Philosophiae Doctor - PhD / Background: Palliative care is specialised health care to support people living with a terminal illness, and their families. Palliative care aims to prevent and relieve suffering, to help people to live as well as possible until they die, and to support the processes of dying and bereavement. Palliative care is holistic care provided by Emergency and Oncology Nurses caring for cancer patients. Palliative care protocols for Professional Nurses working in Emergency Units and Oncology Departments are not always posted or in full view in the government hospitals of the Western Cape. The researcher had noted that the development of a palliative care protocol would be unique in its use at the three targeted government hospitals. Aims and Objectives: This study focused on the development and implementation of palliative care protocols for Emergency and Oncology Nurses in the targeted government hospitals of the Western Cape, i.e., protocols could be beneficial for cancer patients and their families. The overall aim of the research was to develop applied palliative care protocols for Emergency and Oncology Nurses to provide best practice palliative care nursing for Oncology Patients who may present at any one of three Western Cape Provincial Hospitals.

Τα πληροφοριακά συστήματα υγείας είναι μια πραγματικότητα που έχει εφαρμοστεί στο χώρο της υγείας των περισσότερων κρατών της ευρωπαϊκής ένωσης εδώ και αρκετά χρόνια. Στην Ελλάδα ο τομέας αυτός άρχισε να αναπτύσσεται τα τελευταία χρόνια μέσω των έργων των Ολοκληρωμένων Περιφερειακών Συστημάτων Υγείας (ΟΠΣΥ). Το σύνολο αυτών των έργων στοχεύει σε πρώτη φάση στη δημιουργία βασικών υποδομών στις Μονάδες Υγείας (Νοσοκομεία, Κέντρα Υγείας κ.λ.π.) και σε δεύτερη φάση στην καθιέρωση σύγχρονων ηλεκτρονικών υπηρεσιών. Η αποτελεσματική αντιμετώπιση των επειγόντων περιστατικών είναι ζήτημα υψίστης σημασίας για την αξιοπιστία ενός συστήματος υγείας. Στην Ελλάδα, η λειτουργία αυτή πάσχει σημαντικά, γεγονός που δεν οφείλεται στην ποιότητα παροχής ιατρικών υπηρεσιών, αλλά στην οργάνωση του συστήματος καθώς και σε διοικητικές και υλικοτεχνικές ανεπάρκειες, οι οποίες οδήγησαν στη σημερινή εικόνα. Κατά γενική αποδοχή, η ποιότητα στις υπηρεσίες υγείας εξαρτάται, εκτός των άλλων, από την ταχύτητα με την οποία το ιατρικό και παραϊατρικό προσωπικό μπορεί να έχει στη διάθεσή του τα ιατρικά δεδομένα κάθε ασθενή. Ειδικά στα τμήματα επειγόντων περιστατικών (ΤΕΠ), τα κρίσιμα αυτά δεδομένα μπορούν να κρίνουν ακόμα και την έκβαση ενός περιστατικού. Προς αυτή την κατεύθυνση η παρούσα διπλωματική εργασία αφορά την κατασκευή μιας βάσης δεδομένων για την παρακολούθηση και αντιμετώπιση ασθενών που εξετάζονται στο ΤΕΠ. Είναι εμπλουτισμένη με πραγματικά στοιχεία από την περίθαλψη ασθενών στο ΤΕΠ του Π.Γ.Ν.Πατρών στο χρονικό διάστημα Σεπτέμβριος-Δεκέμβριος 2008. Ο σκοπός της είναι να διευκολύνει το έργο του ιατρικού προσωπικού μέσω της άμεσης παροχής πληροφορίας για τους ασθενείς (όπως π.χ. ιστορικό ασθενούς, προηγούμενες εξετάσεις στο ΤΕΠ, εργαστηριακός έλεγχος κ.λ.π.), αλλά και να βελτιώσει την ποιότητα παροχής υπηρεσιών προς όφελος των ασθενών που εξετάζονται στο ΤΕΠ. Στα κεφάλαια που ακολουθούν αναλύονται τα εξής θέματα: Στο 1ο κεφάλαιο γίνεται μια εισαγωγή στις Βάσεις Δεδομένων και περιγράφονται οι βασικές τους έννοιες όπως τα μοντέλα τους, τα Συστήματα Διαχείρισης Βάσεων Δεδομένων (ΣΔΒΔ-DBMS) και η αρχι-τεκτονική τους, το Διάγραμμα Οντοτήτων Συσχετίσεων κ.λ.π. Στο 2ο κεφάλαιο γίνεται μια σύντομη περιγραφή στο DBMS Microsoft Access με το οποίο κατασκευάστηκε η βάση δεδομένων της διπλωματικής εργασίας. Στο 3ο κεφάλαιο γίνεται αναφορά στα πληροφοριακά συστήματα Υγείας στην Ελλάδα και στο εξωτερικό καθώς και σε έρευνες που έχουν γίνει για την επέκταση και τη βελτίωση τους. Στο 4ο κεφάλαιο περιγράφεται η σχεδίαση της βάσης δεδομένων για την παρακολούθηση και αντιμετώπιση ασθενών που εξετάστηκαν στο ΤΕΠ του Π.Γ.Ν. Πατρών και παρουσιάζονται όλα τα εργαλεία που προσφέρει όπως π.χ. ένα γραφικό και φιλικό προς το χρήστη περιβάλλον για καταχώριση και διαχείριση ασθενών, στατιστικά στοιχεία και γραφήματα που τα αναπαριστάνουν, ερωτήματα για επιλογή πληροφορίας, μακροεντολές που διευκολύνουν το χειρισμό της κ.λ.π. Στο 5ο κεφάλαιο παρουσιάζονται τα συμπεράσματα από το πλη-ροφοριακό σύστημα που κατασκευάστηκε, αναλύεται η χρησιμότητα του και προτείνονται τρόποι για τη μελλοντική επέκταση και βελτίωση του. / Medical information systems have been applied in the field of health of most states of European Union for many years. In Greece this sector started to evolve the last years through the Completed Regional System of Health. The total of these projects aims, firstly, to the creation of the basic infractions to the Health Units (Hospitals, Health Centres etc), and secondly, to the establishment of modern electronic services. The effective treatment of urgent incidents is a matter of the utmost importance for the credibility of a health system. In Greece this function suffers considerably, which is not due to the quality of the provision of medical services, but to the organization of the system, as well as to administrative and logistic deficiencies, which led to the current situation. At general acceptance, the quality of the health services depends on the rapidity with which the medical and paramedical personnel can have at his disposal the medical data of each patient. Specifically, in the Emergency Unit, these critical data can even predicate the outcome of an incident. To this direction, this diplomatic essay concerns the construction of a new database system that follows up and treats patients who are examined in the Emergency Units. It is enriched with actual data from the nursing in the Emergency Unit of the General University Hospital of Patras during September-December 2008. Its aim is to facilitate the work of the medical personnel through the direct provision of information for the patients (such as the medical records, previous examinations in the Emergency Unit, laboratory tests, etc), but also to improve the quality of the provision of information for the benefit of the patients who are examined in the Emergency Unit. The following chapters will analyze the following issues: 1st Chapter: Introduction to Database Systems and presentation of their main definitions such as database models, Database Management Systems (DBMS) and their architecture, Entity-Relationship diagram etc. 2nd Chapter: A quick reference to Microsoft Access DBMS, which has been used for the database construction of this diplomatic essay. 3rd Chapter: A presentation about the medical information systems in Greece and abroad, as well as researches that have been taken place concerning their extension and improvement. 4th Chapter: A detailed reference of the construction of the data-base system that follows up and treats patients who are examined in the Emergency Unit of the General University Hospital of Patras and represents all the tools that are used, such as a graphic and user-friendly interface for the registration and management of the patients, statistics and charts that reconstruct them, questions about the choice of the information, macros that facilitate its control, etc. 5th Chapter: The conclusions of the information system that have been constructed, analysis of its utility and proposals about its future extension and improvement.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho objetiva analisar o exercício profissional dos assistentes sociais inseridos nas unidades de pronto atendimento (UPA) municipais da cidade do Rio de Janeiro geridas por Organizações Sociais (OS), no sentido de identificar os reais limites e possibilidades colocados para a efetivação do projeto ético-político do Serviço Social brasileiro como horizonte da prática nesses espaços. Na busca por restaurar suas taxas de lucro, o capital avança sobre o fundo público e tem as políticas sociais como seu lócus privilegiado. A satanização de tudo que é público e a suposta busca por qualidade e eficiência justifica a gestão privada dos serviços públicos. Assim, impõe-se a lógica do lucro, da produtividade, do foco no quantitativo ao setor público. No município do Rio de Janeiro, a expansão da rede de saúde vem se dando por meio da gestão dessas instituições qualificadas como Organizações Sociais (OS). É o caso das UPA que, focadas nos atendimentos de urgência e emergência dentro de uma rede de saúde precarizada que não prioriza ações de prevenção e promoção, são pouco resolutivas e quando geridas por OS estão focadas em números de altas e de transferências. Nesse contexto, o assistente social, um dos profissionais que responde por essa produtividade, uma vez que com prioridade operacionaliza burocraticamente o processo de transferência e alta, fragilizado teoricamente e pelo vínculo precário, não tem sido capaz de criar estratégias e alternativas para uma prática embasada pelo projeto ético-político, ou seja, que caminhe na direção das necessidades e interesses da classe trabalhadora. / This dissertations aims to analyze the social workers practice in the city of Rio de Janeiro Emergency Unit, which are managed by social organizations, in order to identify the real limits and possibilities of the Brazilian ethical-political project effectiveness in those units. Aiming to recover its profits rate, the capital advances into the State Fund, mainly over the public social policies. The depreciation of the public services and the supposed search for quality and efficiency justify the private management of the public services. So, it is imposed the profit logical, the focus on the quantitative results into the public service. In the Rio de Janeiro city, the expansion of the health system is made by the management of the institutions so-called social organizations. Thats what happens with the Emergency Units of Rio de Janeiro, which are focused on the emergency and urgency care within a precarious public health network that does not have priority over prevention and health promotion actions. Dependent upon that, they are not effective. When they are managed by social organizations, they are focused on the numbers of hospital discharge and on the transfers of patients. In this context, the social worker is one of the professionals that works for the productivity, since they operate bureaucratically the transfer and hospital discharge process. They research shows that the social workers have a fragile theory and are working into precarious conditions, so they have not been capable of creating strategies and alternatives to a practice based on the ethical-political project, in other words, a practice that works on the behalf of the needs and interest of the working class.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente trabalho objetiva analisar o exercício profissional dos assistentes sociais inseridos nas unidades de pronto atendimento (UPA) municipais da cidade do Rio de Janeiro geridas por Organizações Sociais (OS), no sentido de identificar os reais limites e possibilidades colocados para a efetivação do projeto ético-político do Serviço Social brasileiro como horizonte da prática nesses espaços. Na busca por restaurar suas taxas de lucro, o capital avança sobre o fundo público e tem as políticas sociais como seu lócus privilegiado. A satanização de tudo que é público e a suposta busca por qualidade e eficiência justifica a gestão privada dos serviços públicos. Assim, impõe-se a lógica do lucro, da produtividade, do foco no quantitativo ao setor público. No município do Rio de Janeiro, a expansão da rede de saúde vem se dando por meio da gestão dessas instituições qualificadas como Organizações Sociais (OS). É o caso das UPA que, focadas nos atendimentos de urgência e emergência dentro de uma rede de saúde precarizada que não prioriza ações de prevenção e promoção, são pouco resolutivas e quando geridas por OS estão focadas em números de altas e de transferências. Nesse contexto, o assistente social, um dos profissionais que responde por essa produtividade, uma vez que com prioridade operacionaliza burocraticamente o processo de transferência e alta, fragilizado teoricamente e pelo vínculo precário, não tem sido capaz de criar estratégias e alternativas para uma prática embasada pelo projeto ético-político, ou seja, que caminhe na direção das necessidades e interesses da classe trabalhadora. / This dissertations aims to analyze the social workers practice in the city of Rio de Janeiro Emergency Unit, which are managed by social organizations, in order to identify the real limits and possibilities of the Brazilian ethical-political project effectiveness in those units. Aiming to recover its profits rate, the capital advances into the State Fund, mainly over the public social policies. The depreciation of the public services and the supposed search for quality and efficiency justify the private management of the public services. So, it is imposed the profit logical, the focus on the quantitative results into the public service. In the Rio de Janeiro city, the expansion of the health system is made by the management of the institutions so-called social organizations. Thats what happens with the Emergency Units of Rio de Janeiro, which are focused on the emergency and urgency care within a precarious public health network that does not have priority over prevention and health promotion actions. Dependent upon that, they are not effective. When they are managed by social organizations, they are focused on the numbers of hospital discharge and on the transfers of patients. In this context, the social worker is one of the professionals that works for the productivity, since they operate bureaucratically the transfer and hospital discharge process. They research shows that the social workers have a fragile theory and are working into precarious conditions, so they have not been capable of creating strategies and alternatives to a practice based on the ethical-political project, in other words, a practice that works on the behalf of the needs and interest of the working class.

Sexual assault is a global public health and human rights challenge which cuts across all social classes. According to a literature review based on 50 studies from around the world, between 10% and 50% of women have experienced some act of physical violence while one in every four women experience sexual violence by an intimate partner at some point in their lives. In an emergency unit in the North West, South Africa there are policies, guidelines and procedures in place with regard to the management of the rape survivors after the incident which focus on a medical orientated approach. The views of female rape survivors on their management are neglected; therefore management is not patient-centred. The main objective of the study was to explore and describe the views of the female rape survivors regarding the management they received in emergency unit to enable the health care professionals to move towards a more patient-centred approach in the management these patients. Appreciative Inquiry was used a research methodology. A qualitative design using purposive sampling was used to select the participants. Unstructured interviews were conducted with 10 female rape survivors and Tesch steps were used to analyse the data. Three main themes were identified, namely 1) therapeutic environment, 2) optimal healthcare received and 3) excellence in service delivery. With regard to the disease orientated management received the female rape survivors found it to be good. The participants voiced that it is important that female rape survivors should have an opportunity to attend group therapy following the rape incident so that they are able to support each other. / Dissertation (MCur)--University of Pretoria, 2014. / lk2014 / Nursing Science / MCur / Unrestricted

Aim and objectives. Although many international sources in literature describe the treatment regimes for the management of adult female rape survivors, very few actually evaluate if the care that is implemented, are beneficial and supportive towards an optimal level of health. The researcher initiated this study to specifically determine what the experiences of adult female rape survivors were with regards to the management they received from health care workers in the emergency care environment. This information that was gathered was then incorporated into the writing of recommendations for health care services towards the improvement of patient-centred care. Method. A qualitative phenomenological methodology guided the research process in which ten semi-structured voluntary interviews was held with adult female rape survivors. This study was conducted in a private hospital in Gauteng, South Africa, which is at the top of the international statistics list for the incidence of rape. Findings. Patient management with regards to accessibility to health care services, the forensic examination and the use of medications proved to be a major concern. Participants in this study emphasized the value and importance of the physical presence of family members or significant others. A positive attitude from these support-givers improved the patient’s psychological state, memory and co-operation. Prolonged waiting times in all areas of management contributed to an increased level of anxiety, where as the prompt and competent interventions by empathetic multi-disciplinary team members had improved patient satisfaction. Various patient responses after the rape incident warranted that minimal, but yet effective and professional health care workers be involved in rape survivor management. Confidentiality and honest, effective communication that is based on patient preference, should guide all interventions. Conclusion. The medical management of adult female rape survivors in this hospital compared favorably to international standards, however, the need to improve the level of specific patient-centred care exists in order to ultimately facilitate a better quality of service provision. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

The A&E unit is a unique environment with unique problems, including those problems pertaining to the documentation of the nursing care provided to the critically ill or injured patient. In such a hectic and turbulent environment where minutes can be the decider between life and death, saving the patient’s life takes priority over record keeping, and crucial information is not recorded. The aim of this study was to develop a nursing record tool to record the management of critically ill or injured patients in an accident and emergency (A&E) unit. The researcher used the collaborative inputs of three different groups of experts in the field of A&E nursing and record keeping to reach this aim. The study was descriptive, explorative and contextual in nature, and a qualitative approach was used. The A&E nurse practitioners views were incorporated into a final nursing record tool that could be used in the A&E unit for critically ill or injured patient for the first six hours of resuscitation. The compiled nursing record tool was comprehensive and included a prehospital management section to ensure the continuity of care in the emergency environment. Although more comprehensive as the current tool, the use of tick-off prompts shortened the time spend to complete this nursing record tool and, in doing so, increased the retaining of crucial information that could enhance the quality and ensure the continuity of care pertaining the critically ill or injured patient in the changing emergency environment. / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted

Bakgrund, att handlägga smärta innebär att identifiera, bedöma och lindra smärta hos patienter och är en central del av arbetet för sjuksköterskan på akutmottagningen. Studiens syfte var att undersöka och beskriva sjuksköterskors erfarenheter gällande handläggning av smärtlindring till patienter på akutmottagning. Författarna valde att göra en empirisk och induktiv studie med en kvalitativ och deskriptiv design då avsikten med studien var att beskriva verkligheten. Den valda metoden var en kvalitativ intervjustudie med semistrukturerade intervjuer för att få fram sjuksköterskornas egna upplevda erfarenheter genom ett induktivt förhållningssätt. Resultatet av studien visar att det framkom att sjuksköterskorna ansåg att bedömning av smärta var en viktig del i sjuksköterskans arbete på akutmottagningen. Samtliga av de intervjuade sjuksköterskorna menade att de använde sin "kliniska blick" vid bedömningen av patientens smärta, det var ofta svårt att bedöma smärtan och det var svårt att tillgodose patientens önskemål om smärtlindring då det gällde relationen till den upplevda smärtan och vad som sjuksköterskan ansåg som nödvändig smärtlindring. De tyckte också att VAS-skalan var svår att använda då patientens upplevda smärta många gånger inte stämde med sjuksköterskans bedömning. Studien visar att flera av de erfarna sjuksköterskornas erfarenhet spelade en avgörande roll då det handlade om att smärtlindra patienterna på akutmottagningen. Det visade sig i studien att det ofta krävs en sjuksköterska med erfarenhet för att snabbt kunna ta beslut om smärtlindring och i vilken omfattning smärtlindring skulle ges. Sjuksköterskorna tyckte också att de behövde mer utbildning angående smärtlindring för att kunna använda sig av de generella ordinationerna. Det framkom även att hög arbetsbelastning kunde göra så att patienterna fick vänta längre innan sjuksköterskorna hade möjlighet att ge smärtlindring till patienten. Vår slutsats, baserad på intervjuer av femton sjuksköterskor, är att när det gäller smärtlindring på akutmottagning beror handläggningen på tryggheten i sjuksköterskans yrkeserfarenhet. Det verkar finnas en brist på erfarenhet gällande handläggning av smärtlindring hos sjuksköterskor på akutmottagningar och vi anser att det på arbetsplatsen bör ses över hur man kan stärka sjuksköterskor i sin bedömning och handläggning genom att ge tillfälle till utbildning och diskussion för att ge en trygg arbetsmiljö, ökad patientsäkerhet och en ökad patientnöjdhet.

Bakgrund: Sjuksköterskan på en akutmottagning arbetar under ständig tidspress med en bristande arbetsmiljö. Genom en ökad förståelse för sjuksköterskors upplevelser avseende arbetsrelaterad stress, kan medvetenheten öka kring problematiken och eventuellt leda till potentiella framtida lösningar.  Syfte: Syftet med denna litteraturstudien var att undersöka samt belysa sjuksköterskors upplevelser av arbetsrelaterad stress på akutmottagningar. Metod: Denna litteraturstudie bestod av 10 vetenskapliga artiklar med kvalitativ ansats. Databassökningen genomfördes i Pubmed och Cinahl. Resultat: Studiens resultat baserades på 10 vetenskapliga studier och delades in i två kategorier och fem subkategorier. Organisatorisk arbetsmiljö, belyste arbetsbördor samt resursbrister som råder på akutmottagningar. Sjuksköterskorna upplevde en bristande arbetsmiljö i form av överbelastning som bidrog till stress i arbetet. I den andra kategorin, konsekvenser av stress, belystes konsekvenser av arbetsrelaterad stress på akutmottagningar som visade sig ha en negativ påverkan på sjuksköterskornas psykiska hälsa, privatliv samt patientsäkerheten . Sjuksköterskorna upplevde att stress till följd av resursbrist medförde en ökad risk för vårdskador. Slutsats: Den upplevda arbetsrelaterade stressen hos sjuksköterskor på Akutmottagningar har en negativ påverkan på sjuksköterskors hälsa, bidrar till en bristande omvårdnad, samt hotad patientsäkerhet. Förbättring av arbetsmiljön är av ytterst vikt för att uppnå en säkrare och effektivare vård samt för att främja sjuksköterskors hälsa.

Emergency nursing is an evolving field in Kenya with the Nursing Council of Kenya (NCK) yet to list it as a speciality area. This study wished to identify and describe the core competencies that should be included in an emergency nurse training programme based on the views of nurses and doctors who work in emergency units in a level 1 hospital in Nairobi, Kenya. The researcher used qualitative explorative and quantitative descriptive designs in phases 1 and 2, respectively, and convenience and purposive sampling. The study found that the respondents emphasised the inclusion of 137 (93.2%) of the 147 skills in the questionnaire as core competencies and disagreed with 10 (6.8%). Concomitantly, the vast majority of the respondents (93.6%) supported the inclusion of the skills compared to those (6.3%) that did not. Based on the findings, the researcher made recommendations of the core competencies to be included in the programme. / Health Studies / M.A. (Health studies)