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)

The critical illness/injury of a family member warranting an admission to an A&E unit can predispose a family to psychological and physiological needs. The patient-centred-care approach rendered in an A&E unit focuses on the patient as a priority, resulting in the family’s needs being neglected during a crisis situation. Based on the Family Resilience Framework, the aim of this study was to assess the needs of the families of the critically ill/injured patients in an A&E unit. Based on the identified needs, recommendations were made with regard to a family-centred-care approach as a relevant resilience-based strategy suitable to these families. The research adopted a quantitative, non-experimental, exploratory and descriptive design. A purposive convenience sample of 100 participants was recruited over a period of four months. The data were collected by means of a structured interview schedule. The study revealed that the five main domains of family needs identified by the respondents as very important was, in order of priority, the need for communication, support, meaning, comfort and proximity. The findings supported the need to initiate and foster a family-centred-care approach in the A&E unit, which could guide the nurse practitioners in supporting the affected families, which in turn could enable these families to become resilient. Copyright / Dissertation (MCur)--University of Pretoria, 2010. / Nursing Science / unrestricted

Mental illness is a major problem in today's society and many individuals have experienced a mental health problem. Severe mental illness, such as schizophrenia, bipolar disorder, and major depression, is also relatively common, and mental illness can even lead to a person taking their own life. For individuals who have such destructive thoughts, quick access to care and proper evaluation and treatment is crucial. Therefore, the value of acquiring a special ambulance with a focus on psychiatric care has been identified. However, to utilize these special ambulances to their full potential, it is important that they are placed at optimal locations.         We propose an optimization model that aims to identify optimal locations for psychiatric emergency units in a specific geographical region. A collaboration with Region Skåne allowed us to use real data, and thus perform a scenario study to evaluate the optimization model. In our scenario study, we used our model to identify the optimal placements of one, two, and three psychiatric ambulances based on population and risk probability, respectively. The results from the scenario study show that the optimal location for a certain area can vary depending on which perspective is chosen. It is therefore important to have clear and well-thought-out goals for the placement of special ambulances.

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Το Τ.Ε.Π ( Τμήμα Επειγόντων Περιστατικών ) ενός νοσοκομειακού συγκροτήματος είναι Αυτόνομο Τμήμα στελεχωμένο από ιατρικό , νοσηλευτικό και παραϊατρικό προσωπικό και που καλείται να αντιμετωπίσει επείγοντα περιστατικά σε καθημερινή 24ωρη βάση. Αποτελεί το μοναδικό ίσως φορέα παροχής επείγουσας φροντίδας σε ολόκληρους πληθυσμούς νομών, δεδομένης της παντελούς έλλειψης ή ανεπάρκειας στη χώρα μας, υπηρεσιών πρωτοβάθμιας φροντίδας υγείας. Οι ανάγκες για παροχή υπηρεσιών υγείας αυξάνονται με ρυθμούς δυσανάλογους σε σχέση με τους διαθέσιμους πόρους για υγειονομική φροντίδα, γεγονός που δυσχεραίνει την εξασφάλιση της αποδοτικής λειτουργίας των Τ.Ε.Π και κατά συνέπεια δεν διασφαλίζεται η παροχή υψηλού επιπέδου υπηρεσιών. Για να επιτευχθεί η αποδοτική λειτουργία των Τ.Ε.Π θα πρέπει να εξευρεθούν τρόποι και λύσεις που θα αξιοποιούν και τις τεχνολογίες πληροφορικής και επικοινωνίας (Τ.Π.Ε) για την επιτάχυνση των λειτουργικών διεργασιών του Τ.Ε.Π και για την αποτελεσματική αντιμετώπιση των περιστατικών, διατηρώντας υψηλά το επίπεδο ικανοποίησης από τις παρεχόμενες υπηρεσίες όλων των ασθενών. / -

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Introduction : Trauma is the leading cause of death in patients between the ages of 1-44 years in South Africa. Taking these statistics into consideration it is essential to better resuscitation strategies in order to improve outcome of trauma patients. Compensated and uncompensated haemorrhagic shock is frequently under diagnosed in trauma patients, which has a definitive effect on mortality. Concerns about inadequate monitoring of patients through the use of only physiological end points are raised. Methods : A comprehensive literature review was conducted on resuscitation strategies for patients presenting with haemorrhagic shock. Physiological and metabolic end points of resuscitation were identified to guide resuscitation strategies. A quantitative, retrospective, non-experimental, descriptive, correlational and crosssectional research design was chosen for this study. Data was collected by using biophysical measures, namely clinical audit checklists. Results : Lactate was identified as a good indicator to predicting mortality in patients presenting with shock caused by haemorrhage. Special consideration to patients’ age and physiological status should be made during resuscitation. The consequence of delayed resuscitation in haemorrhagic shock patients is associated with an increase in mortality that can be prevented. It is found that serum blood lactate levels taken over time are good predictors of patient survival rates. Patients presenting with a raised serum blood lactate level for more than 24-hours has an increase in mortality rate. Conclusion : Emergency nurse practitioners are responsible for the monitoring of patients admitted to the emergency unit with haemorrhagic shock. The use of serum lactate levels during the first 24-hours of the resuscitation of patients with haemorrhage can assist with the implementation of strategies to reverse the effect haemorrhagic shock on cellular level in these patients. / Dissertation (MCur)--University of Pretoria, 2011. / Nursing Science / unrestricted

Introduction: Working in the hospital accident and emergency unit is perceived to be very stressful. However, minimal or no organizational support measures are made available to enable the nurses working in these hospital units to cope effectively with stressful incidents. The purpose of the study was to develop strategies to enhance the support systems of nurses in the accident and emergency unit. Method: The study used a qualitative approach to explore the experiences of and describe the coping strategies used by nurses working in the accident and emergency units of regional urban hospitals at KwaZulu-Natal, in South Africa. Fourteen participants were interviewed in the accident and emergency units of four (4) hospitals. Data were collected through in-depth individual interviews. The data were analysed manually following the steps explained by Creswell (2009:186). Findings: The interviews led to the description of the nurses’ experiences in the accident and emergency units. Four themes emerged from the findings of the interviews, and included working under pressure and stressful conditions, the need for safety and security, limited resources and psychological and emotional problems. Among the problems discussed within the themes, there was anger that was directed by the patients and their relatives to the nurses; absenteeism that contributed to an increase in work pressure; emotional disturbance; lack of physical security; and lack of continuous support from the hospital management. Conclusion: Five strategies were developed to generate a support systems for the nurses whose hospital units formed part of the study and were as follows: develop or strengthen an existing employee assistant program (EAP) specifically for counselling and support of the nurses within the unit; address staff absenteeism through the provision of extra staff through overtime or agency work; enforce attendance of monthly debriefing sessions; strengthen the security system through increasing and evenly distributing the security staff; and give attention to all the problems and provide a quick response. The strategies developed are trusted to remain as a point of reference whenever a need arises. / Health Studies / D. Litt. et Phil. (Health Studies)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)

Triage assessment of patients on arrival at the emergency unit is an essential function in quality emergency care provision. Triage is the process of sorting and prioritising patients according to their level of acuity. This study was performed within an emergency unit that experienced serious problems with the sorting of patients on their arrival. After implementation of the Cape Triage Score, a questionnaire was distributed amongst staff utilising the new triage system. The investigation sought to answer specific questions concerning the triage nurse's roles, competencies required and strengths and weaknesses of the implemented system. The study also suggests guidelines to improve the triage system within the unit. The triage system was received well by participants. The roles of the triage nurse are multifaceted and extensive competencies are required. The strengths of the implemented triage system outweighed the weaknesses as perceived by the respondents. Guidelines for implementing triage in emergency units are provided. / Health Studies / M.A. (Health Studies)