Student Number : 9512861R - MA research report - School of Psychology - Faculty of Humanities / The present study served to investigate the way in which continuous exposure to potentially traumatic incidents impacts on the South African Emergency Care Practitioner (ECP). The study sought to investigate the presence of symptoms of posttraumatic stress (PTS) in the sample and the events which appear to pose the greatest threat to these ECPs’ mental health. The notion that individuals exposed to the same traumatic stressors can present with very different posttraumatic responses has led to the acknowledgement that the relationship between exposure and PTS is a complex one. Studies have examined a multitude of variables believed to impact in some way on this relationship, with particular emphasis on individual appraisals and coping styles. Less attention has been afforded the role of social phenomena in the development of posttraumatic stress disorder (PTSD). The attention that has been afforded these phenomena has tended to examine social support as a unidimensional construct, and studies have often measured different social support conceptualisations. Utilising a recognised psychosocial framework, the present study sought to investigate the impact of social support in the relationship between exposure and PTS. It sought to examine three distinct facets of social support, namely: the appraisal of being supported, the perception of available supportive behaviours from family and friends, and an individual’s orientation towards utilising support. The study used a cross-sectional, correlational design to investigate the relationships between exposure, PTSD symptoms and social support. The procedure involved the anonymous completion of several standardised self-report measures by 107 ECPs from Netcare 911, a private South African emergency care organisation. These measures included a revised version of the Paramedic Work Exposure Checklist (PWEC), the Revised Impact of Event Scale (RIES), the Social Support Appraisals Scale (SS-A), the Social Support Behaviours Scale (SS-B) and the Network Orientation Scale (NOS). The events that tended to be rated as having the most negative emotional impact among respondents involved assisting abused or injured children, witnessing the death or injury of a coworker, assisting victims of sexual assault, dealing with equipment failure or the incompetence of others and receiving inadequate or incorrect information when dispatched on a call. The correlational analyses revealed that exposure to events rated as having a negative emotional impact was significantly and positively associated with symptoms of PTSD in the sample. Correlational analyses also revealed that each of the facets of social support measured was significantly negatively associated with symptoms of PTSD. The results indicate that the mode and source of support most significantly associated with symptoms of PTSD in the sample was the perception of available emotional support from friends. In spite of the direct relationships observed between symptoms of PTSD and the facets of social support examined, none of the social support facets investigated emerged as a significant buffer in the relationship between exposure and PTSD. The study highlights the need for additional research, including longitudinal investigation, into the role of multiple facets of social support in the relationship between exposure and PTSD. Some suggestions for future research and the practical application of the findings of the research are offered.

Background: Every year, about 800 000 people in the world commits suicide, which makes ita serious global public health problem. There are several risk factors that increases the risk ofa person committing suicide. The stigma is a major problem and suicidal patients hasexperienced a poor treatment from nurses in emergency care. Nurses has a significant role inthe care of suicidal patients. Aim: The aim was to describe nurses experience in the care of suicidal patients in emergencycare. Method: A literature review based on 12 scientific articles. Results: The literature review resulted in four different themes; a meeting that evokesfeelings, the nurses approach, shortcomings in the department and the need for education. Conclusion: Nurses experience discomfort and difficulties in the care of suicidal patients.Prejudices and religious values could result in a negative attitude which could have aninfluence on the quality of the nursing care. Nurses are in need of education and to haveguidelines for the care of suicidal patients. Suggestions for continued research: Suggestions for continued research is how religiousvalues affect the suicidal patient. Another suggestion is that more studies within emergencycare are made related to what kind of effects education has on the nurse in the care of suicidalpatients.

My thesis, then, proposes to examine an often-overlooked field in which tensions relating to immigration also occurs: health care. It aims to better understand how Germany’s health care system, particularly its emergency facilities, have responded to the increasing ethnic and cultural diversity of patients as a result of these demographic shifts, and what still must be done to provide equal and satisfactory health care for all patients.

?rea de concentra??o: Pol?ticas de integra??o, sa?de e educa??o. / Submitted by Jos? Henrique Henrique (jose.neves@ufvjm.edu.br) on 2017-03-16T20:50:31Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) raina_pleis_neves_ferreira.pdf: 4111901 bytes, checksum: f2807292d6f426c963b1b610565dfed0 (MD5) / Approved for entry into archive by Rodrigo Martins Cruz (rodrigo.cruz@ufvjm.edu.br) on 2017-03-30T18:33:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) raina_pleis_neves_ferreira.pdf: 4111901 bytes, checksum: f2807292d6f426c963b1b610565dfed0 (MD5) / Made available in DSpace on 2017-03-30T18:33:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) raina_pleis_neves_ferreira.pdf: 4111901 bytes, checksum: f2807292d6f426c963b1b610565dfed0 (MD5) Previous issue date: 2016 / Os cursos de gradua??o da ?rea da sa?de vivem uma nova realidade com a inclus?o de novas estrat?gias no seu processo de ensino/aprendizagem. Hoje, o conhecimento exigido para a pr?tica segura de cuidados aos doentes demanda uma estrat?gia de ensino que vai al?m do ensino did?tico tradicional. O processo tecnol?gico tem possibilitado novas formas de trabalhar o conhecimento no ensino superior, a simula??o ? um exemplo. Esse trabalho objetivou avaliar o conhecimento, satisfa??o e autoconfian?a adquiridos com o uso de diferentes estrat?gias de ensino, em estudantes de Medicina e Enfermagem de uma Universidade P?blica. Trata-se de um estudo quase-experimental, explorat?rio e anal?tico, sobre a utiliza??o da metodologia tradicional com aula expositiva e da interven??o simulada, avaliando a autoconfian?a do estudante no atendimento ao paciente cr?tico. Na coleta de dados utilizou-se de formul?rio para obter a caracteriza??o do sujeito, provas te?ricas antes e depois, Escala de Satisfa??o dos Estudantes e Autoconfian?a na Aprendizagem para avalia??o da simula??o. Os dados coletados foram tabulados e analisados com software Statistical Package for Social Sciences(SPSS), vers?o 23.0. Para verificar se houve diferen?a entre as pontua??es obtidas nas provas, os resultados foram submetidos ao teste de Friedman, com p?s-teste de Wilcoxon. A associa??o de dados categ?ricos foi verificada pelo teste Qui-quadrado. Foi adotado o n?vel de signific?ncia de 95% (p<0,05). Comparando as duas metodologias de ensino utilizadas nesse estudo, os testes demonstraram que os estudantes obtiveram maior ?ndice de acerto nas quest?es da prova, ap?s a simula??o real?stica (p<0,001). Em rela??o ? escala de satisfa??o e autoconfian?a, os dados demonstraram satisfa??o e autoconfian?a dos estudantes ap?s a simula??o real?stica (p<0.001). A integra??o da metodologia tradicional com a da simula??o, teoria e pr?tica, mostrou-se eficaz para a obten??o e consequentemente melhora do conhecimento. Conclui-se que a simula??o ? uma metodologia inovadora e ativa que permite melhorar o conhecimento do estudante, proporcionando maior satisfa??o e autoconfian?a na aprendizagem. Pode-se dizer que a simula??o melhorou o aprendizado ao proporcionar atrav?s da viv?ncia, experi?ncias que simulam a pr?tica cl?nica. / Disserta??o (Mestrado) ? Programa de P?s-gradua??o em Ensino em Sa?de, Universidade Federal dos Vales do Jequitinhonha e Mucuri, 2016. / The health of undergraduate living a new reality with the inclusion of new strategies in their teaching/learning process. Today, the knowledge required for the safe practice of patient care requires a teaching strategy that goes beyond the traditional didactic teaching. The technological process has enabled new ways of working knowledge in higher education; an example of this is the simulation. This study aimed to evaluate the knowledge, satisfaction e self-confidence acquired through the use of different teaching strategies in Medicine and Nursing students of a Public University. It is a quasi-experimental, exploratory and analytical study about the use of the traditional methodology with expository class and simulated intervention, evaluating the student's self-confidence in critical patient care. In the data collection, a form was used to obtain the characterization of the subject, theoretical tests before and after, Student Satisfaction Scale and Self-confidence in Learning to evaluate the simulation. Data were tabulated and analyzed with software Statistical Package for Social Sciences (SPSS) version 23.0. To check whether there was difference between the scores obtained in the tests, the results were submitted to the Friedman test, with post Wilcoxon test. The categorical data binding was checked by chi-square test. The significance level of 95% (p <0.05) was adopted. Comparing the two teaching methods used in this study, the tests have shown that students had higher success rates after the realistic simulation (p<0.001). Regarding the scale of student satisfaction and self-confidence, the data showed satisfaction and self-confidence of students after realistic simulation (p<0.001). The integration of traditional methods with the simulation, theory and practice, proved to be effective to achieve and consequently improves knowledge. We conclude that the simulation is an innovative and active methodology to improve student knowledge, providing satisfaction and confidence in learning. It can be said that the simulation by providing improved learning by experience, experiments that simulate the clinical practice.

Certified athletic trainers (ATCs) are often the first to respond to an athletic sudden cardiac arrest (SCA) and are expected to administer the highest quality of cardiopulmonary resuscitation (CPR) possible. The goal of this study was to investigate the relationship between confidence and CPR quality in ATCs. Fifty ATCs completed confidence questionnaires before and after performing a prolonged CPR assessment on a medium-fidelity manikin. CPR data included measures of chest compression and ventilation quality. Data were analyzed to compare confidence levels pre- and post-CPR assessment, as well as to determine the relationship between CPR performance and self-efficacy. A small, negative correlation was found between confidence and CPR performance but performing a prolonged session of CPR did not affect confidence levels. Overall CPR quality was adequate, but ventilations and compression rates were lacking. The relationship between confidence and CPR quality must be explored further to help revise athletic training educational curricula.

Most medical students across the U.S. currently receive intubation skills training on low fidelity simulation (LFS) plastic mannequins. A limitation of these LFS models is that they do not allow students to attain complete familiarity and proficiency with intubation in a real-world clinical setting. For several years now, ETSU has been utilizing the Thiel embalming technique, which allows for greater joint flexibility and preservation of soft tissues compared to traditional embalming techniques. Our study set out to evaluate the efficacy of Thiel cadavers versus LFS plastic mannequins in assessing whether one model was more suitable in teaching intubation skills. After IRB approval, we exposed thirty-two first-and second-year medical students to both LFS models and Thiel embalmed cadavers in order to assess preparedness and confidence for performing intubations, and overall transference to patient care. Participants were shown an instructional video and given a brief lecture on the steps of a successful intubation by the primary investigators of the project before they were asked to practice intubation on both a Thiel cadaver as well as a LFS plastic mannequin. Participants were randomly assigned to note which teaching method to practice on first (Thiel cadaver or LFS model). Students were given written instructions during the procedure, and they completed a pre and post survey assessing preparedness, confidence, transference to patient care, and overall preference between the Thiel cadaver and LFS model for education. Our study significantly concluded that students felt better prepared and more confident by practicing on the Thiel cadaver and unanimously thought that it had better transference to clinical care. Overall, students also felt that the Thiel cadaver provided more knowledge, and close to two thirds of subjects preferred the Thiel cadaver over the LFS mannequin for learning intubation skills while a third of subjects said that both models should be used in training.

Background: Children are a large patient group in emergency care. It is important that nurses have knowledge about encountering children in the emergency care. The nurse who work primarily at regular emergency departments do usually take care of adult patients. Therefore, the nurses have the most knowledge and competence about these patients. This means that nurses’ may have a lack of capacity when it comes to meeting children and their families in emergency care. Aim: The aim of this literature study was to illuminate nurses’ experiences with children andtheir families in emergency care.  Method: A method of a five-step model was performed and based on analysis of ten qualitative scientific articles in order to contribute to evidence-based knowledge for nursing care. The analysis resulted in three main themes and seven subthemes.  Results: The main themes were: Create a relationship, External factors that affect the care meeting and Knowledge and clinical skills. Nurses experienced insecurity in the meeting with the child and their families. This was based on deficiencies in experience and qualification in pediatric nursing.  Conclusion: The nurse needs to be able to conform the meeting based on the child's developmental level and needs. The environment can be perceived by the child as stressful, which can affect the meeting with the nurse and the quality of care. This literature study showed that family-centered care is important. The nurse needs to take both the child and their family into account in order to be able to provide safe care.

No / Demand for both Emergency Department (ED) and radiology services continues to increase across the UK while simultaneously, healthcare organisations are being asked to evaluate the quality of care provided and constrain service costs. National guidance on radiograph reporting times recommends ED radiographs are reported on day of patient attendance but in practice, delays in reporting persist. This study considers whether a radiographer led immediate reporting service for ED referrals could provide a cost-effective service improvement solution. A pragmatic multi-centre randomised controlled trial was undertaken. 1502 patients were recruited and randomly assigned to an immediate or delayed reporting arm and treated according to group assignment. Patient health gain was measured in terms of change in utilities derived from EQ-5D responses at baseline and 8 week follow-up. Resources used and the costs of an immediate reporting service were analysed at the patient level and compared to standard reporting practices. 1688 radiographic examinations were performed (1502 patients). 79 discordant radiographic interpretations were identified (n = 79/1688; 4.7%). Interpretive errors were significantly reduced within immediate reporting arm. No significant difference was noted in the relative improvement in patient perceived health status between the 2 arms of the study. The average cost saving per patient in the immediate reporting arm was £23.40. Radiographer led immediate reporting of ED radiographs is a cost-effective service development and its universal introduction could make a significant contribution to the current drive to increase service productivity within current budget constraints. / National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB) programme (PB-PG-0407-13033).

Yes / The most common route to a hospital bed in an emergency is via an emergency department (ED). Many recent initiatives and interventions have the objective of reducing the number of unnecessary emergency admissions. We aimed to assess whether ED admission thresholds had changed over time taking account of the casemix of patients arriving at ED. Methods: We conducted a retrospective cross-sectional analysis of more than 20 million attendances at 47 consultant-led emergency departments in England between April 2010 and March 2015. We used mixed- effects logistic regression to estimate the odds of a patient being admitted to hospital and the impact of a range of potential explanatory variables. Models were developed and validated for four attendance subgroups : ambulance-conveyed children; walk-in children; ambulance-conveyed adults; and walk-in adults. Results: 23.8% of attendances were for children aged under 18 years, 49.7% were female and 30.0% were conveyed by ambulance. The number of ED attendances increased by 1.8% per annum between April 2010 – March 2011 (year 1) and April 2014 –March 2015 (year 5). The proportion of these attendances that were admitted to hospital changed little between year 1 (27.0%) and year 5 (27.5%). However, after adjusting for patient and attendance characteristics the odds of admission over the five year period had reduced by: 15.2% (95% CI 13.4% - 17.0%) for ambulance-conveyed children; 22.6% (95% CI 21.7%-23.5%) for walk-in children; 20.9% (95% CI 4%-21.5%) for ambulance conveyed adults; and 22.9% (95% CI 22.4%-23.5%) for walk-in adults. Conclusions: The casemix-adjusted odds of admission via ED to NHS hospitals in England have decreased since April 2010. EDs are admitting a similar proportion of patients to hospital despite increases in the complexity and acuity of presenting patients. Without these threshold changes, the number of emergency admissions would have been 11.9% higher than was the case in year 5.

Andningsbesvär är en av de vanligaste sökorsakerna på Sveriges akutmottagningar. Det är ett komplext tillstånd som består i både fysiska och psykiska faktorer och kräver såväl farmakologisk som icke-farmakologisk vård. Okunskap inom den icke-farmakologiska vården leder till utebliven behandling, förlängt patientlidande och stor risk för vårdskador. Syftet med detta arbete var att belysa akutsjuksköterskans interventioner för att underlätta och förbättra tillståndet för patienter med andningsbesvär inom akutsjukvård. Studiedesignen som tillämpats var en litteraturöversikt med systematisk metod. Vetenskapliga artiklar som behandlat icke-farmakologisk behandlingsstrategi av all form av andningsbesvär som presentationssymtom eller huvudsymtom inom akutsjukvård har inkluderats. Totalt 15 vetenskapliga artiklar uppfyllde kriterierna för studien och genomgick kvalitetsgranskning samt integrerad analys. Resultaten visade att interventionerna kan delas in i fysiska (aktiv motståndsträning, bukläge och kontrollerad andning), såväl som psykologiska (trygg närvaro, kommunikation och utbildning samt vårdrelation). Motståndsträning kan göras med såväl sammandragna läppar som med apparat med god effekt. Bukläge visade sig effektivt på vakna patienter med omfattande andningsbesvär och syrgasbehov. Riktad och strukturerad kommunikation och patientutbildning ledde inte bara till signifikant förbättrade symtom utan även till att patienterna tolererade interventionerna bättre. Även en god vårdrelation med sjuksköterskan visade på lättare acceptans till givna behandlingar. Den slutsats som drogs var att akutsjuksköterskan har en stor roll i att förbättra tillståndet för patienter med andningsbesvär. Akutsjuksköterska kan ge lättillgängliga, men värdefulla ickefarmakologiska insatser för både de fysiska och psykologiska aspekterna av andningsbesvären. De kan även bidra med kunskap och utbildning för patienterna som resulterar i minskad ångest, förbättrad livskvalitet och minskade sjukhusbesök. De undersökta interventionerna kan troligen med fördel implementeras inom sluten- såväl som öppenvård för att förbättra tillståndet hos patienter med andningsbesvär. / Breathlessness is one of the most frequent causes of visit in Swedish emergency departments. It is a complex condition consisting of both physical and psychological factors, requiring both pharmacological and non-pharmacological treatment approaches. Inexperience in nonpharmacological treatment causes missed treatment, prolonged patient suffering and increased risk of care related injuries. The aim of this study was to illustrate the interventions of the emergency care nurse in facilitating and improving the condition for patients with breathlessness in emergency healthcare. The study design applied was a literature review with a systematic method. Scientific articles covering non-pharmacological treatment approaches of any breathlessness as presenting or main symptom within emergency healthcare was included. 15 articles in total met the criteria for the study and underwent a quality control and integrated analysis. The results indicated that the interventions could be divided into physical (active resistance training, prone position and controlled breathing techniques) and psychological (assuring presence, communication and education and care relationship). Resistance training can be achieved either through pursed lips or specific devices with good results. Prone position proved effective in patients with severe breathlessness requiring oxygen therapy. Aimed and structured communication and patient education did not only result in improved symptoms but enabled the patients to better endure the interventions. A good care relationship too facilitated better acceptance to given treatment. The conclusion drawn was that the emergency care nurse played an immense role in improving the condition of patients presenting with breathlessness. The emergency care nurse could provide easily available, although valuable non-pharmacological contributions to both the physical and psychological aspects of breathlessness. Furthermore, they could contribute with knowledge and education for the patients resulting in relieved anxiety, improved quality of life and reduced hospital visits. The analyzed interventions could presumably be successfully implemented within both inpatient and outpatient care improving conditions for patients suffering from breathlessness.