to describe the perception of patients and nurses concerning to the triage of patients in the emergency room service in Goiânia, GO, Brazil. A total of 19 nurses and 21 patients participated in the study. Data were collected from November 2010 to April 2011 through participant observation and semi-structured interviews. The analysis and interpretation of data revealed that the meanings held by the participants concerning to the implementation of a caring and welcoming triage protocol were related to the transformation of the care model and to the limitations and challenges faced in emergency care services. The participants mentioned that before this protocol was implemented, the emergency service was characterized by long wait lines, overcrowding, disorganized service flow, and deaths during waiting in lines. The delayed service, its poor problem-solving capacity, lack of consistency with patient needs, and the presence of work overload were identified as factors that created frustrations not only to the service users but also to the health professionals. organization, priority treatment, efficiency and, consequently, improved quality of care. The limitations and challenges of this protocol implementation are related to promote a caring and welcoming reception in a more respectful way at the emergency room, which involves time, and a greater availability to see, listen, and inform users. The nurses noted the need for continuing education to improve technical competencies (triage protocol) and human skills (welcoming) to care. Among the difficulties mentioned were the lack of capability to problem-solving in ambulatory emergency care, which is hard for the professional during the triage protocol to refer the patient to this service. The outcomes suggested that the protocol enabled the organization and definition of access to the service according to levels of priority. There are, however, many challenges to implementing a welcoming and humanized care provided to people who require emergency care in the hospital and pre-hospital environments. / A crescente demanda e a insuficiente estruturação da rede de atenção às urgências hospitalares têm contribuído para a sobrecarga destes serviços, transformando-os em uma das áreas mais problemática do sistema de saúde brasileiro. Entre as diretrizes propostas pelas políticas públicas brasileiras para solução desta problemática destaca-se o Acolhimento com Avaliação e Classificação de Risco. Neste contexto, optou-se por desenvolver um estudo de caso qualitativo com o objetivo de descrever a perspectiva de usuários e enfermeiros sobre o Acolhimento com Avaliação e Classificação de Risco em um serviço de urgência e emergência hospitalar em Goiânia, Goiás. Participaram 19 enfermeiros e 21 usuários. Os dados foram coletados de novembro de 2010 a abril de 2011, por meio de observação direta e entrevistas semi-estruturadas. A partir da análise e interpretação dos dados, constatou-se que os sentidos atribuídos pelos participantes para a implementação do acolhimento com avaliação e classificação de risco relacionaram-se à transformação do modelo assistencial e aos limites e desafios para o serviço de urgência. Os participantes mencionaram que antes da implantação deste protocolo, o serviço de urgência e emergência hospitalar era caracterizado por longas filas de espera, superlotação, desorganização do fluxo de atendimento, pessoas que morriam na fila. A demora no atendimento, a baixa resolutividade, a falta de atendimento condizente às necessidades dos usuários e a sobrecarga de trabalho foram mencionados como fatores geradores de frustração não apenas para os usuários, mas também para os enfermeiros. As mudanças foram percebidas de modo positivo e estiveram relacionadas à organização do serviço, ao tipo de atendimento, à eficiência da equipe e, conseqüentemente, à melhor atenção ao usuário. Os limites e desafios para implementação do protocolo referem-se à promoção do efetivo acolhimento que envolve tempo, maior disponibilidade para ver, ouvir e informar o usuário. Os enfermeiros destacaram a necessidade do processo de educação continuada para o aprimoramento de competências e habilidades técnicas (avaliação com classificação de risco) e humanas (acolhimento) para cuidar. Entre as dificuldades mencionaram a falta de resolutividade do serviço de urgência pré-hospitalar fixo (atenção básica), o que prejudica o encaminhamento resolutivo para a rede básica de urgência (contra-referência). Os resultados sugerem que o protocolo trouxe organização e definição do acesso ao serviço por nível de prioridade. No entanto, ainda são muitos os desafios para o acolhimento e a humanização do cuidar de pessoas que requerem atendimento de urgência no âmbito hospitalar e pré-hospitalar.

A nova configuração do papel dos hospitais, na perspectiva da construção de redes de atenção à saúde, tem implicações para o trabalho do enfermeiro com cargo gerencial no tocante às suas ações/decisões administrativas, assistenciais e de ensino. Nesse sentido, este estudo teve o objetivo de identificar os aspectos facilitadores e dificultadores do trabalho do enfermeiro em cargos gerenciais, em um hospital público, de urgência, do interior paulista. Para tanto, foi realizado um estudo descritivo de abordagem quantitativa de dados qualitativos, utilizando a Técnica do Incidente Crítico, para o levantamento das percepções e atitudes em relação ao objeto de investigação. O estudo foi desenvolvido em uma instituição hospitalar de ensino, pública, de nível terciário, situada no nordeste do Estado de São Paulo, Brasil. Participaram 15 enfermeiros em cargos gerenciais que atuavam no referido cargo há pelo menos um ano, sendo excluídos aqueles que se encontravam ausentes do local de trabalho à época da coleta dos dados, em decorrência de afastamentos legais ou por não ter sido possível realizar a entrevista após cinco agendamentos cancelados. A coleta dos dados ocorreu por meio de entrevista semiestruturada individual. Foram relatados incidentes críticos, que se constituíram em 42 situações, das quais 33,3% foram positivas e 66,7% negativas; repercutindo em 57 comportamentos, sendo 84,2% positivos e 15,8% negativos e 74 consequências, sendo 41,9% positivas e 58,1% negativas. Os dados da análise de conteúdo foram agrupados por similaridade de conteúdo. Consideram-se aspectos facilitadores situação/comportamento/consequência com referências predominantemente positivas, as categorias, a saber: interação: equipe, paciente, família; gerenciar a unidade de trabalho; questionar a implantação do Grupo Gestor e comunicar-se. Em contrapartida, foram considerados aspectos dificultadores situação/comportamento/consequência com referências predominantemente negativas, as categorias: estrutura organizacional; gestão de infraestrutura e gestão de pessoas. Cabe destacar que esses resultados podem subsidiar o trabalho do enfermeiro em cargo gerencial e, também, dos próprios gestores do hospital, uma vez que os aspectos dificultadores do trabalho do enfermeiro em cargo gerencial dizem respeito, em sua maioria, a questões de pouca governabilidade para esse profissional. Assim, evidencia-se a necessidade de maior aproximação dos gestores e enfermeiros com cargo gerencial, a fim de, juntos, solucionarem questões que favoreçam o processo de cuidar e de coordenar o trabalho. É inegável a clareza que os participantes trouxeram sobre sua responsabilidade profissional, visto que, embora os incidentes tenham tido referências predominantemente negativas, os comportamentos apresentados tiveram referências predominantemente positivas, evidenciando os esforços que esses profissionais despendem para superar as dificuldades vivenciadas e a importância considerada em poder compartilhar decisões e ações a serem realizadas / The new configuration of the role of hospitals, with a view to building health care networks, has implications for the work of nurses in management positions in relation to their administrative, helth care and teaching actions/decisions. This study aimed to identify the facilitating and hindering aspects of the work of nurses in management positions in a public emergency hospital in the interior of the state of São Paulo. A descriptive study with quantitative approach of the qualitative data was performed, using the Critical Incident Technique, to survey the perceptions and attitudes in relation to the researched object. The study was developed in a public tertiary-level teaching hospital, located in the northeast region of São Paulo state, Brazil. In total, 15 nurses in management positions, who worked in the function for at least one year, participated, excluding those who were absent from the workplace at the time of data collection as a result of legal absences or because it was not possible to conduct the interview after five appointments canceled. Data collection was performed through individual semi-structured interview. Critical incidents consisting of 42 cases were reported, of which 33.3% were positive and 66.7% negative, culminating in 57 behaviors, of which 84.2% positive and 15.8% negative, and 74 consequences, 41.9% positive and 58.1% negative. Content analysis data were grouped by similarity of content. Situation, behavior and consequence with predominantly positive references were considered as facilitating aspects, with the following categories: interaction- team, patient, family; to manage the work unit; to question the implementation of the Management Group and to communicate. On the other hand, situation, behavior and consequence with predominantly negative references were considered hindering aspects, with the following categories: organizational structure; infrastructure management and personnel management. It is highligted that these results may support the work of nurses in management positions as well as hospital managers, once the hindering aspects of the work of nurses in management positions are related mostly to issues of poor governance to this professional. Thus, the study evidences the need for closer alignment of managers and nurses with management position, in order to commonly solve issues that favor the care process and work coordination. It is undeniable the clarity that participants have about their professional liability, since although the incidents have had predominantly negative references, behaviors presented had mainly positive references, showing the efforts that these professionals expend to overcome the difficulties experienced and the importance considered in sharing decisions and actions to be taken

O presente estudo teve por objetivo analisar a percepção dos usuários sobre um serviço hospitalar de emergência em oftalmologia, na perspectiva da responsividade. Trata-se de uma pesquisa qualitativa com delineamento descritivo-exploratório. Os dados foram coletados por meio de entrevista semiestruturada, com 27 usuários do Serviço de Emergência SUS do Hospital Banco de Olhos (HBO) de Porto Alegre, no período de julho a agosto de 2016. Para a realização das entrevistas foi utilizado um roteiro com questões sobre o atendimento, com base nos domínios da responsividade. A análise dos dados foi realizada segundo a técnica de análise de conteúdo temática, com identificação das seguintes categorias: dignidade, autonomia, comunicação, confidencialidade, dimensões da qualidade de amenidades básicas (infraestrutura), escolha, suporte social (acesso a redes de apoio social) e atenção imediata (agilidade no atendimento). No domínio interpessoal, a dignidade foi entendida como ser respeitado em sua individualidade, bem orientado e encaminhado em sua necessidade; a autonomia foi ressaltada como participação e compreensão do diagnóstico e das indicações terapêuticas para saber lidar com o seu problema; a comunicação foi descrita como empatia, linguagem acessível e possibilidade de fazer perguntas de esclarecimento; a confidencialidade foi compreendida como privacidade, segurança e confiança em relação às informações pessoais durante o atendimento. 9Continua) No domínio estrutural, na infraestrutura, foi destacada a situação de limpeza dos ambientes e a qualidade da sala de espera; na escolha foi identificada a opção por um serviço especializado em oftalmologia; no suporte social foi indicada a possibilidade de um acompanhante na consulta e o acolhimento de diversidade de situações do usuário; na agilidade foi evidenciado o longo tempo de espera e a acessibilidade, qualidade e resolutividade do atendimento especializado, tendo presente que é um serviço SUS. Esse fato de ser um atendimento público qualificado foi várias vezes mencionado positivamente pelos entrevistados. Quanto à agilidade, o serviço de emergência caracteriza-se como porta de entrada para patologias da visão, causando, em certos momentos, excessiva demanda e consequentemente longo tempo de espera constatada pelos participantes da pesquisa. O que os entrevistados mais apreciam é o profissionalismo do atendimento, por ser um serviço especializado que vai direto ao problema, por ter um acolhimento com classificação de risco bem organizado, por orientar os cuidados terapêuticos que o usuário precisa ter e, se necessário, encaminhar para um outro serviço de atendimento. Essa caracterização de profissionalismo determina em grande parte a percepção dos usuários. Diante desses resultados conclui-se que a acessibilidade e a qualidade do serviço especializado do HBO foram os dois aspectos mais destacados no atendimento. Esses aspectos identificam-se com duas dimensões centrais da responsividade, a agilidade e a dignidade, que foram percebidas pelos entrevistados e corresponderam às suas expectativas. / The present study aimed to analyze the perceptions of users about a hospital emergency service in ophthalmology from the perspective of responsiveness. It is a qualitative research with descriptive-exploratory design. The data were collected through semi-structured interviews with 27 users of emergency service at the Eye Hospital (HBO) in Porto Alegre-RS between July and August 2016. A script with questions about the service based on responsiveness dimensions was used to carry out the interviews. Data analysis was performed according to the technique of thematic content analysis, with identification of the following thematic categories: dignity, autonomy, communication, confidentiality, dimensions of basic amenities’ quality (infrastructure), choice, social support (access to social support networks), and immediate attention (agility in service). In the interpersonal domain, ‘dignity’ was understood as being respected in one’s own individuality, well guided and followed in one’s own needs; ‘autonomy’ was highlighted as participation and understanding of the diagnosis and therapeutic indications to know how to deal with one’s own problem; ‘communication’ was described as empathy, accessible language and the possibility of clarifying questions; ‘confidentiality’ was underst bood as privacy, security and trust in relation to personal information provided during the service. In the structural domain, in relation to ‘infrastructure’, it was highlighted the cleanliness of the rooms and the quality of the waiting room; in ‘choice’ the option for a specialized service in ophthalmology was mentioned; in ‘social support’ the possibility of a company in the doctor’s appointment and the welcoming of diversity of situations was pointed out; in ‘agility’, long waiting time and accessibility were evidenced as well as quality and specialized care efficaciousness, bearing in mind that it is a Unified Health Care System service. The fact of being a qualified public service was several times positively emphasized by the respondents. As for ‘agility’, the emergency service is characterized as a gateway to eye pathologies, causing, at certain moments, excessive demand and consequently long waiting time faced by the participants of the survey. What respondents most appreciated was the professionalism of the service, since it is a specialized service that goes straight to the problem, by having a well-organised risk rating system, by guiding the therapeutic care the user needs and, if necessary, forwarding him/her to another service. This characterization of professionalism largely determines users’ perception. Based on these results, it is concluded that the accessibility and the quality of the HBO specialized service were the two most prominent aspects in service offered. These aspects are identified with two core dimensions of responsiveness, agility and dignity, which were perceived by the interviewed ones and matched to their expectations.

No presente estudo o objetivo foi avaliar as atitudes de profissionais de enfermagem, de um serviço de emergência, no atendimento a pacientes com problemas relacionados ao uso de álcool e realizar treinamento com esses profissionais. O local do estudo foi o Pronto-Socorro Adulto do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil. O desenho metodológico do estudo foi do tipo descritivo com abordagem quantitativa. O instrumento utilizado para coleta de dados foi o SAAPPQ e um questionário com informações sócio-demográficas, aplicado em 82 profissionais de enfermagem, incluindo técnicos e enfermeiros, no entanto, somente 73 profissionais responderam ao questionário. A maioria dos profissionais eram técnicos de enfermagem, muitos deles tinham curso superior concluído, do sexo feminino e com idade média de 37 anos. Na avaliação dos profissionais, as atitudes negativas foram relacionadas à satisfação com o trabalho (4,9±1,6) e atitudes positivas quanto à execução de tarefas específicas e autoestima (6,6±1,5). Em relação à formação profissional, os de nível superior mostraram-se menos motivados a trabalhar com pacientes com problemas relacionados ao uso do álcool, entretanto, aqueles que tinham algum curso de especialização em álcool e/ou drogas apresentaram melhores níveis na adequação ao trabalho e na execução de tarefas específicas e autoestima. Ao mensurar as atitudes dos profissionais relacionadas ao Compromisso terapêutico (motivação, satisfação e autoestima) e à Segurança Profissional (adequação e legitimidade), houve melhores níveis na função Segurança Profissional. O treinamento foi realizado no próprio ambiente de trabalho, com 64,3% de participação da equipe. Conclui-se, portanto, que a formação educacional para atuar no atendimento a pessoas com problemas relacionados ao álcool pode acarretar mudanças positivas significativas no conhecimento e atitudes dos profissionais de enfermagem / This study aimed to evaluate the attitudes of nursing professionals of an emergency service in the care of patients with problems related to alcohol use and to conduct a training with these professionals. The study site was the Adult Emergency Room of the Clinical Hospital of the Federal University at Triângulo Mineiro, in Minas Gerais, Brazil. The methodological design of the study is of the descriptive type with a quantitative approach. A questionnaire of sociodemographic information and SAAPPQ were used. The questionnaire applied to 82 nursing professionals, including technicians and nurses, however 73 professionals answered the questionnaire. Most of the professionals were nursing technicians, many of them had completed college degree, female with average age of 37 years. In the evaluation of professionals, negative attitudes were related to work satisfaction (4.9 ± 1.6) and positive attitudes regarding the performance of specific tasks and self-esteem (6.6 ± 1.5). Regarding professional training, those at higher education level were less motivated to work with patients with problems related to alcohol use, however, those who had some degree of specialization in alcohol and / or drugs had better levels of work adequacy and execution of specific tasks and self-esteem. When measuring the attitudes of professionals related to Therapeutic Commitment (motivation, satisfaction and self-esteem) and Role Security (adequacy and legitimacy), there were better levels in the Role Security function. The training was carried out in the work environment, with a 64.3% participation of the team. It is concluded that the educational training to act in the care of people with problems related to alcohol can lead to significant positive changes in the knowledge and attitudes of nursing professionals

Emergency Departments (EDs) deliver urgent treatment at the ‘front-door' of acute hospitals. In Scotland, occupational therapists have had an increasing presence in EDs, an emerging role with limited evidence to guide its development. There are no predetermined philosophies or existing theories of ED occupational therapy. Therefore, this exploratory study examined the lived experience of ED occupational therapists in order to make an original contribution to knowledge, and to inform practice. Ethical approval was granted from Glasgow Caledonian University. Research methods were framed by Interpretative Phenomenological Analysis (IPA), and purposive sampling was used to recruit nine ED occupational therapists from across Scotland. Individual, semi-structured interviews were audio-recorded and transcribed verbatim. Interview transcripts were analysed line-by-line and interpreted using IPA methods. Two over-arching themes emerged from the data. Theme 1: 'On the Factory Floor' captured the experience of working in an ED. EDs are highly organised, likened to factory production-lines, but also unpredictable, even chaotic. The participants contributed their professional skills to make sense of both the order and the chaos. Theme 2: 'A Stranger in a Strange Land' encapsulated what it was like to enter the ED environment, and the participants were still discovering how they might acculturate. They experienced EDs as challenging environments, which potentially threatened the delivery of occupational therapy in terms of its core-constructs. However, they were able to maintain the values of occupational therapy, though they applied them with constraints. In addition, challenges placed clinicians at high risk of burn-out. Despite this, there were personal and professional rewards, especially enjoyment, being valued and being recognised. Occupational therapy is still emerging in the ED context, professional identity is forming and models of practice are not fully developed. Implications arising from the study are discussed in relation to health policy, future research, occupational therapy practice and occupational therapy education.

No presente estudo o objetivo foi avaliar as atitudes de profissionais de enfermagem, de um serviço de emergência, no atendimento a pacientes com problemas relacionados ao uso de álcool e realizar treinamento com esses profissionais. O local do estudo foi o Pronto-Socorro Adulto do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brasil. O desenho metodológico do estudo foi do tipo descritivo com abordagem quantitativa. O instrumento utilizado para coleta de dados foi o SAAPPQ e um questionário com informações sócio-demográficas, aplicado em 82 profissionais de enfermagem, incluindo técnicos e enfermeiros, no entanto, somente 73 profissionais responderam ao questionário. A maioria dos profissionais eram técnicos de enfermagem, muitos deles tinham curso superior concluído, do sexo feminino e com idade média de 37 anos. Na avaliação dos profissionais, as atitudes negativas foram relacionadas à satisfação com o trabalho (4,9±1,6) e atitudes positivas quanto à execução de tarefas específicas e autoestima (6,6±1,5). Em relação à formação profissional, os de nível superior mostraram-se menos motivados a trabalhar com pacientes com problemas relacionados ao uso do álcool, entretanto, aqueles que tinham algum curso de especialização em álcool e/ou drogas apresentaram melhores níveis na adequação ao trabalho e na execução de tarefas específicas e autoestima. Ao mensurar as atitudes dos profissionais relacionadas ao Compromisso terapêutico (motivação, satisfação e autoestima) e à Segurança Profissional (adequação e legitimidade), houve melhores níveis na função Segurança Profissional. O treinamento foi realizado no próprio ambiente de trabalho, com 64,3% de participação da equipe. Conclui-se, portanto, que a formação educacional para atuar no atendimento a pessoas com problemas relacionados ao álcool pode acarretar mudanças positivas significativas no conhecimento e atitudes dos profissionais de enfermagem / This study aimed to evaluate the attitudes of nursing professionals of an emergency service in the care of patients with problems related to alcohol use and to conduct a training with these professionals. The study site was the Adult Emergency Room of the Clinical Hospital of the Federal University at Triângulo Mineiro, in Minas Gerais, Brazil. The methodological design of the study is of the descriptive type with a quantitative approach. A questionnaire of sociodemographic information and SAAPPQ were used. The questionnaire applied to 82 nursing professionals, including technicians and nurses, however 73 professionals answered the questionnaire. Most of the professionals were nursing technicians, many of them had completed college degree, female with average age of 37 years. In the evaluation of professionals, negative attitudes were related to work satisfaction (4.9 ± 1.6) and positive attitudes regarding the performance of specific tasks and self-esteem (6.6 ± 1.5). Regarding professional training, those at higher education level were less motivated to work with patients with problems related to alcohol use, however, those who had some degree of specialization in alcohol and / or drugs had better levels of work adequacy and execution of specific tasks and self-esteem. When measuring the attitudes of professionals related to Therapeutic Commitment (motivation, satisfaction and self-esteem) and Role Security (adequacy and legitimacy), there were better levels in the Role Security function. The training was carried out in the work environment, with a 64.3% participation of the team. It is concluded that the educational training to act in the care of people with problems related to alcohol can lead to significant positive changes in the knowledge and attitudes of nursing professionals