<p> </p><p><strong>Aim.</strong> To describe patients who have got a recommendation by a telenurse to visit the emergency department and how many of these patients could have received care in the primary health care instead. Further on, the aim was to describe if there are patients not following the recommendations.</p><p><strong>Methods.</strong> Quantitative, descriptive study, with an examination of medical records of the patients, which the telenurses recommended to visit the emergency department, during one week. Assessments whether the patient could seek medical care at the primary health care was made, firstly based on the telenurses documentation and secondly on both the telenurses and the emergency department´s documentation.<strong></strong></p><p><strong>Results.</strong> 15 % of the patients could have gotten care at the primary health care center, based on the first assessment. 33 % could have gotten care at the primary health care center, according to the second assessment. One fifth of the patients chose not to visit the emergency department even though the telenurses recommended it.<strong></strong></p><p><strong>Conclusion.</strong> The telenurses recommended the patients to the right level of care in seven out of ten cases. We consider the telenurses' assessments to work well.<strong> </strong></p><p> </p> / <p> </p><p><strong>Syfte. </strong>Att beskriva vilka patienter som blir rekommenderade av sjukvårdsrådgivningen att söka till akutmottagningen, samt hur stor andel av dessa patienter som hade kunnat få vård i primärvården istället. Syftet var vidare att beskriva vilka och hur många patienter som blivit rekommenderade av sjukvårdsrådgivningen till akutmottagningen som inte följer denna rekommendation.</p><p><strong>Metod. </strong>Kvantitativ, beskrivande studie, med journalgranskning av de patienter som rekommenderas till akutmottagningen av sjukvårdsrådgivningen under en veckas tid. Bedömning av huruvida patienten kunde söka vård i primärvården gjordes, först utifrån sjukvårdsrådgivningen dokumentation och sedan utifrån både sjukvårdsrådgivningens och akutmottagningens dokumentationen.</p><p><strong>Resultat. </strong>Sjutton av de 111 patienterna (15 %) hade kunnat få vård i primärvården, bedömt utifrån sjukvårdsrådgivningens dokumentation. 33 % hade kunnat få vård i primärvården, bedömt utifrån både sjukvårdsrådgivningens och akutmottagningens dokumentation. En femtedel av patienterna valde att inte komma till akutmottagningen trots att sjukvårdsrådgivningen rådde dem till detta.</p><p><strong>Slutsats.</strong> Totalt sett rekommenderade telefonsjuksköterskorna patienterna till rätt vårdnivå i sju fall av tio, trots de svårigheter som rådgivning och bedömning via telefon medför. Därför anser vi att sjukvårdsrådgivningens bedömningar fungerar bra. En femtedel av patienterna valde att inte komma trots rekommendationen och till detta har vi inte funnit något särskilt skäl.</p><p> </p>

Aim:  To describe and develop understanding of  the patient’s first encounter with the involved persons at the scene of an accident and at the emergency department; with a special focus on describing the meaning of emergency care of patients in these caring contexts.  Method: The thesis uses a reflective lifeworld research (RLR) approach founded on phenomenological philosophy. The purpose with this approach is to describe the essential meaning and the variations of a phenomenon. Interviews with a lifeworld perspective were used for data collection and analyzed according to the RLR approach for searching for the essence of the phenomenon.  The four essences in the studies (I-IV) establish a general structure for the phenomenon. Findings:  Emergency care is characterized by an organisation, whose goal and resources are focused on life-saving, and that encounters a human being with needs of emergency care as well as existential support. The responsibility in emergency care means an intertwining of doing and being.  The one who is in charge takes responsibility for performing or “doing” medical actions, and by “being” close and present in the situation the patient can at the same time feel an existential support. The responsibility for the injured or ill body is handed over to a chain of persons with more and more specialized competence and resources. This hand-over entails a relief for all involved but fails in one link in the chain, namely to explicitly hand back  the responsibility to the patient.  When the patient’s condition allows the distance to be larger the responsibility pales and the existential support decreases. A gap between doing and being arises where the patient is left to regain control and independence. The intertwining of doing and being, which appears as soon as the one in charge is close and present to the patient, facilitates the hand-over to the patient who in a natural way is able to receive the responsibility with possibilities to be able to conclude the encounter. Conclusions: A new understanding of emergency care appears which entails more than just life support measures.  Emergency care includes different ways of communication in order to hand over the responsibility and complete the care chain back to the patient in a safe way. The results highlight the importance of empowering patients with a confirming, communicative contact throughout the whole caring process in order for them to retain their identity. There are also implications for educating students and personnel in inter-professional communication and work. In order to assist the intertwining between doing and being there are needs for the development of supportive structures for inter-professional reflection, which in turn would improve the interaction between patients and professionals in their encounter.

The overall aim of this thesis was to describe experiences of emergency treatment among people injured in traffic accidents, and to test and evaluate the effects of follow-up telephone calls from a nurse during the subsequent phase. The thesis is based on four sub-studies of motorists, bicyclists, and pedestrians who had fallen in traffic during the years 2002-2005. The participants were aged 18 to 70 years old and had minor (MAIS 1) or nonminor (MAIS 2+) injuries. Sub-study I was a qualitative study in which individual narrative interviews were conducted with nine persons who had sustained traffic injuries. The aim of this study was to describe the injured individuals’ experiences of pre-hospital and hospital care and subsequent rehabilitation. The interviews were analysed using content analysis, and the experiences of the interviewees were formulated into four themes: facing commotion, experiencing trust and security, lacking security and support, and struggling to return to everyday life. The results showed that a sensitive caregiver who provides comprehensible information facilitates both the emergency treatment and the subsequent period of care and rehabilitation. Sub-study II was a cross-sectional study in which the participants (n=565) estimated their perceptions of the quality of care in the accident and emergency department (A&amp;E) after an injury event. The Mini-KUPP (“Quality from the Patient’s Perspective”) questionnaire was used to estimate quality of care at the A&amp;E. The questionnaire was posted to the subjects’ home addresses three weeks after the visit to the A&amp;E. The results showed that the quality of care was scored on the top half of the scale by all three road user categories. In a multiple logistic regression analysis, significant connections emerged between good quality of care and a short waiting time, non-minor injuries (MAIS2+), higher age, and higher levels of education. The factor most closely associated with the perception of good quality of care was a short waiting time. Sub-study III was a stratified and randomised intervention study including 568 injured persons. In addition to modern trauma care, the intervention group received follow-up via telephone, three weeks after the injury, by a nurse who provided advice and support during the rehabilitation period. The control group received modern trauma care but no follow-up. Both groups estimated their health-related quality of life two weeks (baseline) and six months after the injury. After six months, estimates of health-related quality of life were generally higher in the intervention group than in the control group. A sub-group analysis found that the differences were most pronounced for the group who had received adequate advice in connection with the telephone follow-up. Of the three road user categories, the motorists gained the greatest benefit from the telephone intervention, with milder problems with regard to pains/difficulties and essential activities. Sub study IV was a health economic study. The calculations were built on the results from study III (n=568). A cost utility analysis was performed, including the costs for the intervention and the QALYs gained. The results showed that the telephone intervention was cost-effective. The total gain in the intervention group was 2.60 QALYs, while the car occupants gained 1.54 QALYs. The cost per QALY gained was 16 000 SEK overall and 8 500 SEK for car occupants. Conclusion: A sensitive caregiver who also provides good information can instil security and trust in the patient. For the purposes of generally improving the quality of care in an A&amp;E, the aim above all should be a short waiting time, but the treatment of minor injuries should also be improved. Access to a supportive nurse who is able to provide advice during the subsequent phase has the potential to improve health-related quality of life in a cost-effective way.

Aim. To describe patients who have got a recommendation by a telenurse to visit the emergency department and how many of these patients could have received care in the primary health care instead. Further on, the aim was to describe if there are patients not following the recommendations. Methods. Quantitative, descriptive study, with an examination of medical records of the patients, which the telenurses recommended to visit the emergency department, during one week. Assessments whether the patient could seek medical care at the primary health care was made, firstly based on the telenurses documentation and secondly on both the telenurses and the emergency department´s documentation. Results. 15 % of the patients could have gotten care at the primary health care center, based on the first assessment. 33 % could have gotten care at the primary health care center, according to the second assessment. One fifth of the patients chose not to visit the emergency department even though the telenurses recommended it. Conclusion. The telenurses recommended the patients to the right level of care in seven out of ten cases. We consider the telenurses' assessments to work well. / Syfte. Att beskriva vilka patienter som blir rekommenderade av sjukvårdsrådgivningen att söka till akutmottagningen, samt hur stor andel av dessa patienter som hade kunnat få vård i primärvården istället. Syftet var vidare att beskriva vilka och hur många patienter som blivit rekommenderade av sjukvårdsrådgivningen till akutmottagningen som inte följer denna rekommendation. Metod. Kvantitativ, beskrivande studie, med journalgranskning av de patienter som rekommenderas till akutmottagningen av sjukvårdsrådgivningen under en veckas tid. Bedömning av huruvida patienten kunde söka vård i primärvården gjordes, först utifrån sjukvårdsrådgivningen dokumentation och sedan utifrån både sjukvårdsrådgivningens och akutmottagningens dokumentationen. Resultat. Sjutton av de 111 patienterna (15 %) hade kunnat få vård i primärvården, bedömt utifrån sjukvårdsrådgivningens dokumentation. 33 % hade kunnat få vård i primärvården, bedömt utifrån både sjukvårdsrådgivningens och akutmottagningens dokumentation. En femtedel av patienterna valde att inte komma till akutmottagningen trots att sjukvårdsrådgivningen rådde dem till detta. Slutsats. Totalt sett rekommenderade telefonsjuksköterskorna patienterna till rätt vårdnivå i sju fall av tio, trots de svårigheter som rådgivning och bedömning via telefon medför. Därför anser vi att sjukvårdsrådgivningens bedömningar fungerar bra. En femtedel av patienterna valde att inte komma trots rekommendationen och till detta har vi inte funnit något särskilt skäl.

The hospital sound environment is complex. Emergency Departments (EDs), in particular, have proven to be hectic work environments populated with diverse sound sources. Medical equipment, alarms, and communication events generate noise that can interfere with staff concentration and communication. In this study, sound measurements and analyses were conducted in six hospitals total: three civilian hospitals in Atlanta, Georgia and Dublin, Ohio, as well as three Washington, DC-area hospitals in the Military Health System (MHS). The equivalent, minimum, and maximum sound pressure levels were recorded over twenty-four hours in several locations in each ED, with shorter 15-30 minute measurements performed in other areas. Acoustic descriptors, such as spectral content, level distributions, and speech intelligibility were examined. The perception of these acoustic qualities by hospital staff was also evaluated through subjective surveys. It was found that noise levels in both work areas and patient rooms were excessive. Additionally, speech intelligibility measurements and survey results show that background noise presents a significant obstacle in effective communication between staff members and patients. Compared to previous studies, this study looks at a wider range of acoustic metrics and the corresponding perceptions of staff in order to form a more precise and accurate depiction of the ED sound environment.

Elderly patients in the Emergency Department (ED) receive a different level of care than younger patients. The ED disproportionately deploys resources to serve the needs of the younger patient population, a decision that appears to be mediated by the acuity of the patient’s condition as defined by the institution. This study will seek to examine the institutional work processes by which this disparity in care is created. By looking at the needs of the elderly as ED patients and based on what they identify as important to them, this ethnographic study will examine the work organization of the nurses, physicians, and administrators in the ED. The goal of the research is, through the examination of the organization of work and the texts that mediate it, to explain the ruling relations through which elderly patients are subjugated as patients in the ED.

Elderly patients in the Emergency Department (ED) receive a different level of care than younger patients. The ED disproportionately deploys resources to serve the needs of the younger patient population, a decision that appears to be mediated by the acuity of the patient’s condition as defined by the institution. This study will seek to examine the institutional work processes by which this disparity in care is created. By looking at the needs of the elderly as ED patients and based on what they identify as important to them, this ethnographic study will examine the work organization of the nurses, physicians, and administrators in the ED. The goal of the research is, through the examination of the organization of work and the texts that mediate it, to explain the ruling relations through which elderly patients are subjugated as patients in the ED.

Bakgrund: Våld är ett problem inom vården och på akutmottagningar finns en stor risk att våldsincidenter uppstår. Våld kan skapa fysiska och psykiska konsekvenser, medföra osäker arbetsmiljö och försämrad omvårdnad. Syfte: Syftet var att beskriva sjuksköterskors uppfattningar om vilka faktorer som kan ge upphov till våld på akutmottagningar. Metod: Litteraturöversikt baserat på kvalitativa och kvantitativa vetenskapliga artiklar. Resultat: I resultatet framkom olika faktorer som kan ge upphov till våld, såsom väntetider och stressande arbetsklimat. Sjuksköterskors beteende, attityder och kroppsspråk är andra faktorer. Medicinska och psykiska sjukdomar kan göra att patienter blir våldsamma, liksom användande av droger eller andra substanser. Slutsats: Genom att uppmärksamma faktorer som kan ge upphov till våld kan preventiva åtgärder vidtas vilket kan göra att sjuksköterskor på akutmottagningar får en säker arbetsplats och kan utföra en säker vård till patienter. / Background: Violence is a problem within the care and there is a risk for violence incidents at emergency departments. Violence can bring physical and psychological consequences, cause an unsafe work environment and impair the care. Aim: The aim was to describe nurses’ perceptions about which factors that can generate violence in emergency departments. Method: A literature review based on qualitative and quantitative scientific articles. Result: The result revealed different factors which can generate violence, such as waiting times and a stressful work. Nurses´ behaviours, attitudes and body language are other factors. Medical and psychological diseases can make the patient violent, as well as drug use or other substance abuse. Conclusion: By paying attention to factors which can give rise to violence can preventive actions be taken which can lead to that nurses in emergency departments get a safe workplace and can perform a safe health care to patients.

Syftet var att granska sjuksköterskans dokumentation avseende intagningsorsak, andra identifierade problem/behov utefter CGA och vilka åtgärder det ledde till samt beskriva sjuksköterskans erfarenheter av att använda instrumentet CGA. Metod: Studien har en beskrivande design med kvantitativ och kvalitativ ansats. Totalt granskades 50 bedömningsinstrument och datajournaler. Frågeformulär utformades och 13 sjuksköterskor valde att delta. Journalgranskningarna utfördes med kvantitativ retrospektiv analys och frågeformulären analyserades enligt kvalitativ manifest innehållsanalys. Resultat: Under journalgranskningen framkom 11 olika intagningsorsaker där försämrat allmäntillstånd var den största gruppen. Totalt identifierades 205 problem/behov och 186 initierade åtgärder varav 7 åtgärder/person var högsta antal. Flest initierade åtgärder fanns inom nutrition, social bakgrund och fallrisk. Sjuksköterskornas erfarenheter av att använda CGA var att det fanns behov av tydliga arbetsrutiner gällande CGA, att CGA fungerade bra som checklista men var tidskrävande. De upplevde att CGA gav dubbelarbete men viljan fanns att använda CGA men däremot svårt att få det att fungera i arbetet samt att sjuksköterskorna identifierade problem/behov utan att använda CGA. Sjuksköterskorna upplevde inte att omhändertagandet förändrades men däremot fick teamet helhetsperspektiv på patientens livssituation. Samverkan med anhöriga och kommunen var viktigt. Slutsats: Studiens resultat visade att förutom inskrivningsorsak fanns även andra identifierade problem/behov utefter CGA som hade stor betydelse för att den äldre skulle uppleva hälsa. Sjuksköterskorna upplevde brister inom rutinen runt CGA samt erfor att sjuksköterskornas omhändertagande av den geriatriska patienten inte förändrades efter implementeringen av CGA. / Aim was to examine nurses documentation regarding admission cause, other identified problems/needs by the CGA and the actions that led to and describe nurses experiences of using the instrument CGA. Method: The study has a descriptive design with quantitative and qualitative approach. Total audited 50 assessment instruments and data records. Questionnaires were designed and 13 nurses chose to participate. Journal audits performed by quantitative retrospective analysis and the questionnaires were analyzed by the inspiration of qualitative manifest content analysis. Results: In the journal audit identified 11 different admission causes which reduced general condition was the largest group. Total identified 205 problems/needs and 186 initiated measures which 7 action/person was the highest number. Most measures were initiated in nutrition, social background and risk of falling. Nurses experiences of using the CGA was that there was a need for clear work procedures regarding the CGA, the CGA worked well as a checklist but was time consuming. They felt that the CGA gave duplication but the desire was to use the CGA but hard to make it work at work and the nurses identified problems / needs without using the CGA. The nurses did not feel that the care was changed but got the team holistic view of the patients life situation. Collaboration with families and the municipality was important. Conclusion: The study results showed that in addition the cause enrollment were other identified problems/needs along the CGA that had great importance for the elderly would experience health. The nurses experienced deficiencies in routine around the CGA and required that the nurses taking care of the geriatric patient did not change after the implementation of CGA.

The number of persons with problems of abuse or addiction seeking care has increased during the last years in Sweden. Recent international studies show stigmatizing attitudes among nursing staff, which affect the treatment and care negatively. The purpose of this study was to describe experiences among nursing staff of treating persons with problems of abuse or addiction at an emergency department. The participants were six nurses and one assistant nurse who worked at an emergency department. The interviews were analyzed through qualitative content analysis. The result presented circumstances that complicated or facilitated the treatment of persons with problems of abuse or addiction. Challenging behavior among patients, stigmatizing attitudes and lack of knowledge among staff complicated the treatment while good security routines and a person-centered approach facilitated the treatment. Improved cooperation with the psychiatric clinic was requested to increase the competence of addiction treatment and to make the workflow more effective. The conclusion is that nursing staff at the emergency department lacks the time and knowledge that it takes to give the best treatment to these patients. This contributes to increased stigmatizing attitudes and conscience-related stress. Education, reflection and improved cooperation with the psychiatric ward were seen as important aspects of nursing development.