På akutmottagningen möter akutsjuksköterskor dagligen utmaningen att bedöma och vårda patienter med tidskritiska tillstånd, en central kompetens för deras yrkesroll. Forskning pekar på flera förutsättningar som hämmar deras förmåga att göra vårdande bedömningar, där hela människans behov tillgodoses. Syftet med denna studie var att undersöka tillgänglig vetenskaplig litteratur om förutsättningar som påverkar akutsjuksköterskans vårdande bedömning av patienter med tidskritiska tillstånd på akutmottagning. Genom en systematisk och integrativ analys av fjorton vetenskapliga artiklar med varierande forskningsmetoder, inklusive kvantitativa, kvalitativa och mixad metod med ursprung från olika delar av världen, identifierades flera förutsättningar som påverkar akutsjuksköterskans förmåga att göra vårdande bedömningar. Dessa förutsättningar presenterades i två huvudkategorier: “Förutsättningar för en balanserad bedömning” och "Förutsättningar för en korrekt bedömning", med ytterligare fyra underkategorier, vars innehåll består av bland annat förutsättningar som stress, emotionella påfrestningar, vilja, engagemang, erfarenhet och vårdmiljö. Studiens resultat understryker behovet av att förhålla sig till dessa förutsättningar för att förbättra akutsjuksköterskors bedömningsförmåga. Trots vetskapen om akutmottagningens behov av förändring saknas effektiva insatser till förbättring som kan underlätta akutsjuksköterskans arbete. För att säkerställa patienternas välbefinnande och att upprätthålla hög vårdkvalitet är det avgörande att akutsjuksköterskor gör både balanserade och korrekta bedömningar. / At the emergency department, emergency nurses face the daily challenge of assessing and caring patients with time-critical conditions, a central competency for their professional role. Research indicates several conditions that inhibits their ability to make caring assessments, addressing the holistic needs of individuals. The aim of this study was to review existing scientific literature on conditions influencing emergency nurses' caring assessment of patient with time-critical conditions in emergency departments. Through a systematic and integrative analysis of fourteen scientific articles employing various research methods, including quantitative, qualitative, and mixed methods from different parts of the world, several conditions affecting emergency nurses' ability to make caring assessments were identified. These conditions were categorized into two main categories: "Prerequisites for a balanced assessment" and "Prerequisites for an accurate assessment", with an additional four subcategories, including conditions such as stress, emotional strain, will, commitment, experience, and the healthcare environment. The study's findings emphasize the need to address these conditions to improve emergency nurses' assessment capabilities. Despite awareness of the need for change in emergency departments, effective improvement interventions to facilitate emergency nurses' work are lacking. To ensure patient well-being and maintain high-quality care, it is crucial for emergency nurses to make both balanced and accurate assessments.

Bakgrund Patienter i behov av akutsjukvård söker sig oftast till akutmottagningen för omhändertagande av deras plötsliga skada eller hastigt insatta sjukdom. Enligt Hälso- och sjukvårdslagen ska individer få komma till tals och bli lyssnad på i vårdprocessen för att främja delaktighet. Goda förutsättningar för delaktighet finns när sjuksköterskor och patienter samarbetar för att upprätta en tillitsfull relation och ömsesidigt delar med sig av information och kommunicerar på ett välfungerande sätt. Trots detta tillämpas det inte alltid på akutmottagningen. Bristande delaktighet kan medföra att patienten upplever svårigheter med att förstå vad som händer, vilket kan leda till känslan av förlorad kontroll och bristande tillit för vårdpersonalen. Syfte Att beskriva patienters delaktighet på akutmottagningen. Metod Detta arbete har genomförts som en strukturerad litteraturöversikt med inslag av liknande metodik som används vid systematiska översikter. Litteraturöversikten är baserad på elva vetenskapliga originalartiklar. Resultat I resultatet av denna litteraturöversikt framträder två huvudkategorier; Kommunikation och Bemötande, som presenteras med tillhörande underkategorier. Slutsats Resultatet visade varierande erfarenheter av delaktighet i vården, men en central aspekt var vikten av information för att möjliggöra och främja delaktighet på akutmottagningen. Att bli hörd och respekterad, förtroende och trygghet till vårdpersonal samt visad hänsyn till patientens behov av delaktighet, var andra komponenter som framkom i studiens resultat som identifierades vara viktiga för patientens delaktighet. För att kunna bedriva en god, säker och högkvalitativ vård på akutmottagningen blir det tydligt att personcentrerad vård med fokus på patientdelaktighet bör ingå i vårdprocessen. / Background Patients in need of emergency medical care usually go to the emergency department for treatment of their sudden injury or rapidly developing illness. According to the Health Care Act, individuals must be allowed to speak and be listened to in the care process in order to promote participation. Good conditions for participation occur when nurses and patients work together to establish a trusting relationship and mutually share information and communicate in a well-functioning way. Despite this, it is not always applied in the emergency department. Lack of participation can result in that the patient experiences difficulties in understanding what is happening, which can lead to the feeling of loss of control and a lack of trust for the healthcare staff. Aim To describe patients' participation in the emergency department. Method This work has been carried out as a structured literature review with elements of similar methodology used in systematic reviews. The literature review is based on eleven original scientific articles. Results In the results of this literature review, two main categories emerge; Communication and Reception, which are presented with associated subcategories. Conclusions The results showed varying experiences of participation in care, but a central aspect was the importance of information to address and promote participation in the emergency department. Being heard and respected, trust and security for healthcare personnel and consideration for the patient's needs for participation, were other components that emerged in the study's results and were identified to be important for the patient's participation. In order to be able to provide good, safe and high-quality care in the emergency department, it becomes clear that person-centred care with a focus on patient participation should be part of the care process.

Akutmottagningar har ansvaret att erbjuda vård av hög kvalitet i livets slutskede. Tidigare forskning beskriver att akutsjukvårdsverksamheter och dess ledning brister i utformningen av palliativ vård, vilket potentiellt kan minska förtroendet för hälso- och sjukvårdssystemet. Syftet med denna studie är att undersöka och beskriva sjuksköterskors erfarenheter av att vårda patienter i livets slut på en akutmottagning. Metoden var att utifrån en teoretisk utgångspunkt från de fyra hörnstenarna i palliativ vård göra en systematiserad allmän litteraturstudie. Resultatet grupperades i två huvudkategorier: Faktorer som kan påverka omvårdnaden vid vård i livets slut och Sjuksköterskans upplevelse kan påverka omvårdnaden vid livets slut. Resultatet presenterades i totalt sex underkategorier där det framkommer att vården av patienter i livets upplevs som negativ av sjuksköterskor på akutmottagningar. Akutmottagningens uppdrag, dess miljö och kunskapsbrist anges som orsaker till detta. Upplevelsen av den negativa uppfattningen förstärks av sjuksköterskans upplevelse av hög arbetsbelastning, brist på resurser och brist på tid för att utföra god omvårdnad för patienter i livets slut. Detta bekräftar tidigare forskning att akutmottagning är en olämplig miljö för patienter i livets slut. Slutsatsen är att dels bör akutmottagningens resurser stärkas för denna patientkategori, dels bör akutsjukvårdens styrning ses över så att dessa patienter skall styras till andra mer lämpliga enheter än akutmottagning om behov av akut sjukvård uppstår. / Emergency departments have the responsibility to provide high-quality end-of-life care. Previous research describes deficiencies in the provision of palliative care within emergency healthcare facilities and their management, which could potentially undermine trust in the healthcare system. The aim of this study is to investigate and describe nurses' experiences of caring for patients at the end of life in an emergency department. The method involved conducting a systematic general literature review based on the theoretical framework of the four cornerstones of palliative care. The results were grouped into two main categories: Factors that may affect end-of-life care and Nurses' experiences that may influence end-of-life care. The results were presented in a total of six subcategories, revealing that the care of patients at the end of life is perceived negatively by nurses in emergency departments. The department's mission, its environment, and lack of knowledge are cited as reasons for this perception. The experience of this negative perception is reinforced by nurses' experiences of high workload, resource shortages, and lack of time to provide good care for patients at the end of life. This confirms and concludes previous research that emergency departments are an unsuitable environment for patients at the end of life. In conclusion, resources for this patient category in emergency departments should be strengthened, and the management of emergency healthcare should be reviewed to direct these patients to other more appropriate units than the emergency department when acute healthcare needs arise.

This dissertation employs management systems engineering principles, data science, and industrial systems engineering techniques to address pressing challenges in emergency department (ED) efficiency, infectious disease management at mass gatherings, and student self-efficacy. It is structured into three essays, each contributing to a distinct domain of research, and utilizes industrial and systems engineering approaches to provide data-driven insights and recommend solutions. The first essay used data analytics and regression analysis to understand how patient length of stay (LOS) in EDs could be influenced by multi-level variables integrating patient, service, and organizational factors. The findings suggested that specific demographic variables, the complexity of service provided, and staff-related variables significantly impacted LOS, offering guidance for operational improvements and better resource allocation. The second essay utilized system dynamics simulations to develop a modified SEIR model for modeling infectious diseases during mass gatherings and assessing the effectiveness of commonly implemented policies. The results demonstrated the significant collective impact of interventions such as visitor limits, vaccination mandates, and mask wearing, emphasizing their role in preventing health crises. The third essay applied machine learning methods to predict student self-efficacy in Muslim societies, revealing the importance of socio-emotional traits, cognitive abilities, and regulatory competencies. It provided a basis for identifying students with varying levels of self-efficacy and developing tailored strategies to enhance their academic and personal success. Collectively, these essays underscore the value of data-driven and evidence-based decision- making. The dissertation's broader impact lies in its contribution to optimizing healthcare operations, informing public health policy, and shaping educational strategies to be more culturally sensitive and psychologically informed. It provides a roadmap for future research and practical applications across the healthcare, public health, and education sectors, fostering advancements that could significantly benefit society. / Doctor of Philosophy / Divided into three essays, this dissertation uses industrial and systems engineering and data science to help make emergency departments more efficient, manage the spread of diseases at large events, and predict students' belief in their abilities. The first essay investigates factors that influence how long patients stay in emergency departments, including patient demographics, triage level, the complexity of care they receive, and number of emergency department staff when patient arrived. The essay offers suggestions to improve these services and better manage resources. The second essay models the spread of COVID-19 during the Hajj, a religious mass gathering, and evaluates the effectiveness of three safety measures: limiting the number of attendees, vaccinations, and wearing masks. This essay shows how different strategies can work together to prevent outbreaks. The third essay uses artificial intelligence and machine learning to understand what affects Muslim students' confidence in their abilities, focusing on emotional intelligence, thinking skills, and self-discipline. The findings could help to identify students who need extra support and to create more personalized programs that will help them succeed. Overall, this dissertation contributes to advancing industrial and systems engineering and data science knowledge by addressing complex issues in healthcare, public health, and education, leading to more informed decisions and better strategies. Its broader impact includes improving hospital operations, guiding public health decisions, and helping develop educational programs and interventions that consider cultural and psychological factors.

Sjuksköterskeyrket, i synnerhet arbetet på akutmottagning, är ett yrke vars arbetsmiljö kantas av en mängd olika stressorer. Svenska sjuksköterskors arbete på akutmottagning i relation till stress är inte ett välstuderat ämne. Syftet i studien är att beskriva variationer i hur en grupp sjuksköterskor, verksamma vid akutmottagningar, uppfattar fenomenet stress i arbetsmiljön. Frågeställningarna i studien är: Vad erfar svenska sjuksköterskor som stressorer i arbetsmiljön? Hur påverkas sjuksköterskorna av arbetsrelaterad stress och hur hanteras den? Forskningsansatsen är av induktiv, kvalitativ och fenomenografisk karaktär. Datainsamlingen består av intervjuer med nio sjuksköterskor. Resultatet visade att de främsta stressorerna utlöses av bristande teamarbete, organisatoriska orsaker, ständiga avbrott i arbetet och en känsla av otillräcklighet. Informanterna upplevde flera aspekter av stress i arbetet och att de i olika grad påverkades av den arbetsrelaterade stressen på arbetet. Alla informanter, utom en, uppgav någon slags påverkan från arbetsrelaterad stress på fritiden. Vad gäller stressens påverkan identifierades följande kategorier; Påverkan på kropp och själ, stress som drivkraft, att de egna behoven blir sekundära samt påverkan i förmågan att kommunicera. Den vanligaste copingstrategin i denna studie var av problemlösande karaktär. Resultatet visade vissa likheter med internationella studier i ämnet tex att bristande teamarbete, avbrott i arbetet, konflikter i teamet, hög arbetsbelastning och krävande patienter och anhöriga är stressorer i arbetsmiljön. En slutsats i studien är att sjuksköterskorna sällan stressas av själva patientarbetet, det är andra faktorer i arbetsmiljön som uppfattas som stressorer. Detta underlättar förutsättningarna för ett förbättringsarbete. Studien visade att stressorer, stresspåverkan och stresshantering är av en mångfacetterad karaktär och att upplevelsen är högst personlig. Med en ökad kunskap om stress kan konstruktiva lösningar på problemet leda fram till en god arbetsmiljö. Sjuksköterskorna kan då ägna energi till att uppnå en patientvård i världsklass! / The nursing profession, in particular the work in the emergency department, is a work that is lined a with a variety of stressors. Swedish nurses working in the emergency department in relation to stress is not a well-studied subject. The purpose of the study is to describe variations in how a group of nurses, working in emergency departments, perceive the phenomenon of stress in their work environment. The questions in the study are: What does Swedish nurses experience as stressors in the work environment? How are the nurses affectetd by work-related stress and how is it handled? The research approach is inductive, qualitative and phenomenographic. Data collection consists of interviews with nine nurses. The results showed that the main stressors is triggered by a lack of teamwork, organizational reasons, constant interruptions at work and a feeling of inadequacy. The informants experienced several aspects of stress at work and that they in varying degrees were affected by work-related stress at work. All informants, except one, indicated some sort of impact of work-related stress at leisure. As to the impact of stress the following categories were identified; The effect on body and soul, stress as a driving force, the own needs become secondary and the effect of the ability to communicate. The most common coping strategy in this study were of the problem-solving nature. The results showed some similarities with the international studies on the subject such as the lack of team work, work interruptions, conflicts in the team, heavy workloads and demanding patients and families as stressors in the work environment. One conclusion of the study is that taking care of the patient rarely stresses nurses, there are other factors in the work environment that is perceived as stressors. This facilitates the conditions for improvement projects. The study showed that stressors and the impact of stress are of diverse nature. The experience is highly personal. With greater knowledge of stress constructive solutions can lead to a good working environment. The nurses can then devote energy to achieve a world class patient care!

The overall aim of this thesis is to obtain an understanding of Emergency Healthcare Work (EHW) at the Emergency Department (ED), including the competencies required by EHW, and based on practitioners' and managers' perspectives. Methods: In study I, a quantitative method was employed. A questionnaire was sent to all Swedish EDs and data was analysed using descriptive statistics and content analysis. In studies II- IV, qualitative methods were used. In study II, participant observations and individual and group interviews were conducted. In studies III-IV individual and group interviews were conducted. In studies II-IV, data was analysed using qualitative content analysis. Results: According to head nurses, basic nursing education does not lead to sufficient competence for working at an ED and thus supplementary formal education is needed. A minority of head nurses perceive that they are completely responsible for creating preconditions for competence development (study I). The EHW is characterized by rapid, brief and standardized encounters with limited scope for providing individualized care. Practitioners strive to be adaptable by structuring EHW and they cooperate to achieve a good workflow (study II). Management is characterized by a command and control approach. Managers experience EHW as lifesaving work and they experience difficulties in meeting the expectations of their staff (study III). There is also tension between professional groups in EDs as well as hierarchical boundaries that influence the possibilities to develop competencies in EHW. The focus on competence in EHW is on account of the emergency and lifesaving nature of its actions. Purely medical competencies are valued and caring competencies are subsequently downgraded. A medical competence approach consolidates the current view of competencies necessary in everyday work in EDs (study IV). Conclusions: EHW and the competencies required by EHW are defined from a purely medicalized and result-driven viewpoint. Patients' medical needs are given greater importance than their caring needs. Medicalized and result-driven EHW makes it difficult to provide individualized care. This difficulty is a hindrance to the implementation of a holistic view in EHW. / <p>Akademisk avhandling som för avläggande av filosofie doktorsexamen vid Sahlgrenska akademin, Göteborgs universitet kommer att offentligt försvaras Fredagen den 12 december, kl. 09.00 i hörsalen 2119 Institutionen för vårdvetenskap och hälsa, Arvid Wallgens Backe, Hus 2, Göteborg</p><p>I. Andersson, H. &amp; Nilsson, K. (2009). Questioning Nursing Competences in Emergency Health Care. Journal of Emergency Nursing, 35, 305-311. II. Andersson, H., Jakobsson, E., Furåker, C. &amp; Nilsson, K. (2012). The everyday work at a Swedish emergency department - The practitioners' perspective. International Emergency Nursing. 20, 58-68. III. Andersson, H., Wireklint Sundström, B., Nilsson, K. &amp; Jakobsson Ung, E. (2014). Management of everyday work in Emergency Departments – An exploratory study with Swedish Manager. International Emergency Nursing. 22, 190-196. IV. Andersson, H., Wireklint Sundström, B., Nilsson, K. &amp; Jakobsson Ung, E. (2014). Competencies in Swedish emergency departments - The practitioners' and managers' perspective. International Emergency Nursing. 22, 81-87.</p>

Les pays occidentaux ont connu un accroissement des consultations des services d'urgence (SU). Les deux causes avancées sont la modification du comportement des usagers avec l'augmentation des demandes de soins « non-urgentes » (NU) et l'insuffisance de l'offre de soins dans le secteur libéral. L'objectif de cette thèse est d'analyser la hausse de la fréquentation des SU à travers la problématique des patients NU. Pour répondre aux questionnements, une analyse de la littérature internationale et une étude des comportements des usagers ont été réalisées.Le pourcentage de consultations NU se situerait autour de 30%. Les tendances résultent de l'hétérogénéité de la définition de la NU, qui se traduit par l'hétérogénéité des critères de tri et des méthodes de recueil. Le profil du consultant NU n'est pas celui attendu, tel qu'il est décrit classiquement dans les représentations collectives. L'usager est une personne rationnelle. La décision du recours est le fruit d'un arbitrage entre risques concurrents, par un individu acteur de sa propre existence, qui prend une décision individuelle dans un système de soins qu'il connaît et dont il identifie les limites. L'absence de définition consensuelle de ce qui constitue une « urgence », le manque d'outils de triage fiables pour la reconnaître et de consensus sur le rôle exact des SU, expliquent la difficulté à identifier le patient NU et conduit actuellement à l'incapacité de légitimer la réorientation des patients vers des structures de soins alternatives. Face à ce constat, faut-il poursuivre les actions visant à diminuer le nombre de consultations NU dans les SU ou, au contraire, les accepter et les gérer ? / Emergency Departments (ED) utilization has increased inducing ED overcrowding in many countries. The reasons for ED overcrowding are related partly to misuse of EDs on the part of patients who seek care for nonurgent (NU) problems, and inaccessibility to primary care services. Because the problem of NU ED visits is quite complex, the objective of this thesis was to conduct a critical review of the literature to better understand the conceptual and methodological questions of NU, and to explore why people with NU complaints choose to come to the EDs instead of their primary care provider. The proportion of NU ED visits would be around 30%. The review has highlighted the lack of reliability and reproducibility of methods of categorization. The profile of the consultant NU is not the expected one, as described usually in the collective social representations. The patient behaved as “rational person” when choosing to go to the ED. Among all health care resources available, the ED is the most suitable place and the most efficient provider for their medical needs. ED patients were willing to optimize their medical care by considering the most efficient health care resources. The lack of consensus on methods of categorization and criteria and the confusion between the concepts of NU and inappropriate ED visits explain the difficulty to identify the NU patient. Therefore none methods of categorization should be used to redirected patients outside the ED.

Bakgrund: Akutmottagningen är en arbetsplats som ställer höga krav på sjuksköterskan som arbetar där då vården som bedrivs är mångfacetterad och snabbt skiftande i intensitet. Detta ställer krav på sjuksköterskans förmåga att sortera intrycken för att hantera situationerna som uppkommer på en akutmottagning. Som nyanställd sjuksköterska på en akutmottagning är detta en stor utmaning vilket ställer höga krav på det introduktionsprogram som erbjuds. Syfte: Syftet var att belysa och beskriva nyanställda sjuksköterskors upplevelse och erfarenhet av introduktionsprogrammet samt hur detta förberedde dem inför arbetsuppgifterna på akutmottagningen. Metod: En kvalitativ intervjustudie med deskriptiv design valdes utifrån studiens syfte. Semistrukturerade intervjuer med intervjuguide genomfördes med 11 informanter som var allmänsjuksköterskor på en akutmottagning i södra Sverige. En kvalitativ innehållsanalys med induktiv ansats utfördes på manifest och latent nivå. Resultat: Resultatet presenterades i temat att vara oförberedd på det oförutsedda i vilket det ingick fyra kategorier som beskrev informanternas upplevelse av introduktionen. Dessa var; yttre påverkansfaktorer, inre upplevelser, hantering av situationen samt förslag till förbättringar. Slutsatser: De nyanställda sjuksköterskorna på akutmottagningen upplevde introduktionen för kort i förhållande till informationsmängden och den informationen som gavs upplevdes bristfällig. Studiens resultat bör kunna ses som ett bidrag vid en förändring av introduktionsprogrammet på akutmottagningen. Vidare forskning behövs inom området för att möjliggöra en bra introduktion för sjuksköterskor samt i slutänden kunna leda till ett bra omhändertagande av patienter.

Titel: Vi vill men orkar inte: Sjuksköterskors beskrivningar av varför de slutar på akutmottagning – en kvalitativ studie Bakgrund: På akutmottagningen utförs avancerad akutsjukvård som ställer höga krav på sjuksköterskans kompetens. Under de senaste åren har dock många sjuksköterskor valt att lämna akutsjukvården för att påbörja arbete på annan arbetsplats inom vården. Detta leder till att kompetensen hos kvarvarande personalgrupp sjunker och arbetsbelastningen på akutmottagningarna ökar relaterat till personalbristen. Syfte: Syftet med studien var att belysa arbetsmiljörelaterade anledningar som leder till att sjuksköterskor på akuten slutar sin anställning. Metod: Studien utfördes genom kvalitativ design där tio sjuksköterskor beskrev sina erfarenheter genom semistrukturerade individuella intervjuer. Deltagarna var alla kvinnor verksamma vid olika akutmottagningar i södra halvan av Sverige. Analys av data genomfördes med kvalitativ innehållsanalys. Resultat: Studiens resultat pekade tydligt på att sjuksköterskorna upplevde arbetet på akutmottagningen som givande samtidigt som det fanns allt för många negativa aspekter i form av exempelvis bristande stöd från ledningen, känslan av maktlöshet och upplevelse av påverkad hälsa på grund av arbetsmiljörelaterade faktorer. Resultatet presenteras i tre kategorier: Stimulerande, Frustrerande och Motiverande, där den sista kategorien behandlar sjuksköterskornas egna förbättringsförslag för att orka stanna kvar på akutmottagningen. Slutsats: Studien påvisar att sjuksköterskorna tyckte om arbetet på akutmottagning men att arbetsmiljörelaterade faktorer som stress, påverkan på den egna hälsan och bristande stöd från arbetsledningen påverkade deras vilja att stanna på arbetsplatsen. Arbetsmiljön på akutmottagningen måste således förbättras och till största delen är det arbetsledningen som behöver utveckla sitt ledarskap för att få sjuksköterskorna att känna sig uppskattade, delaktiga och sist men inte minst respekterade. / Title: We want to, but do not have the strength: Nurses descriptions of why they quit their jobs in the emergency department – a qualitative study Background: In the emergency department advanced emergency care is performed which place high demands on nurses’ skills. In recent years, however, many nurses have chosen to leave the emergency medical care to begin work at another workplace in health care. This leads to the a decrease in the skills of remaining staff and the workload on emergency departments increases related to staff shortages. Aim: The aim of the study was to highlight working environment related reasons that makes nurses in the emergency department want to terminate their employment. Method: The study was conducted with a qualitative design with ten nurses that described their experiences through semi-structured individual interviews. The participants were all women active in different emergency departments in the southern half of Sweden. To analyze the data a qualitative content analysis was carried out. Results: Our results clearly indicated that nurses experienced the work in the emergency department as rewarding, whilst there were too many negative aspects in the form of, for example, lack of management support, the feeling of powerlessness and experience of affected health due to working environment related factors. The results are presented in three categories: Stimulating, Frustrating and Motivating, where the last category covers nurses own suggestions for improvement to help them have the strength to remain at work in the emergency department Conclusion: This study demonstrates that nurses enjoy working in the emergency department but working environmental factors affected their ability to remain in the workplace like stress, impact on their own health and the lack of support from the management affected their willingness to stay in the workplace. The work in the emergency department must be improved, for the most part it is the workplace management that need to develop their leadership to help the nurses achieve the feeling of being valued, involved and last but not least respected.

Master of Science / Department of Industrial and Manufacturing Systems Engineering / Chih-Hang John Wu / The University of Kansas Medical Center’s Emergency Department is adopting a new residency program. In the past, generalized Residents have supported attending physicians during a required three month rotation in the Emergency Department. As of July 2010, the University of Kansas Medical Center’s Emergency Department has switched to a dedicated Emergency Medicine Residency program that allows recently graduated physicians the opportunity enter the field of Emergency Medicine. This thesis shows that although not initially a dedicated residency program provides an advantage to the Emergency Department. Discrete Event Simulations have been used to predict changes in processes, policies, and practices in many different fields. The models run quickly, and can provide a basis for future actions without the cost of actually implementing changes in policies or procedures. This thesis applies a learning curve in a Simulation Model in order to provide data that the University of Kansas Medical Center’s Emergency Department can utilize to make decisions about their new Residency Program. A generalized learning curve was used for the base model and compared to all alternatives. When it was compared with an alternative curve following a Sigmoid Function (Logistic Function), there were no significant differences. Ultimately, a Gompertz Curve is suggested for hospitals attempting to develop or improve their residency programs using learning curves because it is easily fitted to their desired shape. This thesis shows the effect that Residents have on the performance of the Emergency Department as a whole. The two major components examined for the generalized learning curve were the initial position for first year residents determined by the variable [alpha], and the shape of the curve determined by the variable [beta]. Individual changes the value of [alpha] had little effect. Varying values of [beta] have shown that smaller values elongate the shape of the curve, prolonging the amount of time it takes for a resident to perform at the level of the attending physician. Each resident’s personal value of [beta] can be used to evaluate the performance in the emergency department. Resident’s who’s [beta] value are smaller the emergency department’s expected value might have trouble performing.