This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.

This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%).Further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments.

Background: Encounters between patient and health care have been shortened and fragmented. Times when the patient is in the continuum of care is related to how well the patient feels confirmed in the meeting with his/her carers. Aim : The aim of this study is to highlight skills that nurses use to provide good care relationships with patients in the ambulance and emergency room. Method: A literature review was done. Search for articles was conducted in the databases Cinahl and Pubmed. Nine articles were selected for analysis. Results: Nurses used various communication strategies to successfully establish a good nursing relationship in the meeting with the patient. Patients experienced the nurse who took time and was present in the meeting as the one who was really professional. Six themes were found. These were: Establish a communicative environment, establish contact, listening, verbal and nonverbal communication, being available and provide information. Conclusion : Nurses need to use his special skill to meet patient's need to feel valuable, seen and significant.

This study describes how new graduate nurses learn to practice in a trauma setting. The research questions focused on how new graduate nurses learn the skills necessary to work in a trauma setting, what were the best methods of introducing new graduate nurses to performing nursing interventions in a trauma setting, and how can this learning be facilitated. The grounded theory research approach was used. The sample was drawn from a population of emergency room nurses working in a level one trauma center. The core category that emerged from the data was overcoming anxiety. Working in a trauma setting is an anxiety provoking experience. New graduate nurses used learning as a method of overcoming the anxiety faced in this setting. Learning methods included observing, discussing, practicing, and rehearsing. Preceptors, mentors, and models helped new graduates learn. Learning took place in three areas: psychomotor learning, conceptual learning, and self-learning. / School of Nursing

This thesis explores triage code as a predictor of direct nursing care time, thus its potential usefulness in a model for calculating and allocating nurse requirements in emergency departments. A framework for nursing work is proposed. This framework is based on the works of O'Brien-Pallas, Irvine, Peereboom, and Murray (1997) and Houser (2003). It suggests that the structures of environmental complexity, nursing characteristics, patient nursing complexity, and patient medical condition and severity, impact on the processes of direct and indirect nursing care to affect patient outcomes. A prospective, non-experimental study was undertaken to examine the relationship between direct nursing care time and triage code. Six potential confounding variables were selected for this study: length of stay, age, ethnicity, sex, complaint type, and discharge category. Data were collected for 261 visits over a three day period in one New Zealand emergency department. Patient visits averaged 200 minutes. The mean direct nursing care time per visit was 49 minutes. On average, patients with more urgent triage codes, longer length of stay, or who were not discharged, received more direct nursing care. The model developed predicted 49% of variation in direct nursing care time (p < .05) related to triage code (16%), length of stay (31%) and disposition category (2%).Further exploration of the proposed framework has potential to develop a model allowing managers to identify nurse staffing required for optimal nursing care in emergency departments.

Internationally violence persists as a complex problem for nurses. While it is widely accepted that nursing staff in any health care setting can be the target of violence, in high acuity areas such as Emergency Departments (ED) nurses have an increased risk of violence. There is limited Australian research into violence experienced by nurses in the Australian Health sector, in particular the rural and regional Australian ED. Greater understanding of the phenomena of violence towards ED nurses, as it is manifest in the ‘real world’ rural and regional Australian setting is needed to enable development of context specific solutions for this problem. This thesis presents a contextual, specialty nurses’ assessment of violence risk, strategies for violence prediction and management, and the sequelae for the nurse. The aims of this study were to: Explore and describe the contextual assessment skills and preventative strategies rural and regional ED nurses use to understand and predict violent events, where the agent of violence is the patient, their family or friends, and understand the nature and scope of the sequelae of work place violent events from the nurse’s perspective. A mixed method instrumental case study was used to generate both qualitative and boundary for inquiry, and a structured process within which the chosen methods were able to define ‘the case’ and answer the research question. This study was undertaken in 2005, at a regional Australian ED. Twenty (20) Registered Nurses were recruited into the study and consented to being observed. Textual qualitative data were generated from two hundred and ninety (290) hours of participant observation, sixteen (16) semi-structured interviews, thirteen (13) unstructured field interviews, and researcher journaling. In addition, sixteen (16) violent events were observed and recorded via a structured observation tool. Textual data were analysed thematically assisted by the qualitative data management and retrieval software NVivo2, and numeric data were analysed using frequency counts. The participants used their nursing knowledge(s), experience and context to assess their risk of violence. Embedded in the practice of these ED nurses was their ability to convey caring and respectfully approach all people presenting to ED. The participants’ caring respectful demeanour underpinned their understanding of violence prevention strategies. Using this violence prevention approach, they attributed contextual meaning(s) to the violent event and agent of violence. The meaning(s) they attributed in turn shaped their response(s) to both the violent event and the agent of violence. A high level of observable collegial awareness supported and fostered their resilience towards the potentially negative affects of violence in the workplace. The five themes revealed by this study were; Conveying caring: Averting violence: Being alert: Recognising, assessing and responding to violence: Attributing meaning: Subjective understandings that shape responses to Violence : Collegial awareness: Forming trusting relationships to help manage violence: Fostering resilience: resisting the negative sequelae of violence. Violence was interpreted by these ED nurses in a more systematic and complex way than the current definitions make possible. Violence assessment, prevention and management skills were embodied in the participant ED nurses’ routine practice and their conceptualisation of caring. The meanings given to violence were contextually constructed and these ascribed meaning(s) and judgments informed the actions that the nurses took in response to both the violent event and the agent of violence. / Doctor of Philosophy (PhD)

This ethnographic study provides insight and understanding, which is needed to educate and support the Triage Nursing role in Australian Emergency Departments (EDs). The triage role has emerged to address issues in providing efficient emergency care. However, Triage Nurses and educators have found the role challenging and not well understood. Method: Sampling was done first by developing a profile of 900 nurses who undertake the triage role in 50 NSW EDs through survey techniques. Purposive sampling was then done with data collected from participant observation in four metropolitan EDs (Level 4 and 6), observations and interviews with 10 Triage Nurses and the maintenance of a record of secondary data sources. Analysis used standard content and thematic analysis techniques. Findings: An ED culture is reflected in a standard geography of care and embedded beliefs and rituals that sustain a cadence of care. Triage Nurses to accomplish their role and maintain this rhythm of care used three processes: gatekeeping, timekeeping and decision-making. When patient overcrowding occurred the three processes enabled Triage Nurses to implement a range of practices to restore the cadence of care to which they were culturally oriented. Conclusion: The findings provide a framework that offers new ways of considering triage nursing practice, educational programs, policy development and future research.

Intervention design ( M.Sc. (N)--University of Ottawa, 2008. / Includes bibliographies.

Thesis (Ph. D.)--University of Tennessee, Knoxville, 2007. / Title from title page screen (viewed on Sept. 18, 2008). Thesis advisor: Mary Gunther. Vita. Includes bibliographical references.

Sammanfattning   Sjuksköterskor som jobbar på akutmottagningen kan vid tillfällen vara exponerade för stressfulla situationer och oförutsedda händelser. Som en konsekvens av detta är utbrändhet och emotionell trötthet vanligt bland personal inom akutsjukvården. Syftet med litteraturöversikten var att identifiera copingstrategier hos sjuksköterskan efter traumatiska omvårdnadsmöten på akutmottagningen. Metoden som användes var litteraturöversikt med en deduktiv ansats. Resultatet presenterades i tre kategorier, problemfokuserad, emotionellfokuserad och undvikande coping, med hjälp av en teoretisk ram konstruerad utifrån Folkmans (1984) och Lazarus (1993) teorier om coping. Den vanligaste copingstrategin som sjuksköterskan på akutmottagningen använde sig av efter ett traumatiskt omvårdnadsmöte var problemfokuserad coping. Problemfokuserad coping visar att sjuksköterskan försöker lösa problemet och ändra situationen. Emotionell coping kan leda till en positiv omvärdering men framstod också som negativ. Den minst använda var den undvikande copingstrategin. Den undvikande copingstrategin användes för att undvika personligt lidande och kan leda till att problem inte blir lösta och därmed ökad stress. Slutsatsen var att sjuksköterskan på akutmottagningen använder sig av olika copingstrategier efter ett traumatiskt omvårdnadsmöte på akutmottagningen. Den problemfokuserade copingstrategin visade sig vara den mest effektiva copingstrategin och innefattar bland annat socialt stöd från arbetsledning, kollegor, familj och vänner. Arbetsledningen har en viktig funktion att stödja sjuksköterskan på akutmottagningen.     Nyckelord: Akutsjukvård, stress, coping / Summary   How do you do it? Copingstrategies by the nurse in the emergency department.     Nurses working at emergency services may at times be exposed to stressful situations and unforeseen events. As a consequence of confrontation with stressful situations, burnout and emotional fatigue are common among emergency medical professionals. The purpose of the literature review was to identify the nursing coping strategies after a traumatic meeting at the emergency department. The method used was a literature review with a deductive approach. The result was presented in three categories based on the theoretical framework of Folkman (1984) and Lazarus (1993). The most common coping strategy that the nurse at the emergency department used after a traumatic meeting was problem-focused coping. The least used was the avoidance coping strategy. Problem-focused coping shows that the nurse is trying to solve the problem and change the situation. Emotional coping can lead to a positive revaluation but also emerged as a negative. The avoidance coping strategy was used to avoid personal suffering and can lead to problems not being resolved and thus increased stress. The conclusion was that the nurse at the emergency department uses different coping strategies after a traumatic meeting at the emergency department. The problem-focused coping strategy proved to be the most effective coping strategy, including social support from work management, colleagues, family and friends. The management team has an important function to support the nurse at emergency department.   Keywords: Emergency nursing, stress, coping