Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2005. / Summary in English. Includes bibliographical references.

Thesis (MCur. (Faculty of Health Sciences))--University of Pretoria, 2005. / Summary in English. Includes bibliographical references.

The major purpose of this study was to develop an Adaptation Model for emergency departments in urban and suburban Health Maintenance Organizations. Questions explored which provided data for the Model were: 1) are there significant differences in the demographic, sociologic, and decision-making characteristics of clients seeking services in emergency rooms and after-hour clinics?, and 2) are there significant differences in perceptions of access-related problems and stated preferences for personal physicians among clients seeking such services? A pilot study was completed, critiqued, and analyzed. Final research instruments were developed for adults and children. Questionnaires were completed by 1,031 clients in an urban and suburban facility of the Kaiser-Permanente Medical Care Program in Portland, Oregon. Data analysis was completed using the Statistical Package for the Social Sciences sub-program FREQUENCIES, CROSSTABULATION, AND DISCRIMINANT. Major findings of this study were: 1) no significant differences existed in the demographic and sociologic characteristics of clients, 2) significant differences were found in perceived problems of access, in decision-making characteristics, and in preferences for personal physicians. Significant items were: 1) convenience of the facility location, 2) immediacy and availability of care, 3) contact prior to arrival, 4) instruction by "nurse" to seek care, 5) clients reporting they did not have a personal physician, and 6) repeated use of the emergency department during the previous year. Different profiles of decision-making characteristics of urban and suburban clients resulted from the analyses. The overall pattern of care for children varied less between urban and suburban settings than did the pattern of care for adults. Findings were discussed in terms of the traditional model of emergency department care. Conflicts arising from system "controls" provided the basis for suggesting changes incorporated into the Adaptation Model. The basic premise for the Adaptation Model advances the point at which triage occurs, eliminates conflicts of control, and thus modifies both consumer behavior and the emergency department system. / Graduation date: 1982

Thesis (Ph.D.)--University of California, Los Angeles, 2004. / Includes bibliographical references.

CO2 and its influence on environmental and ecological processes focuses the attention of all current media. In the medical area, expired CO2 measurement with Capnography has gained acceptance for all patients needing clinical monitoring and supervision. But recent research works are showing the promises of CO2 as a diagnostic tool or therapeutic monitoring. In this case, measurement of expired CO2 in function of the expired volume, called Volumetric Capnography, has a theoretical better performance than the traditional time-based Capnography. When expired CO2 data are combined to arterial CO2 sampling, the clinician faces breath-by-breath curves, which give a bedside knowledge of the pulmonary ventilation and perfusion status of his patient. Pulmonary embolism is a particular application of Volumetric Capnography. This frequent and challenging disease is characterized by impaired relationships between the pulmonary ventilation and perfusion, going from deadspace to shunt. Volumetric Capnography deserves a careful attention in this area, since its combination with other clinical or biological signs could become part of a diagnostic procedure, either for the detection of the disease when capnographic parameters are clearly impaired, or for ruling out this diagnosis when Volumetric Capnography analysis is normal. In the same way, monitoring the efficacy of thrombolytic therapy when pulmonary embolism is massive is another particular interest for expired CO2 measurement. Physicians working in the Emergency Department demand performing devices for improving patient care. Such devices can be particularly adapted to daily practice if they can be used by the bedside, if they are non-invasive, safe, efficient, feasible, and applicable to non-intubated patients. Volumetric Capnography, which seems to answer those requirements, will certainly deserve growing attention and interest in the future as a direct application of pulmonary pathophysiology. Even if Volumetric Capnography is still at the frontier between clinical research and clinical practice, let us hope that the studies presented in this thesis will improve the clinical acceptance of this attractive technology.

Aim: The aim of this study was to describe the nurse’s work at an emergency department trough a perspective of caring. Method: A literature review has been made of twelve studies published between the years of 2002 – 2012. The focus of all the studies was on Swedish emergency departments.   Results: The researchers found four themes that they choose to use as a way of describing the nurses work in the emergency room as detailed as possible. These themes were: ‘The emergency room’, ‘the nurse’s job assignments at an emergency department’, ‘the patient’s experiences’ and ‘lifeworld and communication’. This study shows that it is problematic for the nurses to give a caring nursing. The emergency department is more focused on medicine than caring, as there are certain parameters to follow as a nurse at an emergency department.  Lack of time and manpower has been a consistent factor in this study to explain the inability to give good caring at the emergency department. Conclusion: High workload leads to short time with each patient. This leads to a lack of patient care in the emergency room. In the short meetings with patients, important information could get lost and this could lead to inferior nursing. This study shows that some nurses developed strategies to make a fast and correct assessment of the patient. Other nurses developed strategies to make the patients feel more comfortable. Examples were to make eye contact, touch the patient in a comforting way and take the time to really listen to the patient during the short time they had with each patient.

More than 6 million people present to emergency departments (EDs) across the US annually with chief complaints of chest pain or other symptoms suggestive of acute myocardial infarction (AMI). Of the million who are diagnosed with AMI, 350,000 die during the acute phase. Accurate triage in the ED can reduce mortality and morbidity, yet accuracy rates are low and delays in patient care are high. The purpose of this study was to explore the relationship between (a) patient characteristics, registered nurse (RN) characteristics, symptom presentation, and accuracy of ED RN triage level designations and (b) delay of care of patients with symptoms suggestive of AMI. Constructs from Donabedian’s Structure-Process-Outcome model were used to guide this study. Descriptive correlational analyses were performed using retrospective triage data from electronic medical records. The sample of 286 patients with symptoms suggestive of AMI comprised primarily Caucasian, married, non-smokers, of mean age of 61 with no prior history of heart disease. The sample of triage nurses primarily comprised Caucasian females of mean age of 45 years with an associate’s degree in nursing and 11 years’ experience in the ED. RNs in the study had an accuracy rate of 54% in triage of patients with symptoms suggestive of AMI. The older RN was more accurate in triage level designation. Accuracy in triage level designations was significantly related to patient race/ethnicity. Logistic regression results suggested that accuracy of triage level designation was twice as likely (OR 2.07) to be accurate when the patient was non-Caucasian. The patient with chest pain reported at triage was also twice as likely (OR 2.55) to have an accurate triage than the patient with no chest pain reported at triage. Electrocardiogram (ECG) delay was significantly greater in the patient without chest pain and when the RN had more experience in ED nursing. Triage delay was significantly related to patient gender and race/ethnicity, with female patients and non-Caucasian patients experiencing greater delay. An increase in RN years of experience predicted greater delay in triage. Further studies are necessary to understand decisions at triage, expedite care, improve outcomes, and decrease deaths from AMI.

No description available.

Patient satisfaction is a key outcome measure being examined by researchers exploring the relationships between patient outcomes and hospital structure and care processes. Only a few non-generalizable studies, however, have explored the relationship of nurse staffing and patient satisfaction with nursing care in emergency departments of hospitals. This dissertation aims to address that gap. Using more than 182,000 patient satisfaction surveys collected over a five-year period from 153 emergency departments (EDs) in 107 hospitals throughout Ontario, this study explores the relationship between nurse staffing and patient perceptions of nursing care in a range of Canadian ED settings, including urban and rural, community and academic, and small and large healthcare institutions with varying sizes and case mix. Using an established conceptual framework for investigating the relationship between nurse staffing and patient outcomes, nineteen nurse staffing variables were initially investigated. Ultimately, however, only five staffing variables were used in the multi-level regression analyzes. These five variables included registered nurse (RN) proportion, RN agency proportion, percent full-time nurse worked hours, RN worked hours per patient length of stay and registered practical nurse (RPN) worked hours per length of stay. Emergency department case mix index, patient age and gender, hospital peer group, size, wait times, cleanliness of the emergency department, physician courtesy, and year of measurement were controlled to account for their effect on the relationship between nursing staffing and patient satisfaction in the ED. The study revealed a subset of six patient satisfaction variables representing the overall variation in patient satisfaction with nursing care in the ED. Although RN proportion and RPN worked hours per length of stay were found to have a statistical association with patient satisfaction in the ED, the association was weak and not administratively actionable. Interpersonal and environmental factors such as physician and nurse courtesy, ED cleanliness and timeliness, however, were areas which hospital administrators should consider since they were highly associated with patient satisfaction in EDs.

Failure to recognize and respond to changes in a patient’s condition is a limitation in the effective utilization of Medical Emergency Teams (METs). A system that uses smartphone technology to facilitate vital signs collection at bedside has been developed. The alerts engine, based upon Mount Sinai Hospital’s (MSH) MET calling criteria, can automatically alert the MET of patients exhibiting abnormal vital signs. The system, without automated alerting, was piloted at MSH. Sensitivity and specificity calculations revealed that the MSH algorithm had a lower sensitivity and specificity than the Cuthbertson or the Modified Early Warning Score algorithms. This suggests that the MSH algorithm, compared to the others, was poor at identifying patients that did and did not require a MET consultation. Furthermore, the low positive predictive value suggests that the majority of alerts were not associated with a MET call. Therefore, the MSH algorithm is not recommended for the automated system.