Abstract Bakgrund Varje år hanterar svenska akutmottagningar omkring två miljoner patientbesök. De flesta besök inleds med att sjuksköterskan genomför triagering av patienten för att på så vis besluta vilken vårdnivå och klinik patienten skall hänvisas till. Detta görs för att öka patientsäkerheten och effektiviteten på akutmottagningen.   Syfte Syftet var att beskriva sjuksköterskans upplevelse av att triagera på en akutmottagning.   Metod En litteraturstudie med grund i sju kvalitativa artiklar och en kvantitativ artikel har genomförts. Artiklarna har genomgått kvalitetsgranskning och är funna i databaserna Pubmed och Cinahl.   Resultat Resultatet utgörs av tre huvudkategorier: Arbetsbelastningens inverkan på triagering, Yrkeserfarenhetens inverkan på triagering, med två underkategorier, samt Sjuksköterskors utsatthet vid triagering. Sjuksköterskor upplever arbetet med triagering på akutmottagning som stressigt med hög arbetsbelastning. Det framhålls att oerfarna sjuksköterskor någon gång känner sig osäkra över sina triagebeslut. Erfarenhet tycks vara en viktig aspekt för tidseffektiv och korrekt triagering. På grund av hög arbetsbelastning upplevs möten med patienter ofta vara korta och standardiserade och möjligheten att skapa en god vårdrelation minskar.   Slutsats Om det fanns kunskap och utrymme för att i högre grad möta patienten med ett personcentrerat förhållningssätt skulle detta kunna leda till förbättrade förutsättningar för sjuksköterskor att skapa en god vårdrelation, vilket i sin tur skulle förbättra sjuksköterskors arbetssituation och öka patientnöjdheten.

Till en akutmottagning ankommer patienter i alla åldrar vid akut sjukdom eller skada. Ett högt söktryck på akutmottagningen leder ofta till en lång väntan på att få vård. Första mötet med vårdpersonal sker via ett triagesystem för att avgöra aktuellt tillstånd och vem som skall få vård och behandling först. Information och kommunikation är en stor del av besöket och det är viktigt att vårdpersonal skapar en vårdande relation med patienterna. Syftet var att beskriva patienters upplevelser av hur de bemötts av vårdpersonal på en akutmottagning. Skribenterna har utfört en litteraturstudie som innehåller en granskning och analys av både kvalitativa och kvantitativa artiklar. Totalt består litteraturstudien av 10 artiklar som har analyserats fram till ett nytt resultat. Litteraturstudiens resultat framställs via två huvudteman och fyra subteman. Resultatet påvisar vikten av att en vårdande relation fungerar mellan vårdgivare och patient för ökad tillit. Även vikten av god kommunikation och relevant information framkommer. Betydelsen av delaktighet framställs också som en viktig del på en akutmottagning. Skribenterna presenterar patienters upplevelser av akutmottagningen genom två huvudteman, positiva upplevelser och negativa upplevelser, med underliggande subteman fokuserat på den vårdande relationen, information och kommunikation, delaktighet samt tiden och triaget. I studiens diskussion beskrivs hur studien genomförts samt metodval. I studiens resultatdiskussion lyfter skribenterna bland annat vikten av den vårdande relationen, information och kommunikation samt delaktighet.

A triagem de emergência tem como objetivo dar prioridade aos pacientes mais graves e melhorar a prestação do serviço de emergência, garantindo atendimento no momento adequado, melhor fluxo e segurança. Os objetivos deste trabalho foram traduzir e validar a parte referente às emergências odontológicas do instrumento para triagem de emergência Manchester Triage System (MTS) na língua portuguesa, avaliar a confiabilidade interobservadores e o impacto da aplicação do MTS no Setor de Urgência Odontológica da Faculdade de Odontologia da Universidade de São Paulo. O MTS foi traduzido através do método padrão de tradução/ retrotradução. A versão foi submetida à validação semântica e idiomática e também conceitual e cultural, feita por um comitê de juízes. Em ambas, a concordância final observada após os ajustes realizados foi superior a 80%. Na concordância interobservadores, 200 pacientes participaram das entrevistas realizadas por 2 voluntários independentes com conhecimentos em odontologia e a pesquisadora. Os coeficientes kappa foram de 0.58 e 0.60. Inicialmente foram entrevistados 120 pacientes sem a aplicação do MTS e em seguida 139 pacientes categorizados de acordo com a prioridade clínica. Houve diminuição no tempo médio de espera para atendimento, de 79.96 min para 36.86 min (Mann-Whitney (MW), p=0.00) e aumento do tempo médio de duração do atendimento, de 29.11 min para 34.78 min (MW, p=0.05). Dentre os pacientes categorizados segundo o MTS, os não-urgentes eram mais velhos (MW, p=0.01), tiveram menor duração de atendimento (MW, p=0.00) e menor intensidade de dor (MW, p=0.00). A versão traduzida e validada do MTS mostrou-se adequada e sua aplicação e útil no atendimento de pacientes do Setor. / The emergency triage aims to assign clinical priority to the patients and to improve emergency services, ensuring attendance at the right time, better patient flow and safety. The objectives of this study were to translate and validate part of the Manchester Triage System (MTS) related to dental emergency in Portuguese, to assess the inter-rater reliability and to evaluate the impact of implementation of triage at Setor de Urgência Odontológica of Faculdade da Odontologia of Universidade de São Paulo. The MTS was translated using the standard translation/ back-translation method. The instrument was then submitted to semantic and idiomatic validation, as well as conceptual and cultural validation by a committee of judges. In both, the final concordance after the adjustments was higher than 80%. In the inter-rater agreement, 200 patients were interviewed by two independent volunteers with some knowledge of dentistry and the researcher. The kappa coefficients were 0.58 and 0.60. Then 120 patients were interviewed without the application of the MTS and 139 patients were categorized according to their clinical priority. There was a reduction in the mean waiting time, from 79.96 min to 36.86 min (Mann-Whitney test (MW), p=0.00) and an increase in the mean of treatment duration, from 29.11 min to 34.78 min (MW, p=0.05). Among triaged patients, the non-urgent were older (MW, p=0.01), had shorter duration of treatment (MW, p=0.00) and lower pain intensity (MW, p=0.00). The translated and validated version of the MTS showed to be appropriate and useful in categorization of patients with dental emergencies in this setting.

Orientador: Cristina Broglia de Feitosa Lacerda / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T14:45:28Z (GMT). No. of bitstreams: 1 Pinto_ElaineSoaresMonteiro_D.pdf: 1533807 bytes, checksum: e9fa442c2cdc808029d958967a73fcf9 (MD5) Previous issue date: 2007 / Resumo: O implante coclear é um dispositivo eletrônico de alta tecnologia, que estimula eletricamente as fibras nervosas remanescentes, permitindo a transmissão do sinal elétrico ao nervo auditivo, para que seja codificado pelo córtex cerebral. Ele difere das próteses auditivas convencionais por não amplificar o som, mas, sim, fornecer impulsos elétricos e, portanto, é considerado uma boa alternativa àqueles pacientes que não apresentam benefícios com a amplificação. Esta tecnologia vem sendo utilizada em crianças cada vez menores, e cabe aos profissionais da área eleger os melhores candidatos a este dispositivo. O objetivo principal desta pesquisa foi analisar aspectos do atendimento oferecido às crianças pela equipe de Implante Coclear do HC-UNICAMP, focalizando os protocolos utilizados para elegibilidade de casos, no que diz respeito à capacidade comunicativa dos sujeitos que receberam o implante e sua audibilidade, apontando diretrizes para um procedimento de seleção de casos mais adequados. Foram considerados sujeitos da amostra 7 crianças com deficiência auditiva severa a profunda, que obedecessem os critérios de inclusão do programa de Implante Coclear do HC-UNICAMP. Foram analisados os limiares audiométricos em campo livre, os índices obtidos para o questionário de avaliação da percepção auditiva IT-MAIS (Escala de Integração Auditiva Significativa para Crianças Pequenas (Castiquini, 1998), os dados dos questionários MUSS (Questionário de Avaliação da Linguagem Oral) (Nascimento, 1997), a vídeo-gravação das crianças em situação lúdica e a análise das anotações do prontuário referentes ao desempenho comunicativo. As análises foram feitas no período pré e pós cirúrgico. O processo de seleção de crianças candidatas ao implante coclear precisa valorizar a observação do comportamento dessas crianças em situações lúdicas, com o objetivo de investigar os aspectos comunicativos. A vídeo-gravação demonstrou ser um importante instrumento para esse fim, ao registrar que as crianças com melhor desempenho comunicativo também apresentaram um melhor desempenho com o implante coclear. As crianças portadoras de perda auditiva de grau severo devem ser consideradas como candidatos em potenciais, pois apresentam melhor estímulo com o aparelho auditivo (apesar de muitas vezes não serem capazes de desenvolver fala), o que parece favorecer a resposta com o implante coclear. Os limiares auditivos melhoram com o aprimoramento do mapeamento e também são melhores quando os limiares elétricos são obtidos por meio de resposta comportamental. A percepção auditiva melhora na mesma proporção. No momento pós-cirúrgico, o aparecimento ou a melhora dos comportamentos comunicativos são os primeiros indícios de benefícios do implante coclear / Abstract: Cochlear implants are high- technology electronic devices that electrically stimulate remaining nervous fibers, allowing the transmission of electric signals to the auditory nerve for codification by the cerebral cortex. They differ from conventional auditory prosthesis because they do not amplify sound but supply electric impulses, and are therefore considered a good alternative for patients who are not benefited by sound amplification. This technology is being increasingly used for very young children and professionals of the field are responsible for choosing the best candidates for using the devices. The main goal of this research was to analyze aspects of assistance given to children by the team of Cochlear Implantation of the Hospital of Clinics (HC)-UNICAMP, and focused on protocols used for eligibility to implantation regarding communicative capacity and audibility, suggesting guidelines to a more adequate procedure for selection. The subjects were 7 children with auditory inabilities ranging from severe to profound that met the criteria for inclusion of HC-UNICAMP¿s Cochlear Implantation Program. Free-field audiometric thresholds, rates from IT-MAIS (Infant-Toddler: Meaningful Auditory Integration Scale - Castiquini, 1998), an auditory perception evaluation questionnaire, data from MUSS (Meaningful Use of Speech Scale - Nascimento, 1997), video-recordings of children in a playful situation and notes of clinical histories regarding communicative performance were analyzed both before and after surgery. The process of selection of children for cochlear implantation needs to recognize the value of observing children¿s behavior in playful situations, aiming to investigate the communicative actions they present, and video-recordings turned out to be an important tool. Better-performing children in communicative behaviors presented better results after cochlear implantation. Children with a severe auditory loss must be considered as potential candidates because they present a better stimulation with the auditory device¿s help (although many times they are not able to develop speech), what seems to favor their response to cochlear implantation. Auditory thresholds improve with the improvement of mapping and are better when electric thresholds are elicited through behavioral response. Auditory perception improvement follows the same ratio. Post-surgically, the emergence or improvement of the communicative behaviors is the first indication of benefits of cochlear implantation / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente

nÃo hà / O acolhimento com classificaÃÃo de risco (ACCR) a pacientes pediÃtricos nos serviÃos de emergÃncia à uma estratÃgia adotada pelo MinistÃrio da SaÃde para organizar o atendimento conforme o grau de complexidade. A funÃÃo do enfermeiro neste setor à acolher o paciente, identificar urgÃncias e emergÃncias com base na avaliaÃÃo de critÃrios estabelecidos por protocolos e dar prioridade aos casos mais graves. Sendo assim, o estudo teve como objetivo construir e validar um guia abreviado do protocolo de ACCR em pediatria do municÃpio de Fortaleza-CE. Trata-se de uma pesquisa metodolÃgica desenvolvida em duas etapas: elaboraÃÃo do instrumento e validaÃÃo de conteÃdo. A elaboraÃÃo da primeira versÃo do guia abreviado desenvolveu-se com base no conteÃdo do protocolo ACCR de pediatria de Fortaleza, alÃm de outros instrumentos, tais como: Paediatric Triage Tool, Canadian Paediatric Triage and Acuity Scale (PaedCTAS) e Manchester Triage System (MTS), entre outros. Apresenta-se em material com trinta cÃlulas de um quadro, subdivididas em cinco colunas e sete linhas. A primeira linha identifica os tÃpicos das colunas atravÃs de cinco indicadores de risco denominados vias aÃreas/respiraÃÃo, circulaÃÃo/hemodinÃmica, nÃvel de consciÃncia, dor, eliminaÃÃo/hidrataÃÃo. Cada indicador de risco foi subdividido em duas colunas referentes a queixas principais e sinais e sintomas. A primeira versÃo do guia abreviado foi submetido à avaliaÃÃo por nove juÃzes, sendo quatro docentes/pesquisadores experts em psicometria, denominados juÃzes de conteÃdo selecionados por meio da pesquisa por âAssuntoâ na Plataforma Lattes e, cinco enfermeiros residentes em Fortaleza, com experiÃncia clÃnica em classificaÃÃo de risco â juÃzes tÃcnicos, selecionados por meio da amostragem por bola de neve. Todos os juÃzes atingiram pontuaÃÃo acima do mÃnimo exigido no sistema de classificaÃÃo de experts adotado. Na validaÃÃo de aparÃncia, os juÃzes consideraram os 25 (100%) itens, claros e compreensÃveis com um percentual de concordÃncia de 77,8%. Dos 25 itens (queixas principais e sinais e sintomas), 23 (92%), foram considerados pertinentes à classificaÃÃo de risco relacionada nas cores vermelha, laranja, amarelo, verde e azul. Todos os juÃzes (N=9; 100%) caracterizaram os indicadores de risco como adequados ao conteÃdo dos itens (queixa principal e sinais e sintomas). Para a validaÃÃo de conteÃdo quanto à relevÃncia dos itens no guia abreviado, 17 (68%) foram considerados relevantes e, 8 (32%) nÃo relevantes pelos juÃzes. No entanto, julgou-se oportuno realizar avaliaÃÃo do grau de relevÃncia dos itens e do instrumento como um todo, por meio da aplicaÃÃo do cÃlculo do Ãndice de Validade de ConteÃdo (IVC) e obteve-se IVC geral do instrumento igual a 0,98 e o IVC dos itens variando de 1 a 0,888889. NÃo havendo, portanto, necessidade de retirar os 8 itens com concordÃncia inferior a 80%. Por sugestÃo dos juÃzes, foram feitas alteraÃÃes no layout, estrutura e conteÃdo dos itens, chegando-se, assim, à versÃo final do guia abreviado. Concluiu-se, que se obteve um instrumento vÃlido, capaz de medir corretamente o grau de complexidade clÃnica da crianÃa e, confiÃvel para utilizaÃÃo nos serviÃos de emergÃncia garantindo, aos enfermeiros, reduzir o tempo de avaliaÃÃo da crianÃa e reduzir as chances de erro. / The host with the risk rating (ACCR) to pediatric patients in emergency departments is a strategy adopted by the Ministry of Health to organize the service in accordance with the degree of complexity. The role of nurses in this sector is to accept the patient, identify emergencies and emergencies based on the evaluation criteria established by protocols and give priority to serious cases. However, the conflicting environment of the emergency services more difficult for nurses use protocols, evaluation of the child. The purpose of this study is to obtain a tool able to accurately assess the risk of patients quickly and reliably, to be used as an aid to the protocols. He had intended to construct and validate an abbreviated guide ACCR pediatric protocol in Fortaleza-CE. This is a research methodology developed in two stages: the instrument and content validation. The first abbreviated version of the guide was developed in light of the contents of the protocol in pediatric ACCR of Fortaleza, and followed the structural orientation of the instrument Paediatric Triage Tool (abridged version of scale Australian pediatric screening). Was assessed by nine judges, four teachers / researchers expert in psychometrics, content and so-called judges, five nurses with clinical experience in risk rating - technical judges, selected by experts classification system adopted. We used the strategy of "Subject Search" in the Platform Lattes for selection of judges and content, it was considered the social networks through sampling network technicians to select the judges. For validation of appearance, the court ruled the 25 (100%) items, clear and understandable by the concordance of 77.8%. We also analyzed the relevance of the items (Complaints and Major Signs and Symptoms) regarding classification of risk in the colors red, orange, yellow, green and blue, and considered to be the content of 23 (92%) of 25 items pertaining to related risk rating. Regarding the adequacy of risk indicators (airway/breathing, circulation/hemodynamics, level of consciousness, pain, elimination/hydration) the content of items 5 (100%) say they are relevant in the opinion of the judges (N=9; 100%), characterizing the risk indicators as appropriate to the contents of the "main complaints" and "Signs and Symptoms" related. For the content validation of the relevance of short items in the guide, 17 (68%) were considered relevant, and 8 (32%) not relevant by judges. However, it was deemed appropriate to carry out assessment of the relevance of items and the instrument as a whole, by applying the calculation of the Content Validity Index (CVI) CVI and obtained equal to 0.98. And there is therefore no need to remove the 8 items with less than 80% agreement. In the second abbreviated version of the Guide, there were changes to the layout, structure and content of items, suggestion of judges. It was concluded, they earned a valuable instrument that can accurately measure the degree of clinical complexity of the child, and reliable for us in providing emergency services, nurses, reduce the evaluation time of the child and reduce the chances of error.

This quality improvement project identified a need to improve patient placement between the Fast Track and the Emergency Department treatment areas of an urban Southern Arizona hospital. The current triage process at this hospital excludes patient past medical history, limiting the information given to triage nurses when assigning patient acuity scores and determining placement in the ED. This project sought to improve patient to nurse communication during the triage interview process by educating nurses to ask a ‘targeted history’ question: a question created to obtain concise past medical history information related to the patient’s chief complaint. This targeted history question was worded as “Have you been treated for [chief complaint] before?” Chart audits were performed to gather quantitative data on patient placement, ESI scores, triage interview times, and nursing compliance rates. Stakeholders were also asked open-ended questions regarding their perceptions of triage and the integration of the targeted history question. These interviews were recorded, transcribed, and coded for common categories. Results show low nursing compliance with asking the targeted history question. However, almost two-thirds of triage notes mentioned some form of past medical history – showing that triage nurses assess for pertinent past medical history without prolonging total triage times. Additionally, stakeholder interviews showed healthcare personnel felt the targeted history question helped with gathering useful information and patient placement, and that past medical history is an important part of triage.

No description available.

Var femte patient på akutmottagningen söker vård på grund av akut bröstsmärta, om smärtan misstänks vara kardiellt utlöst skall patienten utredas för hjärtinfarkt. På akutmottagningen skall sjuksköterskan skyndsamt fatta beslut om vilken patient som är i störst behov utav medicinsk bedömning av läkare för att minimera risk för framtida komplikationer för patienten. Symtombilden vid hjärtinfarkt skiljer sig vilket försvårar sjuksköterskans initiala bedömning och det finns differentialdiagnoser som inte kräver omgående vård. Syftet med studien är att kartlägga vilka faktorer som påverkar sjuksköterskans prioritering och triagering vid misstänkt hjärtinfarkt på akutmottagning. Examensarbetets metod är en litteraturöversikt och inkluderar åtta artiklar med kvantitativ ansats. Resultatet visar att det kan föreligga faktorer som påverkar triageprioritet. Kvinnligt kön, hög ålder samt frånvaro av bröstsmärta förefaller kunna leda till lägre triageprioritet. Ankomst till akutmottagningen via ambulans samt förekomst av riskfaktorer för hjärtinfarkt kan kopplas till högre triageprioritet. Sjuksköterskan kan ha en förförståelse som påverkar triagebedömningen men genom diskussion och reflektion kan fördomar åskådliggöras och understödja sjuksköterskans beslut. Genom att beakta särskilda patientgrupper som tenderar att undertriageras säkerställs jämlikheten i vården.

Bakgrund: På en psykiatrisk akutmottagning behöver sjuksköterskan under begränsad tid, bedöma patienters risk för en suicidal handling. Tidigare forskning visar att sjuksköterskor upplever suicidriskbedömningar som svåra och belastande. Syfte: Syftet var att beskriva sjuksköterskors erfarenheter av att göra suicidriskbedömningar inom ramen för triagering på psykiatrisk akutmottagning. Metod: Intervjuer genomfördes med tolv sjuksköterskor som arbetar inom triageringsverksamhet på två psykiatriska akutmottagningar inom Region Skåne. Resultat: Det övergripande temat: Sjuksköterskans suicidriskbedömning i triage får avgörande konsekvenser kom från de fyra kategorierna: En del av det dagliga arbetet, Svårigheter med suicidriskbedömningar, Omständigheter som underlättar suicidriskbedömningar, Behov av stöd. Resultatet visade att trots ett betungande ansvar i att utföra suicidriskbedömningar upplevde sjuksköterskorna en tillfredsställelse i sitt arbete. Flera omständigheter som underlättade och försvårade suicidriskbedömningar identifierades och omvårdnadsalliansens betydelse visade sig vara stor. Även stödet av kollegor och ledning kändes nödvändigt. Konklusion: Suicidriskbedömningar inom triage är komplext. Det finns ett behov av trygghet i arbetsmetoder och kontinuitet i personalgruppen. Resultatet visar dessutom ett ökat behov av stöd och förståelse från ledning och organisation gällande kravbild och hantering vid patienters suicidförsök. / Background: At a psychiatric emergency room the nurse needs, for a limited time, to assess the patient's risk of suicidal disorders. Previous research shows that nurses perceive suicide risk assessments as difficult and stressful. Purpose: The purpose was to describe nurses' experiences of making suicide risk assessments within the framework of performing triage at psychiatric emergency clinics. Method: Interviews were conducted with twelve nurses performing triage at two psychiatric emergency clinics under the auspices of Region Skåne. Results: The overall theme: The nurse's suicide risk assessment at triage can have decisive consequences was based on the four categories: Part of daily work, Suicide risk assessment difficulties, Circumstances that facilitate suicide risk assessments, Need for support. The result showed that despite of a heavy responsibility in conducting suicide risk assessments, the nurses´ experienced satisfaction in their work. Several circumstances that facilitated and made suicide risk assessments difficult were identified and the importance of the nursing alliance proved to be significant. The support of colleagues and management were also experienced as necessary. Conclusion: Suicide risk assessments when performing triage are complex. There is a need for security in working methods and continuity of the staff group. The result highlights an increased need for support and understanding from management and organization regarding requirements and management in patients' suicide attempts.

No description available.