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)

Emergency department nurses are at high risk for violence in the workplace (Keely, 2002; Fernandez et al., 1998; Nachreiner et al., 2005; Mayer et al., 1999). It is estimated that between 52% and 82% of emergency nurses will experience physical violence and 100% of emergency department nurses will experience non-physical violence in their careers. Despite this fact, there are limited studies examining workplace violence among this vulnerable group (Fernandez et al., 1998; Levin et al., 1998). Therefore, the purpose of this qualitative descriptive study was to examine the experiences of emergency department nurses with workplace violence. Levin et al.’s (2003) Ecological Occupational Model (EOHM) was used to guide this study. Four focus groups were conducted with 27 nurses who represented different types of emergency departments (rural community facility to large urban Level 1 trauma center). Results of the study suggested that the majority of participants (96%) experienced some form of work-related violence and 75% had attended at least one violence education class. The major themes of frustration and powerlessness emerged from the data. Sub themes included professional conflict while caring for violent patients, personal detachment as an emotional survival mechanisms, and feelings of victimization. Additional factors contributing to workplace violence included: personal attributes of the nurse, the workplace, and the community where the emergency department was located. These study results have potential to guide intervention development aimed at reducing workplace violence in the emergency department setting.

Bakgrund: Patienters utsatthet och sårbarhet är överhängande inom akut och ambulanssjukvård och kan ses bero dels på situationen de befinner sig i men även då de är i en beroendeställning till vårdpersonalen i ambulansen eller på akutmottagningen. Detta skapar risker i patientsäkerheten om överrapporteringen mellan dessa vårdgivare inte är optimal. Syftet var att beskriva hur patientsäkerheten påverkas vid överrapportering mellan specialistsjuksköterskor på akutmottagning när patienten anländer med ambulans. Metod: Denna magisteruppsats är en litteraturstudie med integrerad analys vilket innebär att arbetet sker i flera steg. Avsikten är att eftersöka relevant vetenskaplig litteratur inom ett specifikt område, granska det och sedan sammanställa materialet. Resultat: Granskningen resulterade i två stycken kategorier med sex stycken underkategorier. Kategorierna i resultatet var “risker för patientsäkerheten vid överrapportering” med underkategorierna “stress”, “miljö” och “verktyg”, samt “förutsättningar för patientsäkerhet vid överrapportering” med underkategorierna “förberedelse”, “kommunikation” och “struktur”. Slutsats: Överrapportering är en vanligt förekommande arbetsuppgift för Specialistsjuksköterskor inom Ambulans- och Akutsjukvård. För att patientens väg genom sjukvården ska bli så säker och trygg som möjligt behöver rapporten innehålla en viss mängd medicinsk information men även det mellanmänskliga, det personliga och ges under rätt förutsättningar för att kunna anses som patientsäker. Faktorer som påverkar kvaliteten och innehållet i rapporten är bland andra; yttre faktorer, så som stress, miljö och brist på utrustning. Förutsättningar för patientsäkerhet kan vara; en god struktur, förberedelser och kommunikation. / Background: Patients' vulnerability is imminent in emergency and ambulance care and can be seen to depend partly on the situation they are in but also when they are in a position of dependence on the care staff in the ambulance or in the emergency department. This creates risks in patient safety if the handover between these care providers is not optimal.   Aim: The purpose was to describe how patient safety is affected by handovers between specialist nurses in the emergency department when the patient arrives by ambulance. Methods: This master's thesis is a literature review with integrative analysis, which means that the work takes place in several stages. The intention is to search for relevant scientific literature in a specific area, review it and then compile the material. Results: The review resulted in two categories with six subcategories. The categories were "risks for patient safety in the event of over-reporting" with the subcategories "stress", "environment" and "tools", and "conditions for patient safety in the event of overreporting" with the subcategories "preparation", "communication" and "structure". Conclusion: Handing over a patient is a common task for Specialist Nurses in Ambulance and Emergency Care. In order for the patient's path through healthcare to be as safe and secure as possible, the report needs to contain a certain amount of medical information but also the interpersonal, the personal and given under the right conditions to be considered patient safe. Factors that affect the quality and content of the report include; external factors, such as stress, environment and lack of equipment. Prerequisites for patient safety can be; a good structure, preparation and communication.

Emergency response is highly time-critical and information dependent: every moment counts and organizations need to access various information that supports their decision making and informs them about the scale and location of the emergency, the damages, and the availability of human and physical resources. This kind information can originate from many different places and the situation can be stressful as there is a need to communicate quickly, reliably and accurately within their own organization, but also inter-organizationally. ICTs make it possible to access and spread information with speed and efficiency, but other factors, such as different professional cultures, can still hinder information sharing. There is a growing need in emergency organizations to develop understanding for how communications between emergency responders can be secured. It seems important to consider how emergency responders respond to security objectives, since the assumptions for secure communications may not only be developed on the premise of ICT, but also how the emergency actors appreciate the emergency environments in terms of secure communications.The aim of this research is to develop understanding of information security and secure communications in a context where it has not been well researched. The research looks at secure emergency communications from a socio-technical viewpoint and concentrates on the communication inside and between the emergency organizations of police, the paramedics, and the rescue department in the municipality of Kemi, and more specifically on the communications of operative emergency actors while they are working in the preparedness and response phases of emergency management. Two persons from each organization were interviewed using semi-structured interviews, and the empirical data was used for writing the appended papers that are the basis of this thesis work.The research started by doing an extensive literature review and analysis on the field of secure emergency communications. The results show that while technical developments on the field aim at effective and secure technologies, organizational aspects of emergency communications seem to involve not only emergency actors, but also how these actors more and more utilize information technology. The landscape for emergency management is becoming very diverse, which challenges the way that secure emergency communications can be understood. The developers of future emergency communications structures not only need to ensure the technical aspects of confidentiality, availability and integrity of information, but they also need to take into account the social rules, norms and structures that guide the emergency communication. Next, this research sought out to re-conceptualize the role of information security in emergency response. A conceptual basis encompassing technical, cognitive and organizational information security layers as a relationship between association and connectivity was developed by synthesizing Actor Network Theory and Theory of Organizational Routines. The approach of combining two theoretical accounts details the enactment of information security in emergency response so as to understand how cognition ties technical security features with organizational security issues. Without the cognitive layer, the technical and organizational aspects of information security remain static or disconnected to the actions performed during emergency response. Theoretically the approach contributes constructively to describe an alternative approach to information security research to address the gap between formal and informal criteria of information security.Lastly, the research sought out to explore the current situation of the case organizations in detail concerning their level of information security, communication challenges faced, and training offered. It was learned that different aspects of information security are valued depending on whether emergency responders work in preparation periods or if they are responding to an emergency: 1) When working in their own respective organizations the most important aspect was information confidentiality 2) When responding to emergency the most important aspects were information availability and integrity. Most communication challenges present in emergency communications can be seen to arise when responding to emergencies. This is not something currently being taken into account in the case organizations. The basic training of emergency actors and the training and guidelines of each organization largely concentrate on confidentiality issues, and tools and communications training that would be needed to ensure information availability and integrity when responding to an emergency is not prioritized. To overcome the communication challenges present in emergency communications and to ensure confidentiality, availability and integrity of emergency information, those responsible for information security in emergency organizations must therefore provide up to date information security training and awareness building, but also tools and communications training that supports inter-organizational communication.

The public health emergencies, such as bioterrorist attacks or pandemic outbreaks, have gained serious public and government attentions since the 2001 anthrax attacks and the SARS outbreak in 2003. These events require large-scale and timely dispensing of critical medical countermeasures for protection of the general population. This thesis research focuses on developing mathematical models, real-time algorithms, and computerized decision support systems that enable (1) systematic coordination to tackle multifaceted nature of mass dispensing, (2) fast disease propagation module to allow immediate mitigation response to on-site uncertainties, and (3) user-friendly platform to facilitate modeling-solution integration and cross-domain collaboration. The work translates operations research methodologies into practical decision support tools for public health emergency professionals. Under the framework of modeling and optimizing the public health infrastructure for biological and pandemic emergency responses, the task first determines adequate number of point-of-dispensing sites (POD), by placing them strategically for best possible population coverage. Individual POD layout design and associated staffing can thus be optimized to maximize throughput and/or minimize resource requirement for an input throughput. Mass dispensing creates a large influx of individuals to dispensing facilities, thus raising the risk of high degree of intra-facility infections. Our work characterizes the interaction between POD operations and disease propagation. Specifically, fast genetic algorithm-based heuristics were developed for solving the integer-programming-based facility location instances. The approach has been applied to the metro-Atlanta area with a population of 5.2 million people spreading over 11 districts. Among the 2,904 instances, the state-of-the-art specialized integer programming solver solved all except one instance to optimality within 300,000 CPU seconds and solved all except 5 to optimality within 40,000 CPU seconds. Our fast heuristic algorithm returns good feasible solutions that are within 8 percent to optimality in 15 minutes. This algorithm was embedded within an interactive web-based decision support system, RealOpt-Regional©. The system allows public health users to contour the region of interest and determine the network of PODs for their affected population. Along with the fast optimization engine, the system features geographical, demographical, and spatial visualization that facilitate real-time usage. The client-server architecture facilities front-end user interactive design on Google Maps© while the facility location mathematical instances are generated and solved in the back-end server. In the analysis of disease propagation and mitigation strategies, we first extended the 6-stage ordinary differential equation-based (ODE) compartmental model to accommodate POD operations. This allows us to characterize the intra-facility infections of highly contagious diseases during local outbreak when large dispensing is in process. The disease propagation module was then implemented into the CDC-RealOpt-POD© discrete-event-simulation-optimization. CDC-RealOpt-POD is a widely used emergency response decision support system that includes simulation-optimization for determining optimal staffing and operations. We employed the CDC-RealOpt-POD environment to analyze the interactions between POD operations and disease parameters and identified effective mitigation strategies. The disease propagation module allows us to analyze the efficient frontier between operational efficiencies and intra-POD infections. Emergency response POD planners and epidemiologists can collaborate under the familiar CDC-RealOpt-POD environment, e.g., design the most efficient plan by designing and analyzing both POD operations and disease compartmental model in a unified platform. Corresponding problem instances are formed automatically by combining and transforming graphical inputs and numerical parameters from users. To facilitate the operations of receiving, staging and storage (RSS) of medical countermeasures, we expanded the CDC-RealOpt-POD layout design functions by integrating it with the process flow. The resulting RSS system allows modeling of both system processes along with spatial constraints for optimal operations and process design. In addition, agent-based simulation was incorporated inside where integrated process flow and layout design allow analysis of crowd movement and congestion. We developed the hybrid agent behavior where individual agents make decision through system-defined process flow and autonomous discretion. The system was applied successfully to determine guest movement strategies for the new Georgia Aquarium Dolphin Tales exhibit. The goal was to enhance guest experience while mitigating overall congestion.

Since its inception, international aid has been premised on the existence of stable and sovereign recipient states. Official aid relies upon such states for its legitimacy and implementation, and aims to consolidate statehood. In the 1990s, this organising pillar of the international aid system was shaken. The ability of governments to fulfil the basic functions of a sovereign power is now widely questioned. The principle of sovereignty is no longer absolute; rather, it is increasingly contingent upon states' adherence to international, largely Western-defined, norms of behaviour. Where these norms are violated systematically, as in conflict-affected countries, sanctions including trade, political and military measures are deployed. In these 'quasi-states', where sovereignty is contested or weak empirically and juridically, development aid relations are usually suspended and relief the only form of aid available. However, the ability of relief aid to respond to these chronic political emergencies is increasingly questioned. There are increasing demands to make relief more developmental, and for aid to be used to address the cause of crisis - conflict. This thesis examines how aid has worked in a particular type of 'quasi-state': situations of 'post'-conflict transition, and asks whether the new demands on aid in these environments can be met. Examining the cases of rehabilitation assistance to the health sector in Cambodia, Ethiopia and Uganda, it draws three primary conclusions. First, the political meaning, objectives and instruments of relief and development aid are categorically distinct; linking them is ethically and technically problematic. Ethically it implies compromising principles of impartiality and neutrality. Technically, political conditions prevent the transition to more developmental aid instruments. Second, the empirical weakness and juridical ambiguity of statehood in these environments mean that there is no clearly accepted and competent authority to make public policy - no one and everyone owns it. This leads to highly fragmented aid investments that do not provide a basis for the development of public health systems. Third, the absolute scarcity of public resources means that the developmental goal of sustainability is not compatible with that of maximising coverage of health services, level of coverage summary, it suggests that conceptually and operationally the international aid system remains fundamentally ill-equipped to respond to the challenges of chronic political emergencies and their aftermath. 4

Dysfunktionell stress bland sjukvårdspersonal är ett ökande problem i dagens samhälle. En av de vanligaste anledningarna för sjukfrånvaro bland sjukvårdspersonal är psykisk ohälsa och värk i rörelseapparaten på grund av dysfunktionell stress. Sjuksköterskor som måste ta itu med svåra skador och avlidna människor löper större risk att utsättas för höga nivåer av dysfunktionell stress. Ökad utsatthet för stress kan leda till en försämrad prestationsförmåga och en ökad risk för misstag som kan äventyra patientens säkerhet och hälsa. Litteraturstudien har för avsikt att beskriva orsaker till stress och dess påverkan på sjuksköterskan på en akutmottagning. Studien bygger på 10 vetenskapliga artiklar, sex kvantitativa samt fyra kvalitativa. Litteraturgranskningen resulterade i två teman. Administrativ och organisatorisk stress: Administrativ och organisatorisk stress härstammar primärt från en bristande blandning av personal med hög och låg kompetens, underbemanning, överbeläggningar samt omvårdnadskrävande patienter. Konflikter på grund av skillnader i senioritet, tjänstgöringstid, skillnader i vanor och arbetssätt ligger till grund för stress. Dåligt stöd har en stor påverkan på hur sjuksköterskor upplever stress. Vårdpersonal som känner stöd från kollegor och ledning upplever en större arbetstillfredsställelse, högre arbetsmoral och upplever mindre stress i arbetsvardagen. Patientrelaterad stress: Sjuksköterskor utsätts för våld samt traumatiska händelser i sitt vardagliga arbete som upplevs vara en stor orsak till stress. Ångest, skuldkänslor, rädsla samt utmattning är några känslor sjuksköterskor upplever efter hot och våld eller traumatiska händelser. Stress kan leda till minskad koncentrationsförmåga  och  fokus  bland  sjuksköterskor  vilket  kan  resultera  i  en försämrad vårdkvalité. Sjuksköterskor som utsätts för traumatiska händelser löper risk för att utveckla PTSD (posttraumatisk stress disorder). För att kunna tillfredsställa grundläggande behov, undvika lidande, bidra till ökat välbefinnande och inge trygghet hos patienten. Är det viktigt med en ökad insikt i sjuksköterskans stressfyllda arbetssituation på akutmottagningar.

published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy

The Texas Education Code has specific requirements for public schools as it relates to emergency planning and response expectations. There are no similar requirements for Catholic schools in state statute. Through a survey, this report will show that Catholic schools in Texas already have planning and response programs in place. This report will make specific recommendations intended to enhance those current programs. / text

This thesis presents the design and evaluation of the location of a cell phone user, to enable more effective performance monitoring. One of the end-uses I propose is in emergency management, by means of a framework that distributes its functionality between establishing data-set characteristics that are relevant to the problem and a visual tool to evaluate resource-scheduling proposals. Manikarnika is a modular framework, which finds translation in a prototype for Reverse 111. The first steps in the process were to establish whether the parameters I hypothesized as useful, indeed were. Using a statistically significant amount of traces, obtained from real calls placed on the network, the utility of the location metric was established. In order to investigate utilizing a second metric of reputation, a benchmark for evaluating ideas from Social Networks research was proposed, in order to move from arbitrary testing to a more systematic environment. This dissertation details the measurement, design and evaluation of an end-to-end and modular framework for Emergency Management, where the functionality is distributed in order to easily incorporate the changing parameters of sources of information, emergency events, resource requirements of these events and identifying callers that might be able to provide better insight into a situation that is essentially very dynamic. The chasm between research proposals for various end-uses and the application of the same to real life is one that I have tried to bridge in my work. By incorporating pieces from core Electrical Engineering measurements and simulation and extending the use of what was originally a tool built for training Emergency Responders to analyze various resource scheduling agents, which take into account a diversity of administrative domains, I lay the ground work for one possible solution, Reverse 111, which proposes the use of proactive crowd-sourcing for emergency response, with easy extensions to commercial location-based applications.