Bakgrund: Säker vård är ett viktigt begrepp inom hälso- och sjukvården. Begreppet är ett av de sex kärnkompetenserna vilket innebär att sjuksköterskor ska ha rätt kunskap för att öka säkerheten och kvalitén inom vården. Genom att ha god kommunikation och att minska stressen inom akutkliniker upprätthålls säker vård.  Syfte: Att beskriva sjuksköterskans upplevelse av vad som påverkar säker vård inom akutsjukvård.  Metod: Genomförandet var en litteraturöversikt med kvalitativ metod och utformades med en induktiv ansats. Resultatet formades av tio kvalitativa artiklar. Resultat: Det finns yttre förutsättningar och inre upplevelser som spelar stor roll i sjuksköterskans arbete kring säker vård. De yttre förutsättningarna är beroende av kunskap och tidigare upplevelser, tydlig dokumentation och kommunikation och organisation och standardisering. De inre upplevelserna inriktar sig på att ha kontroll över en situation och att känna sig stressad.  Slutsats: Utifrån inre upplevelser och yttre förutsättningar påverkas patientens säkerhet, speciellt inom akutkliniker. För att uppnå en säker vård på en akutklinik krävs en god kommunikation. Andra nämnda områden är minskad stress, ökad bemanning och bra samarbete mellan sjuksköterskor för att främja säker vård. På akutkliniker är dessa upplevelser ett problem då sjuksköterskorna aldrig kan förutse dagens omvårdnadsåtgärder. Det leder i sin tur till att stressfaktor hos sjuksköterskor ökar som bidrar till brister i kommunikationen.

Os serviços de emergências hospitalares (EH) desempenham um papel fundamental no sistema de saúde, servindo de porta de entrada para hospitais e fornecendo cuidados para pacientes com lesões e doenças graves. No entanto, as EH em todo o mundo sofrem com o aumento da demanda e superlotação. Múltiplos fatores convergem simultaneamente para resultar nessa superlotação, porém a otimização do gerenciamento do fluxo dos pacientes pode auxiliar na redução do problema. Nesse contexto, o tempo de permanência dos pacientes na EH (TPEH) é consolidado na literatura como indicador de qualidade do fluxo de pacientes. O tema desta dissertação é a previsão e gestão da demanda em EH com alto grau de congestionamento, que é abordado através de três artigos científicos. O objeto de estudo é o Hospital de Clínicas de Porto Alegre (HCPA). No primeiro artigo, são aplicados quatro modelos de previsão da procura por atendimento na EH, avaliando-se a influência de fatores climáticos e de calendário. O segundo artigo utiliza a técnica de regressão por mínimos quadrados parciais (PLS – partial least squares) para previsão de quatro indicadores relacionados ao TPEH para hospitais com alto grau de congestionamento. O tempo médio de permanência (TM) na EH resultou em um modelo preditivo com melhor ajuste, com erro médio absoluto percentual (MAPE - mean absolute percent error) de 5,68%. O terceiro artigo apresenta um estudo de simulação para identificação dos fatores internos do hospital que influenciam o TPEH. O número de exames de tomografias e a taxa de ocupação nas enfermarias clínicas e cirúrgicas (ECC) foram as que mais influenciaram. / Emergency departments (ED) play a key role in the health system, serving as gateway to hospitals and providing care for patients with injuries and serious illnesses. However, EDs worldwide suffer from increased demand and overcrowding. Multiple factors simultaneously converge to result in such overcrowding, and the optimization of patient flow management can help reduce the problem. In this context, the length of stay of patients in ED (LSED) is consolidated in the literature as a patient flow quality indicator. This thesis deals with forecast and demand management in EDs with a high degree of congestion. The subject is covered in three scientific papers, all analyzing data from the Hospital de Clínicas de Porto Alegre’s ED. In the first paper we apply four demand forecasting models to predict demand for service in the ED, evaluating the influence of climatic and calendar factors. The second article uses partial least squares (PLS) regression to predict four indicators related to LSED. The mean length of stay in the ED resulted in a model with the best fit, with mean percent absolute error (MAPE) of 5.68%. The third article presents a simulation study to identify the internal hospital factors influencing LSED. The number of CT exams and the occupancy rate in the clinical and surgical wards were the most influential factors.

Bakgrund: Hot och våld är ett växande problem på akutmottagningar. Vad som upplevs som hot och våld är individuellt. Sjuksköterskor utsätts för hot och våld från dels patienter, anhöriga, andra sjuksköterskor och läkare. Patienter som var våldsamma kände sig ofta missförstådda eller kränkta. De sjuksköterskor som inte vårdade med patientperspektiv blev mer utsatta. Syfte: Syftet med uppsatsen är att beskriva sjuksköterskors upplevelser och erfarenheter av hot och våld på akutmottagningar. Metod: Detta är en litteraturöversikt med kvalitativa och kvantitativa artiklar som följer. Resultat: litteraturöversikten resulterar i tre huvudteman och nio relaterade subteman. Dessa teman är upplevda känslor, behov av stöd och negativ påverkan. Konklusion: Det skulle behöva vidtas åtgärder mot hot och våld för att förbättra sjuksköterskornas arbetsplats. Denna studie visar att HOV påverkar såväl sjuksköterskor som patienter och hela vårdkulturen. Det har negativa konsekvenser som på sikt leder till att sjuksköterskor inte vill arbeta kvar på arbetsplatsen / Background: Threats and violence are a growing problem in emergency departments. What is perceived as threat and violence is individual. Nurses are exposed to threats and violence coming from patients, relatives, other nurses and doctors and more. Patients who were violent often felt misunderstood or offended. The nurses who did not care with the patient perspective became more vulnerable. Aim: The aim of this study is to describe nurse’s experiences of threats and violence in the emergency departments. Method: This is a literature review with qualitative and quantitative articles that follow Friberg (2017) Results: The literature review results in three main themes and nine related sub-themes. These themes are perceived emotions, need for support and negative impact. Conclusion: Action against threats and violence would have to be taken to improve the nurses' workplace. This study shows that HOV affects both nurses and patients and the entire care culture. This has negative consequences that eventually lead to nurses not wanting to work in the workplace.

Aim: Thisstudy aimedto investigatethe knowledge and attitudes of healthcareworkers regardinginfluenza, influenza vaccination,and vaccination practicesin emergency departments in Gothenburg, Sweden. Method: This cross-sectional studyuseda self-administered questionnaire distributed tonurses, assistant nurses,and physiciansin three emergency departments atThe Sahlgrenska University Hospital in January–February2014. Results: Among214 participants, 56% were nurses, 27% assistant nurses,and 17% physicians. The response ratewas 77%. A total of 66 participants (31%)werevaccinated against influenza during the previous12 months.The highest vaccination coverage occurredin the oldestage group(56%;P&lt;0.05).Past vaccinationstrongly predicted future vaccinationbehavior (P&lt;0.001). Ourdata revealed nosignificant difference invaccination coverage betweenprofession, work experience, hospital,or gender. The mean knowledge score was higher among vaccinated vs. unvaccinated health care workers (17.9 ± 2.7vs.16.8 ± 2.6, respectively; P&lt; 0.05). Moreover, influenza risk perception was higher among participants who were vaccinated during the previous12 months compared to unvaccinated participants (P&lt; 0.001). Interestingly, more un vaccinated health care workers believed that personal behavior determines health (higher internal locus of control) compared to vaccinated workers(P&lt; 0.05). More than half of vaccinated health care workers stated that they got vaccinated to avoid influenza. Almost half of the unvaccinated workers voiced concern about vaccine side effects. Fourteen percent of all respondents mentioned patient protection as an important factor in their decision to receive influenza vaccination. Conclusion:This study demonstrates a need for improved knowledge about influenza and influenza vaccinationin health care workers. Increased risk perception of influenza can increase vaccination coverage in emergency department personnel,and may reduce the incidence of healthcare-associated influenza. / <p>ISBN 978-91-86739-77-5</p>

Os serviços de emergências hospitalares (EH) desempenham um papel fundamental no sistema de saúde, servindo de porta de entrada para hospitais e fornecendo cuidados para pacientes com lesões e doenças graves. No entanto, as EH em todo o mundo sofrem com o aumento da demanda e superlotação. Múltiplos fatores convergem simultaneamente para resultar nessa superlotação, porém a otimização do gerenciamento do fluxo dos pacientes pode auxiliar na redução do problema. Nesse contexto, o tempo de permanência dos pacientes na EH (TPEH) é consolidado na literatura como indicador de qualidade do fluxo de pacientes. O tema desta dissertação é a previsão e gestão da demanda em EH com alto grau de congestionamento, que é abordado através de três artigos científicos. O objeto de estudo é o Hospital de Clínicas de Porto Alegre (HCPA). No primeiro artigo, são aplicados quatro modelos de previsão da procura por atendimento na EH, avaliando-se a influência de fatores climáticos e de calendário. O segundo artigo utiliza a técnica de regressão por mínimos quadrados parciais (PLS – partial least squares) para previsão de quatro indicadores relacionados ao TPEH para hospitais com alto grau de congestionamento. O tempo médio de permanência (TM) na EH resultou em um modelo preditivo com melhor ajuste, com erro médio absoluto percentual (MAPE - mean absolute percent error) de 5,68%. O terceiro artigo apresenta um estudo de simulação para identificação dos fatores internos do hospital que influenciam o TPEH. O número de exames de tomografias e a taxa de ocupação nas enfermarias clínicas e cirúrgicas (ECC) foram as que mais influenciaram. / Emergency departments (ED) play a key role in the health system, serving as gateway to hospitals and providing care for patients with injuries and serious illnesses. However, EDs worldwide suffer from increased demand and overcrowding. Multiple factors simultaneously converge to result in such overcrowding, and the optimization of patient flow management can help reduce the problem. In this context, the length of stay of patients in ED (LSED) is consolidated in the literature as a patient flow quality indicator. This thesis deals with forecast and demand management in EDs with a high degree of congestion. The subject is covered in three scientific papers, all analyzing data from the Hospital de Clínicas de Porto Alegre’s ED. In the first paper we apply four demand forecasting models to predict demand for service in the ED, evaluating the influence of climatic and calendar factors. The second article uses partial least squares (PLS) regression to predict four indicators related to LSED. The mean length of stay in the ED resulted in a model with the best fit, with mean percent absolute error (MAPE) of 5.68%. The third article presents a simulation study to identify the internal hospital factors influencing LSED. The number of CT exams and the occupancy rate in the clinical and surgical wards were the most influential factors.

Os serviços de emergências hospitalares (EH) desempenham um papel fundamental no sistema de saúde, servindo de porta de entrada para hospitais e fornecendo cuidados para pacientes com lesões e doenças graves. No entanto, as EH em todo o mundo sofrem com o aumento da demanda e superlotação. Múltiplos fatores convergem simultaneamente para resultar nessa superlotação, porém a otimização do gerenciamento do fluxo dos pacientes pode auxiliar na redução do problema. Nesse contexto, o tempo de permanência dos pacientes na EH (TPEH) é consolidado na literatura como indicador de qualidade do fluxo de pacientes. O tema desta dissertação é a previsão e gestão da demanda em EH com alto grau de congestionamento, que é abordado através de três artigos científicos. O objeto de estudo é o Hospital de Clínicas de Porto Alegre (HCPA). No primeiro artigo, são aplicados quatro modelos de previsão da procura por atendimento na EH, avaliando-se a influência de fatores climáticos e de calendário. O segundo artigo utiliza a técnica de regressão por mínimos quadrados parciais (PLS – partial least squares) para previsão de quatro indicadores relacionados ao TPEH para hospitais com alto grau de congestionamento. O tempo médio de permanência (TM) na EH resultou em um modelo preditivo com melhor ajuste, com erro médio absoluto percentual (MAPE - mean absolute percent error) de 5,68%. O terceiro artigo apresenta um estudo de simulação para identificação dos fatores internos do hospital que influenciam o TPEH. O número de exames de tomografias e a taxa de ocupação nas enfermarias clínicas e cirúrgicas (ECC) foram as que mais influenciaram. / Emergency departments (ED) play a key role in the health system, serving as gateway to hospitals and providing care for patients with injuries and serious illnesses. However, EDs worldwide suffer from increased demand and overcrowding. Multiple factors simultaneously converge to result in such overcrowding, and the optimization of patient flow management can help reduce the problem. In this context, the length of stay of patients in ED (LSED) is consolidated in the literature as a patient flow quality indicator. This thesis deals with forecast and demand management in EDs with a high degree of congestion. The subject is covered in three scientific papers, all analyzing data from the Hospital de Clínicas de Porto Alegre’s ED. In the first paper we apply four demand forecasting models to predict demand for service in the ED, evaluating the influence of climatic and calendar factors. The second article uses partial least squares (PLS) regression to predict four indicators related to LSED. The mean length of stay in the ED resulted in a model with the best fit, with mean percent absolute error (MAPE) of 5.68%. The third article presents a simulation study to identify the internal hospital factors influencing LSED. The number of CT exams and the occupancy rate in the clinical and surgical wards were the most influential factors.

Organizational Resilience is defined as the ability of an organization to anticipate sudden disruptions, effectively respond, and adapt in a changing environment to deliver its objectives, as well as successfully recover. In order to increase resilience at an organizational level, it is important to understand how individuals collectively contribute to resilience capability of an organization. Emergency Departments (EDs) are considered to be particularly well suited to investigating resilience capability due to their highly unpredictable and complex operating environment. Further, the resilience capability of EDs and their staff is suggested to be essential to successful delivery of safe, high-quality, and timely medical care to all patients in cases of mass disruptive events. The purpose of this research is to develop a model of staff resilience to support the improvement of organizational resilience in EDs in the United States. The study was organized into two phases: Initial Model Development based on a Thematic Analysis of existing conceptual models and Preliminary Model Validation via deductive evaluation of published Empirical Case Studies on ED response to mass casualty events. As a result of the first phase, Initial Model was proposed that consists of five dimensions of resilience: Triggers, Factors Affecting Resilience, Resilience Capability, Characteristics of ED Complexity and Outcomes. The results of the second phase determined that the Initial Model was comprehensive and only minor additions were made. Further, recommendations for improving case studies on ED responses were developed. The results of the study provide a model that demonstrates how ED staff supports the organizational resilience capability of the EDs. This research contributes to the general knowledge base of resilience as a critical organizational capability in EDs when dealing with unexpected disruptions as well as provides guidance for EDs in the United States when seeking to become more resilient.

Bakgrund: Säker vård innebär att sjuksköterskor ska arbeta förebyggande mot att minskaoch förhindra vårdskador, vilket både Svensk sjuksköterskeförening ochPatientsäkerhetslagen omnämner. Det är en viktig del i det dagliga omvårdnadsarbetet försjuksköterskor att bedriva patientsäker omvårdnad. Trots att det ingår både ikompetensbeskrivningen och svensk lagstiftning drabbas över 100 000 patienter årligen avnågon form av vårdskada i Sverige.Syfte: Syftet med denna litteraturöversikt är att undersöka hur sjuksköterskor upplever attarbetsbelastningen påverkar patientsäkerheten på akutmottagningar.Metod: Examensarbetet utfördes som en litteraturöversikt där 15 kvalitativa vetenskapligaartiklar inkluderades. Databaserna som användes när artiklarna söktes fram var CINAHL ochPubMed. De artiklar som inkluderades var publicerade mellan åren 2011 - 2021.Resultat: Sjuksköterskorna upplevde flera områden som bidrog till brister ipatientsäkerheten där tidsbrist och teamarbete var de mest framträdande. Andra områden somvar bidragande var svårarbetad arbetsmiljö, konsekvenser av personalbrist och bristandekommunikation. Sammantaget av dessa områden kunde utgöra svårigheter försjuksköterskorna att arbeta patientsäkert och prioritera den grundläggande omvårdnaden.Slutsats: Sjuksköterskor är ofta medvetna om patientens risker och hur det förebyggandearbetet ska gå till för att undvika vårdskada, men det som visas i resultatet tyder på att det ärområden som påverkar patientsäkerheten. Det som i grund och botten skapar vårdskador är attsjuksköterskorna inte har tid att vara noggrann i sitt arbete. Sammanfattningsvis pekarresultatet på att det finns ett glapp mellan den forskning som finns om patientsäkerhet och hurverksamheten är utformad och strukturerad. / Background: Nurses must work to reduce and prevent injuries caused by healthcare thatsafe care entails, which both Svensk sjuksköterskeförening and Patientsäkerhetslagenmention. It is an important part of the daily care for nurses to conduct patient-safe care.Despite the fact that it is included in both the competence description and Swedish legislation,more than 100,000 patients suffer from some form of healthcare injury annually in Sweden.Aim: The aim is to explore how nurses experience that the workload affects patient safety inemergency departments.Method: This study was conducted as a literature review which included 15 qualitativearticles. The databases used when searching for the articles were CINAHL and PubMed. Thearticles that were included were published between the years 2011 - 2021.Results: The nurses experienced several factors that contributed to deficiency in patientsafety, where lack of time and teamwork were the most outstanding. Other factors that werecontributed were difficult work environment, staff shortages and lack of communication.Overall, these factors made it difficult for the nurses to work patient safely and prioritize basiccare.Conclusions: Nurses are often aware of the patient's risks and how the preventive workshould be done to avoid injuries, but what is shown in the results indicates surroundingfactors. What basically creates care injuries is that the nurses do not have time to be accuratein their work. In summary, the results indicate that there is a gap between the research thatexists on patient safety and how the organization is designed and structured.

Caregivers often associate fevers with permanent harm and bring children to emergency departments (EDs) unnecessarily. However, families using EDs for nonurgent complaints often have difficulty accessing quality primary care. Mutual misconceptions among caregivers and healthcare providers regarding nonurgent ED use are a barrier to implementing meaningful interventions. The purpose of this project was to identify dominant themes in caregivers’ narratives about bringing children to the ED for nonurgent fevers. Thirty caregivers were recruited in a pediatric ED for participation in qualitative semi-structured interview from August to November 2014. Interview transcripts were coded and analyzed for themes. Caregivers’ decisions to come to the ED revolved around their need for reassurance that children were not in danger. Several major themes emerged: caregivers came to the ED when they felt they had no other options; parents feared that fevers would result in seizures; caregivers frequently drew on family members and the internet for health information; and many families struggled to access their PCPs for sick care due to challenging family logistics. Reducing nonurgent ED utilization requires interventions at the individual and structural level. Individual-level interventions should empower caregivers to manage fevers and other common illnesses at home. However, such interventions may have limited impact on utilization outcomes among families with poor access to primary care. Afterhours primary care should be expanded to accommodate families with rigid work schedules and limited transportation resources.

Bakgrund Sepsis är ett allvarligt tillstånd som drabbar många miljoner människor i världen, och kan bli livshotande om inte en tidig identifiering sker eller om behandlingsåtgärder blir fördröjda. Därmed har sjuksköterskor en vital roll och ett stort ansvar att upptäcka tidiga symtom eller försämringar hos patienter med sepsis eftersom de utför det patientnära arbetet. Dock finns svårigheter med att göra en korrekt bedömning då symtomen ofta är svårtolkade.   Syfte  Syftet var att belysa sjuksköterskors erfarenhet vid omvårdnaden av vuxna patienter med sepsis på akutmottagningar.     Metod  En allmän litteraturöversikt baserad på 10 vetenskapliga artiklar, av kvalitativ och mixad metoddesign. Samtliga artiklar kvalitetsgranskades och analyserades genom att använda kvalitativ innehållsanalys.   Resultat  Efter genomarbetad dataanalys framkom tre kategorier: Organisatoriska faktorer, Adekvat utbildning och erfarenhet samt Samverkan grupp, därefter tillkom sju subkategorier.   Slutsats Sjuksköterskor möter stora utmaningar vid omvårdnaden av patienter med sepsis. Sjuksköterskor har ett stort ansvar och en viktig roll att upptäcka patienter med misstänkt sepsis i ett tidigt skede. Detta är dock en utmaning för de flesta sjuksköterskor framför allt för de som har en bristfällig kompetensnivå, eftersom det krävs både kunskap och erfarenhet att göra en snabb och korrekt bedömning. I situationer då sjuksköterskor saknar erfarenhet är det betydelsefullt att ha grundläggande kunskap om sepsis och att använda identifieringsverktyg vid bedömningen, samt samarbeta med sjuksköterskor som har en högre kompetensnivå för att på så vis erhålla värdefull kunskap / Background Sepsis is a serious condition that affects many millions of people worldwide and can be life-threatening if early identification is not made or treatment measures are delayed. Thus, nurses have a vital role and a great responsibility to detect early symptoms or deterioration in patients with sepsis because they perform the work close to the patient. However, there are difficulties in making a correct assessment as the symptoms are often difficult to interpret.   Purpose  The purpose was to shed light on nurses' experiences caring for adult sepsis patients in emergency departments.   Method  A general literature review based on 10 scientific articles of qualitative and mixed method design. All articles were quality-reviewed and analysed using qualitative content analysis.   Results  After elaborate data analysis, three categories emerged: Organizational factors, Adequate training and experience, and Group collaboration, then seven subcategories were added.   Conclusions Nurses face major challenges when caring for patients with sepsis. Nurses have a great responsibility and an important role in detecting patients with suspected sepsis at an early stage. However, this is a challenge for most nurses, especially for those who have a deficient level of competence, as it requires both knowledge and experience to make a quick and accurate assessment. In situations where nurses lack experience, it is important to have basic knowledge of sepsis and to use identification tools in the assessment, as well as to collaborate with nurses who have a higher level of competence to obtain valuable knowledge.