Bakgrund: Antalet personer med psykisk ohälsa ökar i Sverige och allt fler söker vård. Allt fler patienter söker sig till den somatisk akutsjukvården vilket gör den påfrestande arbetsbelastningen mer utmanande. En patient med psykisk ohälsa lever i en komplex situation och på grund av detta är det utmanande som sjuksköterska att skapa en fulländad förståelse för patientens välbefinnande. Att främja den vårdande relationen och värna om sjuksköterskans roll inom omvårdnad blir på så sätt utmanande. Syfte: Syftet är att beskriva hur sjuksköterskan upplever vårdande relationer med patienter med psykisk ohälsa inom somatisk akutsjukvård. Metod: En litteraturöversikt innehållande elva artiklar varav två var kvantitativa. Dessa artiklar analyserades enligt Fribergs modell. Reslutat: Det framträder fyra teman i resultatet. Varje tema är starkt influerande i den vårdande relationen. De teman som framkommer är: miljöns betydelse, känslor och erfarenheter, attityder och okunskap och behov av kompetens. Konklusion: Okunskap i kombination med tidspress, bristande kommunikation, attityder och bristfällig strukturell miljö påverkar sjuksköterskors upplevelser av det vårdande mötet med patienter med psykisk ohälsa negativt. / Background: The number of people with mental illness is increasing in Sweden and thenumber of healthcare seekers increases. More and more patients are looking for somaticemergency care, which makes workload more challenging. A patient with mental illnesslives in a complex life situation and therefore it´s challenging for a nurse to create acomplete understanding of the patient's well-being. Strengthening the caring relationshipand preserve the nurse's role in nursing will therefore be a challenge. Objective: Thepurpose is to describe how nurses experiences caring relationships with patients withmental illness in somatic emergency care. Method: A literature review. Result: Fourthemes appear in the result. Each theme is highly influential in the caring relationship. Thethemes that emerge are: The importance of the environment, emotions and experiences,attitudes and lack of knowledge, and need of qualification. Conclusions: Unknowledge incombination with time pressure, lack of communication, attitudes and inadequate structuralenvironment adversely affects nurses' experiences of the care meetings with patients withmental illness.

A inserção da mulher no mercado de trabalho tem ocorrido como um processo crescente; as duplas ou triplas jornadas, os baixos salários e as condições perigosas e insalubres têm ocasionado implicações negativas para sua saúde, especialmente relacionadas aos Acidentes de Trabalho (AT) e doenças relacionadas ao mesmo. Os AT têm aumentando em número e freqüência e retratam a violência e o desrespeito ao trabalhador existente no mundo do trabalho. Mulheres acidentadas e com ferimentos ocupacionais são encaminhados e/ou procuram o atendimento à saúde, sendo que, muitas vezes, os acidentes possuem forte associação com o trabalho. O estudo objetivou identificar a ocorrência de AT, entre mulheres, atendidas em situação de emergência em um hospital-escola na cidade de Ribeirão Preto, São Paulo, caracterizando-as quanto aos seus dados pessoais e profissionais; os AT foram identificados quanto ao número, tipo, causas, partes do corpo afetadas, diagnósticos médicos atribuídos por ocasião do atendimento aos acidentados e eventuais encaminhamentos posteriores efetuados pelos profissionais de equipe de saúde. O estudo abrangeu dois anos (2002-2003), obedecendo os procedimentos éticos recomendados, sendo autorizado pela Direção da instituição, consultando-se as anotações dos prontuários dos pacientes, a fim de que se identificar os AT femininos. Constatou-se que 82 mulheres sofreram 117 AT, considerando que 61 (74,39%) sofreram um acidente no período de dois anos estudados, observando-se também a ocorrência de poliacidentabilidade. Das 82 mulheres que sofreram AT, a maioria tinha idade entre 25 e 40 anos (52,78%); 47,56% casadas; 89,02% eram procedentes de Ribeirão Preto. Quanto à ocupação e/ou profissão exercida, os maiores percentuais (23,17% cada um) eram trabalhadoras dos serviços domésticos e de técnicas e auxiliares de enfermagem. Os AT ocorridos foram, em sua maioria, típicos (60,98%) e ocorreram período da manhã (41,46%). Quanto ao profissional que efetuou o registro no prontuário da acidentada, 52,44% dos casos foi realizado por mais de um membro da equipe de saúde. Quanto às causas dos AT, a maioria (32,93%) ocorreu por “Quedas” seguidas de “Exposição a Forças Mecânicas Inanimadas” (19,51%); Quanto aos diagnósticos médicos a maioria foi Traumatismos (78,62%); as partes do corpo mais afetadas nos acidentes, em 35,37% dos casos, foram os membros inferiores. Em relação aos encaminhamentos efetuados, 39,02% corresponderam a alta do paciente. Sugestões são feitas no sentido de minimizar tais ocorrências, de proteção ao trabalho da mulher e treinamento dos profissionais de saúde para que possam oferecer um melhor atendimento a estas acidentadas. / Women are increasingly inserted in the labor market; double and triple work days, low wages and dangerous and unhealthy conditions have entailed negative implications for their health, especially in terms of Occupational Accidents (OA) and work-related illnesses. The quantity and frequency of OA have increased and reveal the violence and lack of respect for workers in today’s labor world. Female accident victims and women with occupational injuries are sent to and/or seek health care. In many of these cases, the accidents are strongly related to work. This study aimed to identify the occurrence of OA among women attended in an emergency situation at a teaching hospital in Ribeirão Preto, São Paulo, characterizing them in terms of personal and professional data; The following OA characteristics were identified: quantity, type, causes, affected body parts, medical diagnoses reached during care and follow-up by the health team. The study covered two years (2002-2003), attended to recommended ethical procedures and was authorized by the Board of the institution. Patient file notes were consulted to identify OA among women. 82 women were victims of 117 OA, 61 (74.39%) of whom suffered an accident during the study period, while others were victims of various accidents. Most of the 82 female OA victims were between 25 and 40 years (52.78%) old; 47.56% were married and 89.02% came from Ribeirão Preto. Most of the women performed domestic services or were nursing technicians and aides (23.17% each). The largest part of OA was typical (60.98%) and occurred in the morning (41.46%). 52.44% of the accident records in the patient files were realized by more than one health team member. Most of the OA (32.93%) were caused by “Falls”, followed by “Exposure to Inanimate Mechanical Forces” (19.51%). The most frequent medical diagnosis was Traumas (78.62%). The lower limbs were the most affected body parts in 35.37% of the cases. 39.02% of follow-up records referred to the patient’s discharge. Suggestions are presented to minimize these events, in terms of protecting women’s work and train health professionals to enable them to offer better care to these accident victims.

O SAMU brasileiro utiliza o modelo francês e opera com uma Central Única de Regulação Médica regionalizada, hierarquizada e descentralizada na composição das equipes de socorro e unidades móveis como USBs (Unidade de Suporte Básico) e USAs (Unidade de Suporte Avançado) que variam de acordo com o tipo de gravidade do caso. Na cidade de Ribeirão Preto, o serviço do SAMU, implantado em 1996, era municipal até 2012, porém seguindo as resoluções e portarias do Ministério da Saúde houve a necessidade da transição do SAMU Municipal para o SAMU Regional, com um único número (192) para os 26 municípios do Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) sendo composto/constituído por 38 (trinta e oito) USBs sendo 01 USB para cada base descentralizada, 13 USB para Ribeirão Preto, 01 (uma) equipe de motolância e mais 03 (três) USAs (unidades de suporte avançado de vida) para cada base nos municípios polos microrregionais (Ribeirão Preto, Sertãozinho e Batatais). Com base nessas informações, este estudo visou caracterizar a estrutura e funcionamento do SAMU Municipal e sua Central de Regulação de Urgência e a transição para a regionalização nos seus aspectos estruturais, recursos humanos, tecnológicos e principalmente a viabilidade financeira, considerando o repasse tripartite (estado - união e município) insuficientes. Para a viabilidade financeira foi instituído o Consórcio CIS-AVH (consórcio intermunicipal de saúde - Aquífero guarani, Vale das cachoeiras e Horizonte verde). Os Consórcios Intermunicipais de Saúde (CISs) são importantíssimos instrumentos de cooperação e gestão entre municípios integrados, com 9interesses comuns definidos através do Plano Anual de Trabalho descritos pelos gestores municipais, conselhos e entidades públicas que estabelecem as prioridades e necessidades de determinado local e região. O objetivo foi criar soluções para problemas comuns, racionalizando a ação governamental a partir da realização conjunta de atividades de promoção, proteção e recuperação da saúde. Observa-se o fortalecimento da co-gestão compartilhada em saúde, em especial para os municípios de menor porte, cujas capacidades de investimento no setor são reduzidas em razão do limitado orçamentos disponível, as crescentes necessidades dos cidadãos, o avanço do aparato tecnológico e seus custos e principalmente o ganho por meio de editais de aquisição, compras ou contratação em escala seja de serviços, exames ou insumos. / The Brazilian SAMU uses the French model and operates with a regionalized, hierarchical and decentralized Single Regulated Medical Regulation Center in the composition of rescue teams and mobile units such as USBs (Basic Support Unit) and USAs (Advanced Support Unit) that vary according to with the type of severity of the event. In the city of Ribeirão Preto, the SAMU service, implemented in 1996, was municipal until 2012, but following the resolutions and ordinances of the Ministry of Health, there was a need to transition from SAMU Municipal to SAMU Regional, with a single number (192) for the 26 municipalities of the Regional Health Department of Ribeirão Preto (DRS XIII) consisting of 38 (thirty-eight) USBs, with 1 USB for each decentralized base, 13 USB for Ribeirão Preto, 01 (one) motolance team and more 03 (three) USAs (advanced life support units) for each base in the microregional poles municipalities (Ribeirão Preto, Sertãozinho and Batatais). Based on this information, this study aimed to characterize the structure and functioning of the Municipal SAMU and its Central Emergency Regulation and the transition to regionalization in its structural aspects, human resources, technological and mainly financial viability, considering the tripartite pass-through insufficient. (2013 to 2016). For the financial viability, the CIS-AVH Consortium (inter-municipal health consortium - Aquifer, Guaraní, Vale das cachoeiras and Horizonte verde) was instituted. The Intermunicipal Health Consortiums (CISs) are very important instruments of cooperation and 11management among integrated municipalities, with common interests defined through the Annual Work Plan described by municipal managers, councils and public entities that establish the priorities and needs of a given place and region. With the objective of creating a solution to common problems, rationalizing government action through joint activities to promote, protect and recover health. The strengthening of shared co-management in health is observed, especially for smaller municipalities, whose investment capacities in the sector are reduced due to the limited budgets available, the growing needs of the citizens, the advancement of the technological apparatus and its costs, and especially the gain through purchase, purchase or scale calls for services, examinations or inputs.

A dengue é uma doença infecciosa febril aguda causada por um arbovírus com quatro sorotipos conhecidos: DENV-1, DENV-2, DENV-3 E DENV-4. É transmitida pelo mosquito Aedes aegypti. Manifesta-se clinicamente por febre alta associada à cefaleia, mialgia, prostração, dor retrorbitária, artralgia e exantema. Geralmente é de curso benigno, porém pode evoluir para formas graves e óbito. A dengue é um dos principais problemas globais de saúde pública: a OMS estima que a cada ano ocorram 50-100 milhões de infecções. No ano dengue 2014-2015 uma epidemia da doença atingiu o Brasil em toda a sua extensão. A região sudeste foi a mais acometida e, dentre os seus Estados, São Paulo contabilizou um número aumentado de casos e óbitos. Ribeirão Preto, município situado no nordeste paulista, permaneceu em estado de alerta durante o período. Frente à possibilidade de epidemia local, a estruturação do plano de contingência municipal para dengue 2015-2016 tornou-se prioritária. Dentre os seus elementos estruturais destacou-se a necessidade de organização dos serviços de atendimento para pacientes com suspeita de dengue e a Comissão de Urgência e Emergência, participante do gerenciamento da assistência em urgências e emergências no município foi imbuída desta tarefa. Objetivo: Descrever a experiência do processo de organização da assistência em urgências e emergências para pacientes com suspeita de dengue no Município de Ribeirão Preto, mediante a estruturação do plano de contingência municipal para dengue, 2015-2016, com elaboração de novas propostas. Métodos: Trata-se de um estudo descritivo do tipo relato de experiência, que ocorreu no Município de Ribeirão Preto, no período correspondente a junho de 2015 a janeiro de 2016. Foi solicitada dispensa do Termo de Consentimento Livre e Esclarecido uma vez que foram utilizados dados retroativos de materiais previamente elaborados e autorizados. Os dados coletados foram submetidos à análise estatística descritiva. Resultados: Através da descrição da experiência do processo de organização da assistência em urgências e emergências no Município de Ribeirão Preto e elaboração de propostas norteadoras em gestão de epidemias, vislumbrou-se 11 enriquecer a composição do plano municipal de contingência para dengue e proporcionar o incremento do cuidado aos pacientes com suspeita de dengue. / Dengue fever is an acute febrile infectious disease caused by an arbovirus with four known serotypes: DENV-1, DENV-2, DENV-3 and DENV-4. It is transmitted by the mosquito Aedes aegypti. The dengue is clinically manifested by high fever associated with headache, myalgia, prostration, retro-orbital pain, arthralgia and rash. It is usually benign, but can progress to severe forms and death. Dengue is a major global public health problem: WHO estimates that each year 50 million to 100 million infections occur. In the dengue year 2014-2015 a disease epidemic hit Brazil in all its extension. The Southeast region was the most affected, and among the states, São Paulo recorded an increased number of cases and deaths. Ribeirão Preto, São Paulo municipality located in the northeast, remained on alert during the period. Faced with the possibility of local epidemic, the structure the municipal contingency plan for 2015-2016 dengue has become a priority. Among its structural elements highlighted the need for the organization of care services for patients with suspected dengue and the Emergency Committee, service management participant in emergency care in the city was imbued with this task. Objective: To describe the experience of the care organization process in emergency care for patients with suspected dengue in Ribeirão Preto, through the structuring of municipal contingency plan for dengue, 2015-2016, with elaboration of new proposals. Methods: This is a descriptive study of type experience report, which occurred in the city of Ribeirão Preto, in the corresponding period June 2015 to January 2016. Informed Consent Term waiver was requested and informed as they were used retroactive data previously elaborated and approved materials. Data were submitted to descriptive statistical analysis. Results: Through the description of the experience of the process of organization in emergency care in the city of Ribeirão Preto and preparation of guiding proposals for epidemic management, envisioned to enrich the composition of the municipal contingency plan for dengue and provide increased care patients with suspected dengue.

Bakgrund: Palliativ vård är en vårdform som skall förbättra eller upprätthålla livskvalitet för döende patienter och dess närstående. I stora delar av världen finns ingen tillgång till specialiserad palliativ vård, men kraven ökar för att det skall erkännas som en mänsklig rättighet. Närstående till döende patienter på vårdavdelningar inom akutsjukvård upplever inte att de får tillräckligt med stöd och uppmärksamhet. Vården bör kännetecknas av en professionell vårdrelation och från sjuksköterskans perspektiv skall vårdrelationen präglas av kunskap, öppenhet och reflektion. Syfte: Att beskriva sjuksköterskors upplevelser av att vårda döende patienter på en   vårdavdelning inom somatisk akutsjukvård. Metod: En litteraturöversikt baserad på tio vetenskapliga originalartiklar. Av dessa artiklar var nio kvalitativa och en mixad. Resultat: Sammanställningen för materialet resulterade i fyra huvudteman och två underteman; Sjuksköterskans uppfattning om en god palliativ vård, Döden i sjuksköterskans dagliga arbete med två underteman När tiden inte räcker till och När döden närmar sig. Sjuksköterskors upplevelser av att skapa en god vårdmiljö och Kommunikationens betydelse för palliativ vård. Diskussion: Det sammanställda resultatet och dess tillvägagångssätt diskuterades i en resultat- och metoddiskussion. Resultatet problematiserades i relation till bakgrund, utökad litteratur och vetenskapliga studier samt utifrån Virginia Hendersons omvårdnadsteori. / Background: Palliative care is a type of care that should improve or maintain quality of life for dying patients and their relatives. In many parts of the world specialized palliative care is not available but there is an increasing demand that it should be recognized as a human right. Relatives of dying patients at wards in emergency hospitals do not experience that they receive enough support and attention. The care should be characterized by a professional care relation and from the nurses’ perspective the care relation should contain knowledge, openness and reflection. Aim: To describe nurses’ experiences of caring for dying patients at a somatic ward in emergency hospitals. Method: A literature review based on ten scientific articles. Nine articles were qualitative and one article mixed method. Results: The compilation of the material resulted in four main themes and two subthemes; Nurse’s perception of good palliative care, Death in nurses daily work with two subthemes When there is not enough time and When death comes closer. Nurses’ experiences of creating a good caring environment and The meaning of communication for palliative care. Discussion: The compiled result and the way it was achieved were discussed in a result- and method discussion. The result was problematized in relation to background, additional literature and scientific studies and Virginia Hendersons nursing theory.

Bakgrund: Sjuksköterskor möter dagligen vårdsökande personer och närståendesom kräver en samlad bild över vårdtagarens livssituation. För att detta ska varamöjligt krävs en vårdande relation som skapas genom kommunikativa färdigheter. När sjuksköterskor upplever höga förväntningar och krav försvåras skapandet av relationerpå grund av uppkommen stress. Saknas en vårdande relation försvåras arbetet med patientsäkerhet. I längden leder upplevd stress till utbrändhet. Syfte: Att beskriva erfarenheter som leder till utbrändhet hos sjuksköterskor somutför akutsjukvård. Metod: En litteraturöversikt har genomförts med kvalitativa artiklar och induktiv ansats. Sökning genomfördes i databaserna Psycinfo, Medline och Cinahl. Thomas &Hodge (2010) beskrivna metod har använts. Studien har sammanställt forskning från fjorton olika artiklar. Resultat: Två huvudteman och fem subteman har identifierats. Huvudtema “Bägaren rinner över” med följande subteman: “Att inte räcka till”, “Att varaemotionellt engagerad” och “Upplevelse av ohälsa”. Huvudtemat “Distanstagande” med följande subteman: “Vilja fly situationen” och “Vilja isolera sig”. Slutsats: Brist på tid och bemanning gör att sjuksköterskor upplever otillräcklighet som i sin tur orsakar fysisk och psykologisk ohälsa. Otillräcklig förmåga att hantera känslomässig påfrestning kommer att orsaka utmattning och utbrändhet. Med tiden kommer sjuksköterskor att distansera sig och isolera sig från omgivningen vilket islutändan leder till att vilja lämna arbetet. / Background: Nurses encounter patients and their relatives in a daily basis whichrequire a complete picture of the patient's life situation. This requires a nurturant relation which is achieved by communicative skills. When nurses experience high expectations and demands it makes the creation of a relationship even harder because of the arising stress. A missing nurturant relationship obstructs the work with patientsafety. In the long term experienced stress leads to burnout. Aim: To describe nurses’ experience that leads to burnout in a emergency care setting. Method: A literature review with qualitative articles and inductive approach was used as a design. Searching was made in the databases Psycinfo, Medline and Cinahl. Thomas & Hodges (2010) described method has been used. The literature review compiled research from fourteen different articles. Result: Two main- and five subthemes were identified. Maintheme “The beaker runsover” with following subthemes: “To not be enoguh”, “To be emotionally engaged” and“Experience illness”. Maintheme “Distance taking” with following subthemes: “Wannaflee the situation” and “Wanna isolate oneself”. Conclusion: Lack of time and staffing causes nurses too experience inadequacy whichin turn manifest into physical and psychological illness. Inadequate ability to handle emotional distress will manifest exhaustion and burnout. In due course nurses will distance and isolate themselves from their environment which will ultimately result in them leaving work.

Introduktion Patienter som får akut sjukvård har ofta en närstående med sig. Denna person finns där som stöd för patienten och kan förse sjuksköterskan med information. Sjuksköterskor skall utefter ett personcentrerat arbetssätt och förhållningssätt involvera de närstående i vården i den mån det går. Syfte Syftet var att beskriva sjuksköterskors erfarenheter av närstående i akuta vårdsituationer. Syftet var även att beskriva valda artiklars undersökningsgrupp Metod En litteraturstudie med beskrivande design. Studien inkluderade 15 vetenskapliga artiklar, av dessa var nio med kvantitativ ansats och sex med kvalitativ ansats. Studien använde sig av databaserna Medline via PubMed samt Cinahl Resultat Sjuksköterskorna erfor att den närstående var en resurs. Det framkom en eftersträvan hos sjuksköterskorna att skydda de närstående. Under själva vårdmomentet så låg allt fokus på patienten. Sjuksköterskorna erfor att närstående hade orealistiska krav eller hopp om vad vården kunde göra. Det framkom en rädsla av att den närstående kunde störa vårdmomentet. Slutsatser Det framkommer blandade erfarenheter av närstående i akuta vårdsituationer. Sjuksköterskorna erfor både fördelar och utmaningar med att involvera närstående i vården. / Introduction Patients receiving emergency care often have a relative with them. This person is there to support the patient and can provide the nurse with information. By following a person-centered approach nurses should involve the relative in health care as far as possible. Aim The aim of the study was to describe nurses experience of relative in emergency care situations. The aim was also to describe included articles sampling group. Method A literature study with descriptive design. The study included 15 scientific reports, of which nine were of quantitative approach and six of qualitative approach. The study used Medline via PubMed and Cinahl as databases. Result Nurses experienced the relative to be a resource. There was a striving for nurses to protect the relatives. During the caring situation, all focus was on the patient. Nurses have experienced that the relative had unrealistic demands and hope for what they could do. There was a fear that the relative could interfere with the caring situation. Conclusion There are mixed experiences of relative in emergency care situations. Nurses experienced both benefits and challenges of involving relatives in health care.

The thesis deals with the analysis of the risks of the work of dispatchers of the Emergency care Areión (in czech: Tísňová péče Aerión = TPA) for the elderly people. The aim was to find out what their dispatchers consider to be burdensome and demanding and what, on the contrary, helps them in emergency situations. With the help of idiographic research with emergence, which I analyzed with using the principle of the grounder theory, I tried to answer by the interviews with five respondents how TPA dispatchers perceive their work and workload. Whether they feel competent to communicate and deal with people in crisis and perceive their competencies. What are all the factors and situations in the work, which are burdensome and demanding for the dispatchers and how they deal with such a burden. And finally, what could improve the overall quality of TPA work from the point of view of dispatchers. In the theoretical part I deal with issues of aging and elderly as a target group of TPA social service. Next to the service itself; and the techniques of conducting crisis calls on emergency lines and telephone crisis intervention methods used on trust lines, as two types of work that are most closely resemble to the TPA social service. KEY WORDS: elderly people, emergency care, crisis intervention, call techniques

Bakgrund Barn finns ofta bland de drabbade i samband med allvarliga händelser och har utifrån ålder och mognadsgrad behov som skiljer dem från vuxna i dessa situationer. Sjukvårdspersonal anger att det är svårare och mer påfrestande att hantera situationer där flera barn drabbats, men sjukvårdens förmåga kan optimeras om barnaspekter uppmärksammas rutinmässigt vid utformning av katastrofmedicinsk beredskap. Internationella rapporter anger att barnaspekter ofta förbises vid utformning av katastrofmedicinsk beredskap, men ämnet är bristfälligt kartlagt i Sverige. Syfte: Att undersöka om barnperspektivet uppmärksammas vid utformning av katastrofmedicinsk beredskap på regional nivå. Metod: Enkätstudie där populationen utgjordes av Sveriges 21 beredskapssamordnare på regional nivå. Resultat: I studien deltog samtliga beredskapssamordnare på regional nivå i Sverige (n=21). 16 av 20 deltagare angav att katastrofmedicinsk beredskap kan utformas efter barnets särskilda behov i hög grad. 19 av 21 deltagare uppgav dock att katastrofmedicinsk beredskap endast i liten grad är anpassad för barn. Medverkan av barnsjukvården ses som en viktig faktor för att säkerställa sjukvårdens katastrofmedicinska förmåga inför allvarliga händelser som drabbar barn. 20 av 21 deltagare angav dock att barnsjukvården är representerad endast i liten grad vid planering av katastrofmedicinsk beredskap på regional nivå. Vid risk- och sårbarhetsanalyser och systematisk kvalitetssäkring uppgav 18 av 21 respektive 17 av 18 deltagare att barnaspekter uppmärksammas i liten grad. Sex av 21 landsting/regioner synliggör barnaspekter i regional katastrofmedicinsk plan. Slutsats: Barnperspektivet uppmärksammas endast i begränsad omfattning vid utformning av regional katastrofmedicinsk beredskap. Studien påvisar nödvändigheten av att uppmärksamma och utveckla sjukvårdens katastrofmedicinska förmåga med fokus på barnets särskilda behov. / Introduction: Children are often among the victims in major incidents and have specific needs that separate them from adults in these situations. Healthcare personnel often find events including children more demanding than events only affecting adults. The health care, thus, has to integrate child aspects in all phases of disaster planning. International reports suggest that planning for disaster medical preparedness often fails to consider the special needs of children, but there is a lack of Swedish research in this field. Objective: To investigate if the child perspective is considered in regional disaster medical planning in Sweden. Method: A questionnaire was sent to the 21 regional disaster planning officers in Sweden. Results: All of the regional disaster planning officers in Sweden participated in the study (n=21). 16 of 20 participants claimed that child aspects can be integrated in disaster preparedness to a large extent. However, 19 of 21 planners indicated that disaster preparedness is adjusted to the needs of children only to a small extent. Participation of pediatric personnel in disaster medical planning was seen as an important step to ensure optimal preparedness for events including children. 20 of 21 planners stated that this is the case only to a small extent. Participants claimed that risk and vulnerability analysis (18 of 21) and quality assurance (17 of 18) reflects the needs of children to a small extent. Six of 21 participants claimed that pediatric aspects were integrated in regional disaster medical plans. Conclusion: The child perspective is considered only to a small extent in regional disaster medical planning in Sweden. This study indicates the need to highlight and develop the disaster medical capability with focus on the special needs of the pediatric population.

Aim and objectives. Although many international sources in literature describe the treatment regimes for the management of adult female rape survivors, very few actually evaluate if the care that is implemented, are beneficial and supportive towards an optimal level of health. The researcher initiated this study to specifically determine what the experiences of adult female rape survivors were with regards to the management they received from health care workers in the emergency care environment. This information that was gathered was then incorporated into the writing of recommendations for health care services towards the improvement of patient-centred care. Method. A qualitative phenomenological methodology guided the research process in which ten semi-structured voluntary interviews was held with adult female rape survivors. This study was conducted in a private hospital in Gauteng, South Africa, which is at the top of the international statistics list for the incidence of rape. Findings. Patient management with regards to accessibility to health care services, the forensic examination and the use of medications proved to be a major concern. Participants in this study emphasized the value and importance of the physical presence of family members or significant others. A positive attitude from these support-givers improved the patient’s psychological state, memory and co-operation. Prolonged waiting times in all areas of management contributed to an increased level of anxiety, where as the prompt and competent interventions by empathetic multi-disciplinary team members had improved patient satisfaction. Various patient responses after the rape incident warranted that minimal, but yet effective and professional health care workers be involved in rape survivor management. Confidentiality and honest, effective communication that is based on patient preference, should guide all interventions. Conclusion. The medical management of adult female rape survivors in this hospital compared favorably to international standards, however, the need to improve the level of specific patient-centred care exists in order to ultimately facilitate a better quality of service provision. Copyright / Dissertation (MCur)--University of Pretoria, 2009. / Nursing Science / unrestricted