<p>To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint.<em> </em>The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital.</p><p>Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation.</p><p>The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted.</p><p>Triage supports the assessment and prioritization of patients.<strong> </strong>A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.</p>

To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint. The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital. Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation. The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted. Triage supports the assessment and prioritization of patients. A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.

Introduction: Rural emergency nurses face unique obstacles to providing quality end-of-life (EOL) care. Stories provided by emergency nurses embody their most difficult EOL care obstacles. Methods: A questionnaire was sent to 53 rural hospitals. Respondents were asked to share stories that epitomized the obstacles faced while providing EOL care in the rural emergency setting. Results: The lack of an ideal death (nurse personally knows the patient, issues with family members, and unknown patient wishes) was the top obstacle. Other reported obstacles were insufficient ED staff and power struggles between nurses and physicians. Discussion: Rural emergency nurses often provide EOL care to friends and family members, while their urban counterparts are likely to transfer care to nurses with no relation to the dying patient. Not only does caring for patients, that the nurse knows or is related to, cause great distress to rural emergency nurses, this unfortunately common situation may also prevent patients from receiving the highest quality of EOL care. Conclusion: Emergency nurses often face obstacles that hinder their ability to provide high quality EOL care to patients. These obstacles are compounded by a unique set of challenges faced by nurses working in rural emergency departments. Stories from rural emergency nurses revealed that being unable to provide optimal care at the EOL, having difficulties with family members, or not knowing the patient's wishes for EOL care were the most common obstacles. Additional obstacles included stories about the impact of low or unavailable staff and feeling powerless in some EOL situations.

<p>The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim.</p><p>The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain.</p><p>The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day.</p> / <p>Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad.</p><p>Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan.</p><p>Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.</p>

The study aimed to investigate the acute medical chain consisting of SOS operator, ambulance nurse, emergency nurse and emergency physician with regard to the assessment and prioritization of the victim. The design of this journal study is retrospective with descriptive approach. Data were collected from all ambulance missions carried out in Uppsala county 2009-01-01 between the hours 00:00 to 12:00. Sample period was chosen because the prerequisite for high frequency on the ambulance mission was supposed to be good. In order to be able to systematize the compilation of data a protocol were prepared and used. Applicable data were collected from three databases SOS Alarms, ambulance operations, and the University Hospital in Uppsala. The study was divided into three stages and record documents usefulness was assessed individually based on inclusion criteria's. During the measurement period the SOS operator assessed need of an ambulance at 62 occasions in Uppsala County. Of these 62 ambulance missions there were 18 that could be followed during the whole acute medical chain. The results showed that the participants of the acute medical chain most of the time did the same assessment of the victim main problem/symptom and thus the criterion. Without considering the priority it appeared that the criteria were the same in 83% of all 18 included ambulance missions. SOS operator assessed ambulance mission as a priority one in 39% (7/18), and the ambulance nurse judged that priority one on the way to the hospital was justified in 17% (3/18). Of the 18 victims who were transported by ambulance to the emergency department at the University Hospital in Uppsala 72% (13/18) went home the same day. / Studiens syfte var att undersöka den akutmedicinska vårdkedjan bestående av SOS operatör, ambulanssjuksköterska, akutsjuksköterska och akutläkare med avseende på bedömning och prioritering av drabbad. Designen på denna journalstudie är retrospektiv med deskriptiv ansats. Data insamlades från samtliga ambulansuppdrag som genomfördes i Uppsala län 2009-01-01 mellan klockan 00:00 - 12:00. Urvalsperioden valdes därför att förutsättningen för hög frekvens på ambulansuppdrag förmodades vara goda. För att systematisera sammanställningen av data utarbetades och användes ett protokoll. Tillämpbara uppgifter inhämtades från tre databaser SOS Alarms, ambulansverksamhetens och Akademiska sjukhusets. Studien delades upp i tre steg och journalhandlingarnas användbarhet bedömdes var för sig utifrån inklusionskriterier. Under mätperioden bedömde SOS operatören behov av ambulans vid 62 tillfällen i Uppsala län. Av dessa 62 ambulansuppdrag gick 18 att följa under hela vårdkedjan. Resultatet visade att aktörerna i akutmedicinska vårdkedjan för det mesta gjorde samma bedömning av den drabbades huvudproblem/symtom och därmed kriteriet. Utan hänsyn taget till prioritet så visade det sig att kriterierna övrrensstämde vid 83% av alla 18 inkluderade ambulansuppdrag. SOS operatören bedömde ambulansuppdraget som prioritet ett i 39% (7/18) och ambulanssjuksköterskan bedömde att prioritet ett på väg till sjukhus var motiverat i 17% (3/18). Av de18 drabbade som transporterats med ambulans till akutmottagningen på Akademiska sjukhuset fick 72% (13/18) åka hem samma dag.

Barnmisshandel är ett världsomfattande problem i dagens samhällen och mörkertalet är stort eftersom alla fall inte anmäls. I flera länder råder anmälningsplikt vid misstanke att barn utsätts för misshandel och akutpersonal har en viktig roll i skyddandet av utsatta barn. Akutpersonal möter ofta barnen i hemmiljön och är därför den första instansen som kommer i kontakt med det utsatta barnet. Detta ställer höga krav på akutpersonalen, att de kan göra adekvata bedömningar och dokumentera sina misstankar eftersom deras bedömning kan komma att ligga till grund för en anmälan.   Syftet var att belysa akutpersonalens erfarenhet av situationer där barn misstänkts utsatta för barnmisshandel.   Metoden var en litteraturöversikt där vetenskapliga artiklar söktes fram genom databasen PubMed. Artiklarna kvalitetsgranskades och 15 stycken valdes ut för analys och samtliga av dessa låg till grund för resultatet, som redovisas i kategorier samt subkategorier.   Litteraturöversiktens resultat delades in i två kategorier, som består av tre respektive två subkategorier. Den första kategorin var akutpersonalens bristande kunskap avseende barnmisshandel. Subkategorierna som här framkom var identifiering av tecken som kan tyda på barnmisshandel, dokumentation och anmälan samt utbildning inom ämnet. Akutpersonal upplevde att det var svårt att identifiera tecknen, som kunde härledas till misshandel och det kunde bero på en osäkerhet kring vad som var naturliga skador eller vilka skador som åsamkats av annan person. Likaså upplevdes svårigheter kring vad som ska dokumenteras och hur en anmälan ska göras. Utebliven anmälning kunde också bero på osäkerheten i tillvägagångssätt. Akutpersonal önskade mer utbildning i ämnet och om hur barnmisshandel ska upptäckas och anmälas. Den andra kategorin som framkom var akutpersonalens emotionella upplevelser av barnmisshandel, under vilken subkategorierna rädslor och stress identifierades. Akutpersonal upplevde rädsla för att anmäla och det kunde härledas till deras rädsla att göra fel, för rättsliga påföljder eller rädsla för anhörigas reaktioner. Slutligen upplevde akutpersonalen stress i olika varianter relaterade till fall där barnmisshandel förekommit. Själva mötet med utsatta barn skapade stress men även att göra en anmälan kunde verka stressande.   Slutsatsen var att barnmisshandel är ett svårt ämne, som behöver lyftas fram och uppmärksammas. Akutpersonal upplever otillräckliga kunskaper kring barnmisshandel och att situationer, där misstankar fanns att barn utsattes för misshandel, kunde skapa stress och rädslor. Med en klar bild hur akutpersonalen ska upptäcka tecken, vilka frågor och undersökningar som ska ställas/ bli gjorda och var anmälan ska göras, finns möjligheterna för att akutpersonal ska upptäcka och våga anmäla mer än de gör. / Child abuse is a worldwide problem within the society today and the problem is larger than we are aware of due to all cases are not reported. In several countries there is a duty to report suspicions of child abuse and ambulance staff have an important role in protecting vulnerable children. Emergency staff often meet the children in the home environment and is therefore the first instance to meet the vulnerable child. This imposes high demands on emergency staff, that they can make adequate assessments and document their suspicions as their assessment will form the basis for a notification. The aim was to highlight the emergency staff experience of situations where children were suspected of being exposed to child abuse. The method was a literature review where scientific articles were sought through the PubMed database. The articles were quality-reviewed and 15 were selected for analysis, and all of them were selected to the results, which are reported in categories and subcategories. The results of the literature review were divided into two categories and three subcategories. The first category was of emergency staff's lack of knowledge regarding child abuse. The subcategories that emerged were the identification of signs that could indicate child abuse, documentation and notification as well as education in the subject. Emergency staff found that it was difficult to identify the signs that could be traced to abuse, and it could be due to uncertainty about what was natural injuries or injuries caused by another person. Likewise, difficulties were experienced regarding what to document and how a notification should be made. An unsubscribed notification could also be due to the uncertainty in the approach. Emergency staff wanted more education on the subject and how child abuse should be detected and reported. The other category that emerged was the emotional experiences of emergency staff of child abuse, under which subcategories fears and stress were identified. Emergency staff experienced fear of reporting and it could be derived from their fear of wrongdoing, for legal penalties or for fear of relatives' reactions. Finally, emergency staff experienced stress in different variants related to cases of child abuse. The actual encounter with vulnerable children created stress but also making a notification could seem stressful.   The conclusion was that child abuse is a difficult subject which needs to be highlighted. Emergency staff experience insufficient knowledge of child abuse and situations, where suspicions were found, that children were abused could create stress and fears. With a distinct plan how the ambulance staff will detect signs, what questions and investigations should be made / where to be notified, there are opportunities for emergency staff to detect and have the courage to report more than they do.

För många människor blir besöket på akutmottagningen deras första kontakt med sjukvården. Specialistsjuksköterskan i akutsjukvård har en ledande funktion i bemötandet och omvårdnaden av patienten. Bemötandet ska vara professionellt och akutsjuksköterskan ska ha ett empatiskt och har ett etiskt förhållningssätt så patienterna känner sig uppmärksammade och omhändertagna. Sjuksköterskans initiala bemötande och omsorg är essentiella för den fortsatta vården och patientens upplevelse.  Syftet var att beskriva patienters upplevelser av akutsjuksköterskans bemötande på akutmottagningen.  Metoden är en litteraturöversikt med systematisk metod användes för att analysera befintliga studier vars syfte var att beskriva patienters upplevelser. Databaser som användes för sökning av vetenskapliga artiklar var CINAHL, MEDLINE, och PubMed.  Resultatet delades in i två huvudkategorier och 8 underkategorier. Kategorierna var Akutsjuksköterskans profession, attityd, holistiska perspektiv, uppmärksamhet, kommunikation, förmedlande av information, inställning till delaktighet, tillfredsställande av behov och övergivenhet. I vår litteraturstudie framkom flera perspektiv av hur patienterna upplever akutsjuksköterskans bemötande på akutmottagningen som de anser vara mycket viktiga. De viktigaste aspekterna för positiv upplevelse för patienten var att bli bemött professionellt med respekt, empati, holistisk omvårdnad, delaktighet, god kommunikation, uppmuntran och trygghet.  Slutsatsen är att patienternas upplevelser av akutsjuksköterskans bemötande på akutmottagningen blir positivt då patienten bemöts på ett professionellt, trevligt och respektfullt sätt. Patienterna upplevde trygghet då akutsjuksköterskan visade ömsesidig respekt, arbetade strukturerat och professionellt. En annan viktig aspekt var att man var tydlig i sin kommunikation där patienten kontinuerligt får personlig information om den fortsatta vården. Patientens upplevelse blir negativt då det brister i bemötandet, kommunikationen, där patienten inte känner sig sedd, hörd. Genom denna litteraturstudie var tydligt att akutsjuksköterskans bemötande spelade en viktig roll för patienternas upplevelse av vården. / To many people the visit to the emergency department becomes the first contact with healthcare. The specialist nurse of emergency care has a leading function in the meeting with the patient and in the caring of the patient. The contacts are supposed to be professional, and the emergency nurse should have an empathic and an ethical approach, so the patients feel noticed and cared for. The nurse's initial contact and caring are essential for the proceeding care and the patient's experience. The aim of the study was to describe patients' experiences of the emergency nurse's treatment in the emergency department. The method used was a literature review with a systematic method was performed to analyze existing research where the purpose was describing patients' experiences. Databases used for searching scientific articles were CINAHL, MEDLINE and PubMed. The result was divided into two main categories: emergency nurses professional perspective and emergency nurses attitude towards patients wellbeing. In our literature review, several perspectives emerged of how patients experience the emergency nurse's treatment in the emergency department that they consider to be very important. The most important aspects of a positive experience for the patient were to be treated professionally with respect, empathy, holistic care, participation, good communication, encouragement and security. The conclusion is that the patients' experiences of the emergency nurse's treatment in the emergency department are positive when the patient is treated in a professional, pleasant and respectful manner. The patients felt safe when the emergency nurse showed mutual respect, worked in a structured and professional manner. Another important aspect was that they were clear in their communication where the patient continuously receives personal information about the continued care. The patient's experience becomes negative when there is a lack of treatment, communication, where the patient does not feel seen, heard. Through this literature review, it was clear that the emergency nurse's treatment played an important role in the patients' experience of care.

Bakgrund: En specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård hanterar hjärtstopp enligt algoritmen för avancerad hjärtlung-räddning och verkar i komplexa situationer såväl prehospitalt som intrahospitalt, där krav ställs på specialistsjuksköterskan att kunna tolka tillstånd, hantera avancerad utrustning och läkemedel samt ställs inför etiska och komplexa situationer.  Syfte: Att belysa specialistsjuksköterskors erfarenheter av att delta vid hjärtstopp  Metod: Kvalitativ metod med deskriptiv ansats. Intervjuerna genomfördes med en semistrukturerad frågeguide, vilket gav möjlighet för följdfrågor. Tio deltagare intervjuades och intervjuerna analyserades med hjälp av kvalitatitv innehållsanalys av Graneheim &amp; Lundman (2004).  Resultat: Studiens resultat presenteras i två kategorier. Den fokuserade experten samt Människan med behov för återhämtning och reflektion. Arbetet som specialistsjuksköterska inom akutsjukvård med inriktning mot ambulans- och/eller intensivvård ger deltagarna upplevelser som påverkar dem i både yrket och privat. Förberedelser att hantera situationerna sker i form av utbildning i avancerad hjärtlung-räddning men också erfarenheter av att delta vid hjärtstopp är viktiga för att utvecklas i yrkesrollen och hantera utrustningen som finns tillhanda för hjärtstopp. För att kunna hantera upplevelserna krävs, förutom stödinsatser av arbetsgivaren i form av debriefing, även informellt stöd av kollegor samt personliga copingstrategier. Konklusion: Arbetet som specialistsjuksköterska kräver avancerade kunskaper och förberedelser i form av utbildning, hantering av medicinteknisk utrustning men även upplevda erfarenheter, för att kunna formas i sin yrkesroll. Att genomföra formella debriefingar, använda kollegialt stöd och egna copingstrategier gör att specialistsjuksköterskor hanterar exponeringen av att möta patienter med hjärtstillestånd till en hanterbar situation. Dock anser en del av specialistsjuksköterskorna att det finns brister som kan förbättras vad gäller utbildning för att hantera hjärtstopp. / Background: A specialist nurse in emergency care with focus on prehospital- and/or intensive care manages algoritms for cardiac arrests and are active in complex situations, both pre- and intrahospital, were the specialist nurses have demands on them to interpret conditions, manage advanced equipment and drugs and are encountered to ethical and complex situations.  Purpose: To enlighten the experiences of specialist nurses when managing cardiac arrests, the complexity that sorrounds the situation whenever a patient is in cardiac arrest, could give the specialist nurse tools to better understand and cope with that type of emergency situations and increase safety in their professional role Method: Qualitative method with a descriptive approach. The interviews were conducted through a semi-structured interview guide. Ten participants were interviewed and the interviews were transcribed and analyzed according to qualitative content analysis by Graneheim &amp; Lundman (2004). Result: The result of the study is presented in two categories, the focused expert and the person with need for recovery and reflection, with seven sub categories belonging to the categories. Working as a specialist nurse within emergency care with focus on prehospital- and/or intensive care and taking care of patients in cardiac arrest give the participants in this study experiences that affect them both professionally and private. Preparation to manage cardiac arrests involve training in advanced cardiopulmonary resusciation but also experiences of participating during cardiac arrests are important to evolve in their professional role and manage the equipment that are being used for cardiac arrests. To be able to manage the experiences they need to accept supportive measures from their employer and informal measures such as peer-support and personal coping strategies.  Conclusion: The role of being a specialist nurse in emergency with focus on prehospital  and/or intensive care demands advanced knowledge and preparations through education, managing medical technology equipment and lived experiences, in order to be shaped in their professional role. By conducting formal debriefings, use peer-support and their own coping strategies the specialist nurse manage to cope with exposure of meeting patients in cardiac arrest. However, some of the specialist nurses considers there should be room for improvement regarding their education to manage cardiac arrests.

No / The misinterpretation of radiographs is recognised as a key source of emergency department (ED) errors, regardless of clinician profession. This article compares ENP and medical staff accuracy in the interpretation of musculoskeletal trauma X-rays between immediate and delayed radiology reporting pathways. The data for this study was drawn from a larger pragmatic randomized controlled trial of immediate reporting. Patients were recruited and randomly assigned to immediate or delayed reporting arms and treated according to group assignment. Image interpretive accuracy between ED staff groups and arms was undertaken together with an assessment of the influence of immediate reporting on patient pathways and journey times. Six hundred and seventy-four radiographic examinations were performed (598 patients). There was a significant reduction in the interpretive errors in the immediate reporting arm for all ED clinicians (proportional difference = 4.2%; 95% CI [0.017,0.068]; p = 0.001), but no significant difference in proportion of interpretive errors was evident between ENPs and medical staff. Patient journey times, discharge and referral rates were not significantly different between study arms, although admission rates varied for medical staff collectively. ENP X-ray interpretation accuracy is comparable with that of medical staff, but immediate reporting was seen to reduce errors without increasing patient journey times.

No / Background: Many accident and emergency clinicians regard the radiographic image as an extension of the clinical examination, as a provisional diagnosis, based on clinical signs and symptoms, can be confirmed or refuted by inspection of X-rays. However, the value of radiography in this context is not determined by the actual presence of trauma or pathology on the radiograph, but is dependent on the ability of a clinician to identify any trauma or pathology present. Traditionally, the responsibility for interpreting radiographic images within the accident and emergency environment in the United Kingdom (UK) has been with medical clinicians. However, expansion of the nursing role has begun to change the boundaries of professional practice and now many nurses are both requesting and interpreting trauma radiographs. Aim: To ascertain the ability of accident and emergency doctors and nurses to interpret trauma radiographs, and identify whether there is a consistent standard of interpretive accuracy that could be used as a measure of competence. Methods: A literature review was conducted using the Cochrane Library, Medline and CINAHL databases and the keywords radiographic interpretation, radiographic reporting, accident and emergency and emergency/nurse practitioner. Findings: The ability of accident and nursing doctors and nurses to interpret trauma radiographs accurately varies markedly, and no identified published study has established an appropriate level of accuracy that should be achieved in order to demonstrate satisfactory competence in the interpretation of radiographic images. Conclusions: Determining a measure of interpretive accuracy that can be used to assess ability to interpret radiographic trauma images is fraught with difficulties. Consequently, nurses may attempt to prove their skills by directly comparing their abilities to those of their medical colleagues. However, as a result of marked variation in the ability of senior house officers to interpret trauma radiographs, a similar ability does not automatically imply that a satisfactory level of ability has been achieved.