Consolidation of Acute Care Surgical Services (ACSS) as a response to multiple challenges in providing timely and high-quality emergency services is a growing interest among healthcare policymakers. However, very little is known about patient experiences within this system. This study explores patient perceptions of their acute care surgical experiences within a consolidated ACSS program. A qualitative study guided by the tenets of Appreciative Inquiry was conducted. Data were collected by means of semi-structured interviews and personal stories. Thirteen participants were involved, seven females and six males of varying ages; all underwent emergency surgeries including appendectomy, cholecystectomy, and small bowel obstruction surgery. Findings suggest that clear and effective communication, excellent nursing care, timely access to surgical services, continuity of care, patient safety, transfer to an Acute Care Surgical (ACS) site, communication regarding transportation, and process of admission to an ACS site play important roles in patient experiences within a consolidated ACSS.

The problem of the study was to determine the status of bloodborne pathogen education for injection drug users in Indiana hospital emergency departments. The study was designed to answer the following research questions: (a) Do Indiana hospital emergency departments have written policies on bloodborne pathogen education for injection drug users? (b) To what extent do Indiana hospital emergency departments provide bloodborne pathogen education for injection drug users? and (c) What are the major barriers for Indiana hospital emergency departments in providing bloodborne pathogen education for injection drug users?A valid instrument was developed and sent to 110 Indiana hospital emergency department nurse managers. Forty-six instruments were returned for a response rate of 43.8%.The results indicated only three (7.1 %) responding hospital emergency departments had written bloodborne pathogen educational policies. Ten (20.8%) emergency departments provided some form of bloodborne pathogen education for injection drug users. Major barriers indicated for not providing patient education consisted of insufficient monetary resources, injection drug users denying a drug history, and emergency department nurses being unable to identify injection drug usage. / Department of Physiology and Health Science

Background: The majority of patients requiring medical attention experience some degree of pain. The nurses´ assessment of pain is crucial in reducing the patients suffering in a proper and timely manner. Previous studies have shown that the treatment of pain in a emergency situation is poorly managed. The patients´ pain experience is often under assessed and undertreated which leads to increased suffering for the patient. This results in higher costs for the health care system due to prolonged hospitalization. Aim: The purpose of this study is to define the ambulance nurse´s pain assessment of patient in the field and the affecting factors their evaluation. Method: A qualitative interview study with a descriptive design was conducted including seven emergency services nurses. Both male and female participants were involved with varying degrees of education as well as durations of employment. Result: Pain assessment by emergency personnel in the field was broken down into four categories for analysis as follow: communication (both verbal and nonverbal), measurable components, environment and evaluation of diversities. Verbal communication with appraisal of patients´ body language and facial expression was the most frequent factors in assessing pain. Measurable components such as vital signs and generalized symptoms were also accounted. VAS and NRS scales where most frequently used by nurses in rating pain among patients. The result suggested differences in pain assessment with respect to gender, age and cultural background. Conclusion: The participating nurses in this study describe verbal and nonverbal communication as the most influential factors in pain assessment of patients. In rating pain, the most frequently used tool was the NRS scale providing the nurses with what they consider to give the best understanding of patients´ pain experience. A risk has been identified in the analysis of patients´ vital signs which could lead to an under assessment and restrictive treatment of pain. The authors of this study believe that lack of knowledge in pain assessment and how to implement pain rating tools could contribute to this fact, and would therefore appreciate an improvement in skills assessing pain and a better understanding in the use of pain tools for emergency service nurses. This could lead to a better caliber of patient care for those suffering with pain. / Bakgrund: En stor andel av patienter som söker akutsjukvård upplever smärta. Smärtbedömning är en viktig del i sjuksköterskan arbetsuppgifter för att minska lidandet för patienten. Tidigare studier har visat på att smärtbehandlingen inom akutsjukvården varit dålig. En anledning till detta kan vara en underskattning och underbehandling av patientens smärta som i en förlängning kan leda till ett ökat lidande för patienten samt ökade samhällskostnader i form av längre vårdtider. Syfte: Syftet med uppsatsen var att beskriva hur sjuksköterskan i ambulanssjukvården bedömer smärta hos patient prehospitalt och vad som påverkar smärtbedömningen. Metod: En kvalitativ intervjustudie med deskriptiv design genomfördes med sju stycken sjuksköterskor som var verksamma inom ambulanssjukvården. Informanternas anställningsår och utbildningsnivå skilde sig åt, både män och kvinnor har deltagit i studien. Resultat: Resultatet beskrivs i fyra kategorier, kommunikation, mätbara observationer, miljö och bedömning av mångfald. Kommunikation innefattar verbal och icke-verbal kommunikation. Verbal kommunikation tillsammans med bedömning av patientens kroppsspråk och ansiktsuttryck (non- verbal kommunikation) användes mest frekvent för att bedöma patientens smärtupplevelse. Även mätbara observationer som vitalparametrar och allmän påverkan bedömdes. VAS-skala och NRS-skala var smärtbedömningsinstrumenten som sjuksköterskan använde mest frekvent. Resultatet visade även på skillnader i smärtbedömning gällande kön, ålder och kulturell bakgrund. Diskussion: Sjuksköterskorna som deltog i studien beskrev verbal och icke-verbal kommunikation som viktiga faktorer för att smärtbedöma patient. Sjuksköterskorna beskrev att numerisk skattnings skala (NRS-skala) var det smärtskattningsinstrument som används mest frekvent för att skapa en förståelse om patientens smärtupplevelse. En risk som identifierades var sjuksköterskornas bedömning av vitalparametrar, som kunde leda till att smärtupplevelsen hos patienten kunde underskattas eller överskattas. Författarna anser att kunskapsbrist i smärtbedömning och hur man använder smärtskattningsinstrument kan vara en bidragande orsak. Författarna anser att mer kunskap om smärtbedömning och användandet av smärtskattningsskalor som arbetsverktyg för sjuksköterskor inom ambulanssjukvården, skulle leda till bättre omhändertagande för patienter som lider av smärta.

Consolidation of Acute Care Surgical Services (ACSS) as a response to multiple challenges in providing timely and high-quality emergency services is a growing interest among healthcare policymakers. However, very little is known about patient experiences within this system. This study explores patient perceptions of their acute care surgical experiences within a consolidated ACSS program. A qualitative study guided by the tenets of Appreciative Inquiry was conducted. Data were collected by means of semi-structured interviews and personal stories. Thirteen participants were involved, seven females and six males of varying ages; all underwent emergency surgeries including appendectomy, cholecystectomy, and small bowel obstruction surgery. Findings suggest that clear and effective communication, excellent nursing care, timely access to surgical services, continuity of care, patient safety, transfer to an Acute Care Surgical (ACS) site, communication regarding transportation, and process of admission to an ACS site play important roles in patient experiences within a consolidated ACSS.

Thesis (M.H.A.)--University of Michigan, 1965.

Thesis (DR. P.H.)--University of Michigan.

Thesis (DR. P.H.)--University of Michigan.

Thesis (M.H.A.)--University of Michigan, 1965.

Quality of health care delivered in the public sector remains a major challenge with diminishing resources to meet the increasing health care demands. Improvements in quality health care are identified in the Department of Health’s strategic framework as a key challenge. In order to improve quality, one needs to measure it. The patients’ views are important in identifying what is important to them. Inexpensive, easy to collect metrics need to be developed to measure quality of care. The study investigated perceptions of patients as a reflection of quality of care provided. The study also determined the key success factors in quality care in emergency departments and priorities of quality of care for improvement. A prospective study was conducted using one of Gauteng hospitals’ emergency departments as a case study. A structured questionnaire based on an overall care index focusing on specific dimensions of patients’ experience with health care was used to collect the data. Quantitative analysis was done using the Epi Info statistical package and the results summarised in frequency diagrams and tables. The findings indicate that waiting time is a major factor in perception of quality of health care. Although other hospitality issues in health care are important to patients, the degree to which they affect perception of quality of health care is difficult to determine because of the overwhelming influence of waiting time. It is recommended that priorities in addressing what users really want from health care should concentrate on strategies to shorten the waiting time. It is further recommended that a similar study be carried out in future once the waiting times have been improved considerably thus eliminating its excessive influence. This may highlight other variables important to the patients that may need to be improved in order to improve quality of care. / Dr. Susan Jennifer Armstrong

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