The increase and changes in the demand for emergency care require pro-active responses from the designers and implementers of the emergency care system. The role of Emergency Care Practitioner (ECP) was introduced in England to improve the delivery of emergency care in the community. The role was evaluated using cost-benefit approach and compared with other existing emergency care roles. An analysis of the cognitive elements (situation awareness (SA) and naturalistic decision making (NDM)) of the ECP job was proposed considering the mental efforts involved. While the cost-benefit approach can justify further spending on developing the role, a cognitive approach can provide the evidence in ensuring the role is developed to fulfil its purpose. A series of studies were carried out to describe SA and NDM amongst ECPs in an ambulance service in England. A study examined decision-making process using Critical Decision Method interviews which revealed the main processes in making decision and how information was used to develop SA. Based on the findings, the subsequent studies focus on the non-clinical factors that influence SA and decision making. Data from a scoping study were used to develop a socio-technical systems framework based on existing models and frameworks. The framework was then used to guide further exploration of SA and NDM. Emergency calls that were assigned to ECPs over a period of 8 months were analysed. The analysis revealed system-related influences on the deployment of ECPs. Interviews with the ECPs enabled the identification of influences on their decision-making with respect to patient care. Goal-directed task analysis was used to identify the decision points and information requirements of the ECPs. The findings and the framework were then evaluated via a set of studies based on an ethnographic approach. Participant observations with 13 ECPs were carried out. Field notes provided further insight into the characteristics of jobs assigned to the ECPs. It was possible to map the actual information used by the ECP to their information needs. The sources of the information were classified according to system levels. A questionnaire based on factors influencing decision-making was tested with actual cases. It was found that the items in the questionnaire could reliably measure factors that influence decision-making. Overall, the studies identify factors that have direct and indirect influences on the ECP job. A coherent model for the whole emergency care systems can be developed to build safety into the care delivery process. Further development of the ECP role need to consider the support for cognitive tasks in light of the findings reported in this thesis.

Bakgrund: Stressrelaterad ohälsa och sjukskrivningar bland sjuksköterskor är ett återkommande problem som vi ofta läser om. Yrket innebär stort ansvar och ställer höga krav på sjuksköterskan. Vi hade ett intresse av att fördjupa oss i hur sjuksköterskan upplever stress i arbetet. Syfte: Att belysa stressfaktorer samt upplevelser av stress hos sjuksköterskor inom akutsjukvården. Metod: En litteraturöversikt har gjorts med en sammanställning av resultatet från åtta kvalitativa och fyra kvantitativa artiklar. Resultaten har sammanställts i sex teman. Resultat: De sex teman som framkom var: bristande stöd  och uppskattning, underbemanning, arbetsbelastning och tidsbrist, bristande inflytande över arbetssituationen och maktfördelning, konflikter och mobbing på arbetsplatsen, fysisk arbetsmiljö samt vårda svårt sjuka patienter. Diskussion: Resultaten har diskuterats i förhållande till Antonovskys teori om känsla av sammanhang, KASAM, där begreppen begriplighet, hanterbarhet och meningsfullhet kopplats till sjuksköterskans upplevelse av stress. Resultatet har även diskuterats i förhållande till tidigare forskning samt egna reflektioner. / entails large responsibilities and high demands for the nurse. We had an interest to highlight how stress affects the nurse in her work. Aim: To highlight stress factors and experiences of stress in nurses in emergency care. Method: A literature review of eight qualitative and four quantitative articles has been made. The results have been arranged into six themes. Results: The six themes were: lack of support and appreciation, understaffing, work load and lack of time, lack of influence over the work situation and power- sharing, conflicts and bullying in the work place, physical work environment and caring for severely ill patients. Discussion: The results have been discussed in relation to Antonovsky’s theory of SOC, Sense of Coherence, where comprehensibility, meaningfulness and manageability have been related to the nurse’s experience of stress. The results have also been discussed in relation to previous research and our own reflections.

The Patient Protection and Affordable Care Act (ACA) aimed to increase accessibility to medical resources for those previously uninsured. Certainly, the ACA has expanded insurance to millions of Americans, however, the evidence and discourse surrounding health accessibility calls into question why, despite the growth of insured Americans, the increase in health insurance coverage under the ACA has not lead to greater accessibility for low income minorities. I propose that disparities in preventive care, the emergency room, and primary care provider services stand as barriers for low income minorities. Insurance coverage does not necessarily equate to greater accessibility if individuals do not have the means to utilize those resources.

Made available in DSpace on 2016-04-29T14:16:15Z (GMT). No. of bitstreams: 1 Elaine Cristina Silva.pdf: 1961461 bytes, checksum: 106cec8f6d1e04fc9d53b996c7939acf (MD5) Previous issue date: 2012-09-04 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The National Health System (Sistema Único de Saúde - SUS) has completed more than two decades in 2012, bringing in its history the contradictions and inequalities of Brazilian society, expressed mainly by the lack of access to goods and services produced collectively, but unequally appropriate, of the which highlight the universal access to health . There is a reality that pushes the Brazilian population to obtain access to health care wherever possible , not respecting the proposal of health care model of health policy that advocates the Basic Health Units (Unidades Básicas de Saúde - UBS) as the gateway for the system (ALMEIDA et al., 2002; ROCHA, 2005; SIMONS, 2008; JESUS and ASSIS, 2010). In everyday practice, it is significant the demand of the users for urgent and emergency services as a gateway to the health system (CECÍLIO, 1997). We adopt as central categories of analysis health in its multiple dimensions approached and understood as a result of the conditions of life and work; and "access" as a central category of analysis of social policies, conceptualized as the result of the effective availability, accessibility, acceptability and accommodation of health services (PENCHANSKY and THOMAS, 1981), such that they can guarantee full attendance, articulated and continued to the users. The purpose of this study was: to analyze the universal access to health, taking as the empirical field the Adult Emergency Care Center in the city of Barueri. In the systematic observation of the health care professionals, there is a perception that the users are seeking the emergency services and emergency inappropriately. We started from the hypothesis that, in view of users, the UBS s do not are the only entrance to the health system, may be appealed to emergency services and emergency according with their care needs. Methodology: bibliographical and documentary research; questionnaire applied to a sample of the systematic type - to 100 users of the Adult Emergency Care Center Barueri, in a typical week; and semi structured interviews with coordination of the service. Results: The study revealed that only 7% of demands that arrived at the Adult Emergency Care Center Barueri were not relevant to that level of attention. On the other hand, a significant portion of users believes that the demand for primary care should occur only when if needs, not considering the idea of continuity and longitudinality of care on this level / O Sistema Único de Saúde (SUS) completou mais de duas décadas em 2012, trazendo na sua história as contradições e desigualdades da sociedade brasileira, expressas sobretudo pela falta de acesso a bens e serviços produzidos coletivamente, mas apropriados de modo desigual, dos quais destacamos o acesso universal à saúde . Uma realidade que impulsiona a população brasileira a obter acesso ao sistema de saúde por onde for possível , não respeitando a proposta de modelo assistencial da política de saúde que preconiza as Unidades Básicas de Saúde (UBS) como a porta de entrada para o sistema (ALMEIDA et al., 2002; ROCHA, 2005; SIMONS, 2008; JESUS e ASSIS, 2010). Na prática cotidiana, é expressiva a demanda dos usuários pelos serviços de urgência e emergência como porta de entrada ao sistema de saúde (CECÍLIO, 1997). Adotamos como categorias centrais de análise a saúde abordada em suas múltiplas dimensões e compreendida como resultado das condições de vida e trabalho. E acesso , como categoria central de análise das políticas sociais, conceituada como o resultado da efetiva disponibilidade, acessibilidade, aceitabilidade e acomodação dos serviços de saúde (PENCHANSKY e THOMAS, 1981), de modo que possam garantir atendimento integral, articulado e continuado aos usuários. O objetivo deste estudo foi: analisar a universalização do acesso à saúde, tomando como campo empírico o Pronto Atendimento Adulto Central no Município de Barueri. Na observação assistemática dos profissionais da área de saúde, há uma percepção de que os usuários buscam os serviços de urgência e emergência inadequadamente. Partiu-se da hipótese de que, na perspectiva dos usuários, as UBS não se constituem como a única porta de entrada ao sistema de saúde, podendo-se recorrer aos serviços de urgência e emergência de acordo com as suas necessidades de atendimento. Metodologia: pesquisa bibliográfica, documental, questionário aplicado a uma amostra do tipo sistemática, a 100 usuários do Pronto Atendimento Adulto Central de Barueri, em uma semana típica e entrevista semiestruturada com a coordenação do serviço. Resultados: o estudo revelou que apenas 7% das demandas que chegavam ao Pronto Atendimento Adulto Central de Barueri não eram pertinentes àquele nível de atenção. Por outro lado, parte significativa dos usuários considera que a demanda para a atenção básica deve ocorrer apenas quando se precisa, desconsiderando a ideia de continuidade e longitudinalidade do atendimento nesse nível

Bakgrund: Hot och våld kan yttra sig både verbalt och fysiskt samt leda till fysiska och/eller psykiska skador på individen. Olika typer av hot och våld kan vara sexuella trakasserier eller andra sätt att hota en person på. Sjuksköterskan har ett stort ansvar gällande omvårdnaden, detta i kombination med dålig struktur och underbemanning på akutmottagningar kan sätta sjuksköterskan i en utsatt position. Syfte: Syftet med denna litteraturstudie var att beskriva sjuksköterskors erfarenheter av hot och våld inom somatisk akutsjukvård. Metod: En deskriptiv litteraturstudie gjordes med 12 vetenskapliga artiklar, vilka söktes fram i databasen Medline via sökmotorn PubMed. Huvudresultat: Resultatet visade att hot och våld var vanligt förekommande. Sjuksköterskor hade erfarenheter av att bli utsatt för både verbalt och fysiskt hot och våld. Resultatet visade även att anhöriga oftast var förövaren i dessa situationer och att triagearbetet kunde vara en bidragande faktor. Utsatthet för hot och våld kunde ge en känsla av rädsla och ångest, inte bara på arbetet utan även i privatlivet. Relevanta åtgärder skulle kunna vara att höja närvaron av säkerhetspersonal, installera överfallslarm och ha ett bra teamarbete. Slutsats: Litteraturstudien visade på att det fanns erfarenheter av verbalt samt fysiskt hot och våld. Studien visade att detta känslomässigt påverkar den utsatta individen. De åtgärder som många tyckte behövdes var att öka tillgången till säkerhetspersonal samt att bära överfallslarm. Den här studien kan öka medvetenheten på området, vilket i sin tur kan leda till förbättrade arbetsrutiner för att öka tryggheten för sjuksköterskor inom akutsjukvård. Med trygga sjuksköterskor kan det bidra till en bättre omvårdnad av patienterna. / Background: Violence could be both verbal and physical and can lead to physical and psychological damages for the victim. Different types of violence can be sexual harassment other ways to threat a person. The nurse has a big responsibility regarding the care of patients. Together with a bad structure and lack of personnel in the emergency care, could it put nurses in an exposed situation. Aim: The aim of this study is to describe nurses’ experiences of threat and violence in the somatic emergency care. Method: A descriptive literature review was conducted with 12 scientific articles that was found by using the database Medline via the search engine PubMed. Findings: This study found that threats and violence are an existing problem. The findings showed that nurses had experience of both verbal and physical threats and violence.The results also showed that relatives were usually the perpetrator and triage could escalate a situation. Exposure of threats and violence could give an emotional impact, both at work and in private life. Relevant actions could be to increase the presence of security personnel and assault alerts as well as to have good teamwork. Conclusion: The literature review found that nurses have experiences of verbal and physical threats and violence, this left an emotional impact on the exposed individual. The measurements nurses’ see as the most important in order to reduce the threats are to raise the presence of security personnel and to wear assault alerts.This study increases the awareness of threats and violence within emergency care. Increased awareness can lead to improved working conditions and procedures which increases the safety of the nurses. Nurses who are secure at the workplace will give better care to the patience in emergency care.

Background: Primary care faces the challenge of developing an easily accessible and effective health care system to meet the needs of the population and to fulfill the care guarantee. Teamwork with satisfactory communication can provide more efficient work and good results for patients. In Gävleborg County, three healthcare centers have started a joint emergency care, where collaboration in teams should optimize resources. Aim: The aim of the this study was to describe district nurses and nurses' experiences of working in the emergency care of primary care. Method: The study had a qualitative approach and a descriptive design. Data were collected using semi-structured interviews and was analyzed with qualitative content analysis. Main result: The interviews resulted in three categories: The teamwork in the emergency care, Changes with a new way of working and Challenges in working with the emergency care. The categories describe district nurses 'and nurses' experiences of a team-based approach where collaboration and accessibility facilitate work and make it effective. The categories also describe challenges in working with the emergency care that led to difficulties in work and shortcomings for the patient. Conclusion: District nurses and nurses in the present study described that the work in primary emergency care was an effective teamwork with satisfactory cooperation and communication between professions. Advantages of the method were accessibility to get advice and support from others and not to be alone. Challenges and difficulties emerged in the work that affected both the working group and the patients. The result in the study give an insight into a common approach of emergency care in the primary care based on the experience of district nurses and nurses. The result in the study can hopefully lead to development and improvement of working methods within emergency care in the primary care.

Recent events throughout the world and in the US lend support to the belief that another terrorist attack on the US is likely, perhaps probable. Given the potential for large numbers of casualties to be produced by a blast using conventional explosives, it is imperative that health systems across the nation consider the risks in their jurisdictions and take steps to better prepare for the possibility of an attack. Computer modeling and simulation offers a viable and useful methodology to better prepare an organization or system to respond to a large scale event. The real question, given the shortage, and in some areas absence, of experiential data, could computer modeling and simulation be used to predict the resource requirements generated by this type of event and thus prepare a health system in a defined geographic area for the possibility of an event of this nature? Research resulted in the identification of variables that surround a health system at risk, the development of a computer model to predict the injuries that would be seen in an injured survivor population and the medical resources required to care for this population. Finally, methodologies were developed to modify the existing model to match unique health system structures and processes in order to assess the preparedness of a specific geographic location or health system. As depicted in this research, computer modeling and simulation was found to offer a viable and usable methodology for a defined geographic region to better prepare for the potential of a large scale blast event and to care for the injured survivors that result from the blast. This can be done with relatively low cost and low tech approach using existing computer modeling and simulation software, making it affordable and viable for even the smallest geographic jurisdiction or health system.

No description available.

Traumos yra pagrindinė vaikų, paauglių ir jaunų suaugusiųjų mirties priežastis. Stebimas didžiulis skirtumas Europos Sąjungos (ES) šalyse lyginant mirštamumą nuo traumų. Lietuvoje didžiausias ES standartizuotas traumų mirčių dažnis (150.9 mirtys dėl traumų 100.000 gyventojų). Palyginimui: ES šalių vidurkis yra 41.4 mirtys dėl traumos 100.000 gyventojų, mažiausias standartizuotas traumų mirčių dažnis yra Olandijoje – 26.4 mirtys 100.000 gyventojų. Toks skirtumas nurodo potencialią galimybę sumažinti mirčių dėl traumų skaičių, naudojant visas priemones: tiek traumų prevenciją, tiek skubios pagalbos prieinamumą ir kokybę. Darbo tikslas – išanalizuoti vaikų, patyrusių sunkias traumas, ikihospitalinės pagalbos ir skubiosios pagalbos ligoninėje laiko bei apimties įtaką traumų išeitims, atliekant perspektyvinį tyrimą Vilniaus Universiteto Santariškių klinikų Vaikų ligoninėje bei Vilniaus Greitosios medicinos pagalbos stotyje. Rezultatai parodė, kad pagalbos lygis ikihospitaliniu laikotarpiu susijęs su išeitimi: pacientams, gavusiems aukštesnio lygio pagalbą traumos išeitys pagal Glazgo išeičių skalę buvo geresnės. Ilgesnis laikas nuo paciento atvežimo į ligoninę iki pirmos skubiosios intervencijos statistiškai patikimai koreliavo su blogesne traumos išeitimi. Apskaičiavus išgyvenamumo tikimybę (Ps) pagal traumos skalės pažeidimų sunkumo modelį (TRISS), 74 proc. mirčių dėl traumų pateko į netikėtų mirčių (Ps > 50 proc.) kategoriją. Kiekviena netikėta mirtis, identifikuota naudojant... [toliau žr. visą tekstą] / Trauma is the main cause of death in paediatric population worldwide. Lithuania has the highest trauma-related mortality in the European Union (EU). Lithuanian standardised injury death rate is 150.9 per 100000 inhabitants while in comparison the mean standardised injury death rate in the EU is 41.4, and the lowest one is in the Netherlands (26.4 injury death rate per 100000 inhabitants). The aim of this study was to analyze the impact of pre-hospital and in-hospital emergent trauma care on severe pediatric trauma outcomes, performing a prospective observational clinical trial in the Vilnius University Children’s Hospital and Vilnius Pre-hospital Emergency Service Center. Trauma registry fields were defined in details and validated during this study. The recommended quality indicators were defined and used for pre-hospital pediatric trauma care and in-hospital emergent management evaluation. The study results showed that the level of pre-hospital care is associated statistically significantly with trauma outcomes: higher pre-hospital care level caused better trauma outcome assessed according to the Glasgow Outcome Scale. The longer time until the first key emergency intervention in hospital was associated statistically significantly with the worse trauma outcomes. Calculation of the Probability of survival (Ps) according to Trauma Score Injury Severity Score model (TRISS) revealed unexpected death (Ps > 50 %) rate 74%. The reasons for fatal outcome in the patient group with... [to full text]

Bakgrund: Mäns våld mot kvinnor förekommer i hela världen. För att upptäcka de kvinnor som blir utsatta för våld är det viktigt att våga ställa frågan om våld till kvinnor som söker vård. Syfte Syftet med denna studie var att undersöka sjuksköterskors upplevelser och erfarenheter kring att ställa frågan om våld till kvinnor som söker vård på en akutmottagning. Metod: Denna studie hade en deskriptiv design med kvalitativ ansats. Semistrukturerade intervjuer utfördes med åtta sjuksköterskor på en akutmottagning i mellansverige. Resultat: Sjuksköterskorna på akutmottagningen kände överlag att de inte hade tillräckligt med utbildning och beredskap för känna sig trygga med att ställa frågan om våld till kvinnor som söker vård. I Intervjuerna framfördes att det både fanns positiva och negativa aspekter på att ställa frågan om våld till kvinnor. Det fanns delade meningar om att frågan om våld bör ställas rutinmässigt till alla kvinnor som söker vård. Vissa sjuksköterskor ansåg att det skulle vara bra att akutmottagningen hade det som rutin, medan andra ansåg att det skulle blir slentrianmässigt. Att ställa frågan om våld samt tankar kring den våldsutsatta kvinnans situation skapade många känslor. Slutsats: Studien visade på starka känslor kring ämnet våld i nära relationer och att sjuksköterskorna upplevde det som komplext att ställa frågan om våldsutsatthet till kvinnor som söker vård. Brist på tid i mötet med den våldsutsatta kvinnan samt avsaknad av utbildning i ämnet påverkade känslan av beredskap för att kunna ställa frågan om våld i nära relationer rutinmässigt och det rådde delade meningar om huruvida detta bör vara en rutinmässig fråga eller inte.