Bakgrund: Personer med opioidberoende är till sin omfattning mer än 26 miljoner människor världen över. Läkemedelsassisterad rehabilitering av opioidberoende (LARO) i kombination med omvårdnad och psykosocial behandling är en effektiv behandlingsmetod vid opioidberoende. Målen med LARO-behandling är utöver att minska dödligheten att personer med opioidberoende ska få ökad psykisk och fysisk hälsa samt få ett socialt fungerande liv. Klinisk erfarenhet visar dock att det finns svårigheter med att kvarhålla personer i LARO-behandling, vilket ofta leder till att personer i stället avlider. Sjuksköterskan har ett ansvar att ge omvårdnad på ett personcentrerat tillvägagångssätt i samband med behandling och kunskap som en sjuksköterska besitter kan hjälpa till att förbättra vårdresultaten i en LARO-behandling. Syfte: Syftet med studien var att belysa hur vuxna patienter med opioidberoende upplever omvårdnad vid LARO-behandling (läkemedelsassisterad rehabilitering vid opioidberoende). Metod: En allmän litteraturöversikt genomfördes där resultatet baserades på nio vetenskapliga artiklar med kvalitativ ansats som inhämtats genom systematiska sökningar i databaserna PubMed och CHINAL. Data analyserades i enlighet med Fribergs analys bestående av fem steg. Resultat: Analysen resulterade i tre huvudkategorier med sex tillhörande subkategorier. Huvudkategorierna var: Sjuksköterskan villkorar LARO-behandlingen, Vårdrelationen med sjuksköterskan och Utmaningar i tillgängligheten. Subkategorierna var: Begränsad delaktighet, Stigmatisering, Vikten av en god relation, Brister med informationen, Begränsad tillgänglighet och Avsaknaden av omvårdnadsutbud. Slutsats: Patienter med opioidberoende upplevde LARO-behandlingen som villkorad. Patienter upplevde bristande delaktighet gällande omvårdnaden. Upplevelse av stigmatisering kopplat till omvårdnaden framkom även. Patienter upplevde att de misstänkliggjordes efter flertalet år i behandling. Brister avseende tillgänglighet kopplat till LARO-behandlingen identifierades. Relationen till sjuksköterskan upplevdes vara en viktig del i behandlingen. Relationen skulle bidra till att bygga förtroende, reducera stigma och upplevas accepterande. Rådgivande samtal tillsammans med medicinering ansågs vara den viktigaste aspekten i behandlingen. / Background: People with substance use disorder are to its extent more than 26 million people worldwide. LARO treatment (drug-assisted rehabilitation in opioid dependence) for people with substance use disorder in combination with other nursing care and psychosocial treatment is an effective treatment for people with substance use disorder. The goals of LARO treatment are for people with opioid dependence to have increased mental and physical health, have a socially functioning life and a reduced mortality. However, clinical experience shows that there are difficulties in retaining people in LARO treatment, which often leads to people dying instead. The nurse has a responsibility to provide nursing in a person-centered approach. Knowledge that a nurse possesses can help improve care outcomes in a LARO treatment. Aim: The purpose of the study was to highlight how adult patients with opioid dependence experience nursing care during LARO treatment. Method: A literature review was conducted where the results were based on nine scientific articles with qualitative approaches obtained through systematic searches in the databases PubMed and CINAHL. The data was analyzed in accordance with Friberg's analysis that consists of five steps. Results: The analysis led to three main categories with six associated subcategories. The main categories were following: The nurse conditions the treatment, The care relationship and Accessibility challenges. The associated categories were: Limited participation, Stigma, The imprtance of a good relationship, Deficiencies with the information, Limited availability and Lack of nursing services. Conclusion: Patients with opioid dependence experienced LARO treatment as conditional and experienced a lack of participation. Experiences of stigma linked to nursing emerged. Deficiencies regarding accessibility linked to the LARO treatment were identified. The relationship with the nurse was perceived to be an important part of the treatment. The relationship would help build trust, reduce stigma, and be perceived as accepting. Counseling along with medication was considered the most important aspect of treatment.

Bakgrund: HBTQ-personer riskerar högre grad av ohälsa jämför med heterosexuella. Hälsoskillnaderna kan förklaras av att HBTQ-personer är mer utsatta för diskriminering och trakasserier av samhällets negativa föreställningar om normer, könsidentitet och sexuell läggning. Inom hälso-och sjukvården är kunskapsbrist hos sjuksköterskan kring HBTQ-hälsofrågor och normer ett hinder för ett bra bemötande och en jämlik vård. Kunskapsbrist skapar en atmosfär av otrygghet och rädsla för HBTQ-personer som i slutet undviker att söka vård. Syfte: Syftet med litteraturstudien var att beskriva sjuksköterskans erfarenhet av att bemöta HBTQ-personer inom hälso-och sjukvården. Metod: Litteraturstudien med kvalitativ ansats som baseras på tolv vetenskapliga artiklar. Studien genomfördes enligt Polit och Becks niostegmodell, samt analyserades utifrån Braun och Clarkes tematiska analysmodell. Resultat: Två teman och sex subteman identifierades. Temat Utmaningar vid vård av HBTQ-personer, hade subteman Bristande kunskap och utbildning, Kommunikation och terminologi samt Jämlik vård. Temat Mötet med HBTQ-personer hade subteman Främjande och hindrande attityder, Att vilja vårda samt Osäkerhet vid vårdmötet. Slutsats: Sjuksköterskan utrycker vilja att erbjuda god och jämlik vård för alla, men det finns behov av ytterligare utbildning och kunskap kring vård av HBTQ-personer. Bristande kunskap leder till sämre kommunikation och ett dåligt bemötande. / Background: LQBTQ-people have a higher risk of ill health compared to heterosexuals. Health differences lead to LGBTQ-people being more exposed to discrimination and harassment from society´s negative ideas about norm, gender identity and sexual orientation. Lack of knowledge among nurses regarding LGBTQ-health issues and norm is an obstacle to a good health care and equal care. Lack of knowledge creates insecurity and fear for LGBTQ-people, who end up avoiding seeking care. Aim: The aim of the study was to describe nurses experince in the health care-encounter with LGBTQ-people. Method: Literature study with a qualitative approach based on twelve scientific articles. The study used Polit and Beck`s nine-step model and was analyzed with Braun and Clarks' thematic analysis. Results: Two themes and six subthemes were identified. The theme Challenges in the care of LGBTQ-people, had sub-theme: Lack of knowledge and education, Communication and terminology and Equal care. The theme Meeting LGBTQ-people had sub-themes: Promoting and hindering attitudes, wanting to care and Uncertainty at the care meeting. Conclusion: Nurse's express a desire to offer good and equal care for everyone, but there is a need for further education and knowledge about care for LGBTQ-people. Lack of knowledge leads to poor communication and care.

Background: Diabetes type 2 is a growing public disease worldwide that is primarily acquired through lifestyle habits, which is why self-care plays a large role in treatment. Untreated type 2 diabetes can lead to serious complications for the patient, which is why the nurse's work is focused on a person-centered approach in education, treatment and communication to support the patient in performing self-care.Aim: To describe how nurses can promote health in patients with type 2 diabetes.Method: General literature review based on a thematic analysis based on nine scientific articles, six quantitative and three qualitative studies.Results: Categories identified in the analysis included person-centered approach, increased self-efficacy and reduced risk of complications.Conclusion: Diabetes type 2 is an already widespread public disease where incidence estimates show a continuous and alarming increase worldwide. In addition, type 2 diabetes poses enormous costs to society. The authors therefore recommend that all nurses, already during basic education, should acquire broader competence in lifestyle and MI in order to more easily meet the growing population of patients with type 2 diabetes. However, research is needed into whether an implementation would be possible.

BakgrundPå grund av olika omständigheter tvingas allt fler människor fly från sina ursprungsländer, vilket leder till att allt fler länder blir mångkulturella. Ett mångkulturellt samhälle återspeglas i sin tur inom hälso- och sjukvården. Sjuksköterskor ställs inför stora utmaningar i vården av patienter som har andra kulturella bakgrunder. Därför är det viktigt att sjuksköterskor är kulturellt kompetenta samt kan kommunicera med patientersom inte har samma språk och kultur. SyfteSyftet var att beskriva sjuksköterskans upplevelser av transkulturell omvårdnad bland vuxna patienter. MetodEn litteraturöversikt som är baserad på 15 vetenskapliga artiklar genomfördes. Insamlingen av data gjordens genom att använda databaser PubMed och CINAHL ResultatResultatet av studien påvisade att sjuksköterskor står inför flera utmaningar inom området transkulturell omvårdnad vilken inkluderar bristande kulturkompetens, kommunikationsbarriärer, fördomar och individuella värderingar. Det blev tydligt att tillräcklig kulturell kompetens, effektiv kommunikation, respekt och ett välkomnande bemötande utgör betydande och avgörande faktorer för att kunna tillhandahålla meningsfull och värdig omvårdnad till patienter med en annan kulturell bakgrund. SlutsatsSjuksköterskor står inför utmaningar i vården av patienter med olika kulturella bakgrunder, vilket kan leda till osäkerhet och missförstånd. För att säkerställa kvalitativ vård behöver sjuksköterskor öka sin kunskap om transkulturell omvårdnad och utveckla effektiva kommunikationsstrategier. / Background Due to various circumstances, more and more people are forced to flee their countries of origin, which leads to more and more countries becoming multicultural. A multicultural society is in turn reflected in health care. Nurses are faced with great challenges in the care of patients who have other cultural backgrounds. Therefore, it is important that nurses are culturally competent and able to communicate with patients who do not share the same language and culture. AimThe purpose was to describe the nurse's experiences of transcultural nursing among adult patients. MethodA literature review based on 15 scientific articles was conducted. The collection of data was done by using databases PubMed and CINAHL ResultsThe results of the study showed that nurses face several challenges in the field of transcultural nursing which include lack of cultural competence, communication barriers, prejudices, and individual values. It became clear that sufficient cultural competence, effective communication, respect, and a welcoming attitude are significant and decisive factors in being able to provide meaningful and dignified care to patients with a different cultural background. ConclusionsNurses face challenges in caring for patients from different cultural backgrounds, which can lead to uncertainty and misunderstanding. To ensure quality care, nurses need to increase their knowledge of transcultural nursing and develop effective communication strategies.

Våld i nära relationer är ett allvarligt globalt problem som drabbar främst kvinnor i relation till en man. Våldet innefattar främst psykiskt, fysiskt och sexuellt våld. Våldets omfattning uppfyller samma kriterier som för tortyr och den farligaste platsen för en kvinna idag är det egna hemmet. I Sverige dödas omkring 19 kvinnor varje år till följd av partnerrelaterat våld. Då sjuksköterskan oftast har den första kontakten med våldsutsatta kvinnor är det av stor vikt att utforska hur sjuksköterskor upplever möten med kvinnorna. Bemötandet från sjuksköterskan har en central roll och är avgörande i huruvida kvinnan känner trygghet i att öppna upp sig och berätta om våldet. Syftet med studien är att belysa sjuksköterskors upplevelser av att vårda kvinnor utsatta för mäns våld i nära relation. Denna studie är en allmän litteraturöversikt som innefattar en sammanställning av tidigare forskning. Åtta artiklar valdes ut för att svara på studiens syfte. Utifrån dessa artiklar kunde tre huvudteman och åtta subteman identifieras till resultatet. Huvudfynden visar att sjuksköterskor upplever bristande kunskaper kring handläggning av utsatta kvinnor, vilket skapar osäkerhet i vårdandet. Sjuksköterskor upplevde maktlöshet och bristande stöd från arbetsgivare och kollegor. Arbetet med våldsutsatta kvinnor upplevdes som något komplext och kräver därför goda kunskaper. Sjuksköterskor är i behov av utbildning i att identifiera och vårda våldsutsatta kvinnor, men behöver även motiveras till att inta ett vårdvetenskapligt förhållningssätt där respekt för kvinnan och bibehållandet av hennes värdighet är i fokus. / Intimate partner violence is a serious global problem that mainly affects women in a relationship with a man. The violence mainly includes psychological, physical and sexual violence. The extent of the violence meets the same criteria as for torture and the most dangerous place for a woman today is her own home. In Sweden, around 19 women are killed each year as a result of partner-related violence. As nurses usually have the first contact with women exposed to violence, it is of great importance to explore how nurses experience these meetings. The treatment from nurses has a central role and is decisive in whether the woman feels secure in opening up and talking about the violence. The purpose of the study is to shed light on nurses' experiences of caring for women exposed to men's violence in an intimate relationship. This study is a general literature review that includes a compilation of previous research. Eight articles were selected to answer the purpose of the study. Based on these articles, three main themes and eight subthemes could be identified for the result. The main findings show that nurses experience a lack of knowledge regarding care for vulnerable women, which creates uncertainty. Nurses experienced powerlessness and a lack of support from employers and colleagues. The work with abused women was perceived as somewhat complex and therefore requires good knowledge. Nurses are in need of training in identifying and caring for women exposed to violence, but also need to be motivated to adopt a nursing scientific approach where respect for the woman and maintaining her dignity is the focus.

No / OBJECTIVES: Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. Our objective was to evaluate the clinical appropriateness of prescribing by these professionals. METHODS: A modified version of the Medication Appropriateness Index (MAI) was used by 10 medical, seven pharmacist and three nurse independent raters to evaluate a sample of 100 audio-recorded consultations in which a medicine was prescribed by a nurse or pharmacist. Raters were current prescribers with recognized experience in prescribing. Consultations were recorded in nine clinical practice settings in England. RESULTS: Raters' analysis indicated that, in the majority of instances, nurses and pharmacists were prescribing clinically appropriately on all of the ten MAI criteria (indication, effectiveness, dosage, directions, practicality, drug-drug interaction, drug-disease interaction, duplication, duration, cost). Highest mean 'inappropriate' ratings were given for correct directions (nurses 12%; pharmacists 11%) and the cost of the drug prescribed (nurses 16% pharmacists 22%). Analysis of raters' qualitative comments identified two main themes: positive views on the overall safety and effectiveness of prescribing episodes; and potential for improvement in nurses' and pharmacists' history-taking, assessment and diagnosis skills. CONCLUSIONS: Nurses and pharmacists are generally making clinically appropriate prescribing decisions. Decisions about the cost of drugs prescribed and assessment and diagnostic skills are areas for quality improvement.

No / The United Kingdom is considered to be the world leader in nurse prescribing, no other country having the same extended non-medical prescribing rights. Arguably, this growth has outpaced research to evaluate the benefits, particularly in areas of clinical practice where patients have complex co-morbid conditions such as palliative care. This is the first study of non-medical prescribing in palliative care in almost a decade. AIM: To explore the current position of nurse prescribing in palliative care and establish the impact on practice of the 2012 legislative changes. DESIGN: An online survey circulated during May and June 2013. PARTICIPANTS: Nurse members (n = 37) of a regional cancer network palliative care group (61% response rate). RESULTS: While this survey found non-medical prescribers have embraced the 2012 legislative changes and prescribe a wide range of drugs for cancer pain, we also identified scope to improve the transition from qualified to active non-medical prescriber by reducing the time interval between the two. CONCLUSION: To maximise the economic and clinical benefit of non-medical prescribing, the delay between qualifying as a prescriber and becoming an active prescriber needs to be reduced. Nurses who may be considering training to be a non-medical prescriber may be encouraged by the provision of adequate study leave and support to cover clinical work. Further research should explore the patients' perspective of non-medical prescribing.

Bakgrund: Inom neonatalvård vårdas sjuka och för tidigt födda barn med varierande vårdbehov. För att främja anknytning och välbefinnande är hud-mot-hud och familjecenterad omvårdnad en central del inom neonatalvården. Hud-mot-hud har flera fördelar för barnet och föräldern men respiratorvård kan vara en utmanande faktor för att möjliggöra denna typ av vård på ett tryggt och säkert sätt.  Syfte: Var att beskriva barnsjuksköterskors erfarenheter av att vårda hud-mot-hud vid respiratorvård. Metod: Kvalitativ intervjustudie med induktiv ansats utfördes. Elva barnsjuksköterskor med erfarenhet av neonatal intensivvård och respiratorvård vid fem olika neonatalavdelningar deltog. Semistrukturerade intervjuer genomfördes via videosamtal och granskades enligt kvalitativ manifest innehållsanalys enligt Graneheim och Lundman (2004).  Resultat: Innehållsanalysen resulterade i tre generiska kategorier: Att vårda hud-mot-hud vid respiratorvård och dess positiva effekter, Att vårda hud-mot-hud medför utmaningar, Att använda strategier för att möjliggöra hud-mot-hud. Barnsjuksköterskorna strävade för att vårda hud-mot-hud vid respiratorvård. Deras erfarenhet var att vårdmiljön var av betydelse samt att förflyttningen var en utmanande faktor. Med strategier och erfarenhet upplevde de att de etablerade en säker och trygg vård hud-mot-hud.  Slutsats:  Med vetskap om fördelarna med hud-mot-hud har barnsjuksköterskorna en viktig del i att främja hud-mot-hud i den neonatala intensivvården. Genom inarbetade rutiner för hud-mot-hud som bidrar till en trygg och säker vård är det betydelsefullt att ytterligare neonatalavdelningar tar del av detta för att alla barn ska få lika och rättvis vård i Sverige. / Background: Children who are born prematurely or sick have different needs of care in the neonatal unit. To promote attachment and well-being, skin-to-skin contact as well as family centered care are important. Skin-to-skin contact has several advantages for the newborn and the parents, but respiratory care can be a challenging factor to enable this type of care in a safe and secure way.  Aim: Was to describe pediatric nurses' experiences of providing skin-to-skin care during respiratory care.  Method: Qualitative interview study with an inductive approach. Five neonatal units participated, involving 11 pediatric nurses with experience in neonatal intensive care and respiratory care. Semi-structured interviews were conducted through video calls and analysis using qualitative manifest content according to Graneheim and Lundman (2004).  Result: The content analysis results in three generic categories: Skin-to-skin care with respiratory care and the positive outcomes, Skin-to-skin care involves challengers, Employing strategies to enable skin-to-skin care. The pediatric nurses aimed to provide skin-to-skin care during respiratory care. Their experience was that the environment was significant, and that mobility was a challenging factor. With strategies and experience, they felt that they established a safe and secure skin-to-skin treatment. Conclusion: With an understanding of the benefits of skin-to-skin contact, pediatric nurses have an important part in promoting it in neonatal intensive care. With incorporated routines for skin-to-skin that can contribute to a safe and secure care, it is significant that further neonatal units take part so that all newborns get the same care in Sweden overall.

No / PURPOSE/OBJECTIVES: To assess and improve the safety of hospital-based adult chemotherapy administration. DESIGN: Prospective, systems-focused clinical risk assessment. SETTING: An adult inpatient and outpatient oncology unit in a large urban hospital in the United Kingdom. SAMPLE: 8-person nurse-led multidisciplinary team, which included managerial staff and patient safety researchers. METHODS: Failure mode and effects analysis (FMEA), a prospective, systems-focused risk assessment methodology, was undertaken in biweekly team meetings and included mapping the chemotherapy administration process, identifying and numerically prioritizing potential errors (failure modes) for each process step, and generating remedial strategies to counteract them. MAIN RESEARCH VARIABLES: The analysis aimed to identify chemotherapy administration failure modes and to generate remedial strategies to address them. User feedback on the FMEA process also was collected. FINDINGS: Several specific chemotherapy failure modes were identified, the majority of which had not previously been recognized, and several novel strategies to counteract them were generated. Many of the strategies were specific, environment-focused actions, which are simple, quick, and inexpensive to implement; however, more substantive, longer-term initiatives also were generated. User feedback generally was very positive, and the process of undertaking the analysis improved multidisciplinary teamwork and communication. CONCLUSIONS: Although time and resource intensive, FMEA is a useful safety improvement tool. IMPLICATIONS FOR NURSING: Nurses should be aware of and informed about FMEA as a tool they can use in partnership with management and other disciplines to proactively and collectively improve the safety of high-risk oncology procedures such as chemotherapy administration.

Este estudo teve como objetivo geral analisar a dimensão gerencial do processo de trabalho do enfermeiro em um serviço hospitalar de emergência. Trata-se de uma pesquisa qualitativa do tipo estudo de caso com base no referencial teórico dos estudos sobre processo de trabalho em saúde, processo de trabalho gerencial do enfermeiro e gerenciamento do cuidado. Os dados foram coletados entre junho e setembro de 2009, por meio de observação participante e entrevista semi-estruturada com enfermeiros do Serviço de Emergência de um Hospital Universitário do Rio Grande do Sul – RS, Brasil. O material empírico foi analisado segundo a técnica de análise de conteúdo temática, a partir da qual se constituíram quatro categorias: 1) O trabalho dos enfermeiros no cotidiano do serviço de emergência; 2) Atuação dos enfermeiros no gerenciamento do cuidado; 3) Articulação entre os profissionais e trabalho em equipe; e, 4) Desafios no gerenciamento do cuidado e estratégias para superá-los. O trabalho dos enfermeiros no serviço de emergência é constantemente influenciado por situações inesperadas e pela procura por atendimento, que variam em diversidade e complexidade. A dimensão gerencial do trabalho do enfermeiro tem como foco o atendimento às necessidades dos pacientes e contempla a realização e o planejamento do cuidado, a previsão e provisão de recursos para o bom funcionamento da unidade e a liderança, supervisão e capacitação da equipe de enfermagem. Os enfermeiros reconhecem a importância do trabalho em equipe e sua responsabilidade na articulação das ações dos profissionais de saúde. A superlotação e manutenção da qualidade do cuidado são os principais desafios gerenciais dos enfermeiros. As estratégias para superá-los incluem mudanças no fluxo de atendimento dos pacientes e na estrutura física da unidade e a reorganização do sistema de saúde para a atenção às urgências. Esses resultados podem colaborar com o trabalho dos enfermeiros possibilitando que discutam e reflitam sobre suas práticas e avancem na compreensão do gerenciamento do cuidado como instrumento para a melhoria da assistência e das práticas de atenção à saúde nos serviços de emergência. / The purpose of this study was to analyze the managerial dimension of the nurse work in a hospital emergency service. It is a qualitative research approached as a case study based on the theoretical referent of the studies on the working process in health, managerial working process, and care management. The data were collected between June and September 2009 through participant observation and semi-structured interview with nurses of the Emergency Service of a University Hospital of Rio Grande do Sul – RS, Brazil. The empirical material has been analyzed according to theme content analysis, from which four categories had been set: 1) Nurse work in the quotidian of emergency service; 2) Care management; 3) Articulation among professionals and team work; and, 4) Challenges for care management and strategies to overcome them. The work of nurses in emergency services is constantly influenced by unexpected situations and the great search of people to be attended to; which varies in diversity and complexity. The managerial dimension of nurse‟s work focuses in the fulfillment of patients' needs and contemplates the accomplishment and care planning, prevision, provision of resources for the unit; as well as the leadership, supervision, and training of nursing team. Nurses recognize the importance of team work and their responsibility in joining health professional actions. Overcrowding and quality of care are the main challenges nurses face in managing care. The strategies to overcome them include changes in the flow of patients and physical structure of the unit and reorganization of the health system for emergency attention. These results might collaborate with the work of nurses enabling those professionals to discuss and reflect on their practices and advance in the comprehension of care management as a tool for assistance improvement and of the practices in health attention in emergency services. / Este estudio tuvo como objetivo general analizar la dimensión gerencial del proceso de trabajo del enfermero en un servicio hospitalario de emergencia. Se trata de una investigación cualitativa de tipo estudio de caso basada en el marco teórico de los estudios sobre proceso de trabajo en salud, proceso de trabajo gerencial del enfermero y gerenciamiento del cuidado. Se recolectaron los datos entre junio y septiembre de 2009, por medio de observación participante y entrevista semi-estructurada con enfermeros del Servicio de Emergencia de un Hospital Universitario del Rio Grande do Sul – RS, Brasil. Se analizó el material empírico según la técnica del análisis temático de contenido, a partir del cual se establecieron cuatro categorías: 1) El trabajo de los enfermeros en el cotidiano del servicio de emergencia; 2) Atuacción de los enfermeros en lo gerenciamiento del cuidado; 3) Articulación entre los profesionales y trabajo en equipo; y, 4) Retos en el gerenciamiento del cuidado y estrategias para superarlos. El trabajo de los enfermeros en el servicio de emergencia recibe frecuentemente la influencia de situaciones inesperadas y de la gran búsqueda por atención, que varían en diversidad y complejidad. La dimensión gerencial del trabajo del enfermero tiene como foco la atención a las necesidades de los pacientes y comprende la realización y la planificación del cuidado, la previsión y la disposición de recursos para el buen funcionamiento de la unidad y el liderazgo, supervisión y capacitación del equipo de enfermería. Los enfermeros reconocen la importancia del trabajo en equipo y su responsabilidad en la articulación de las acciones de los profesionales de salud. La superpoblación de la unidad y la manutención de la calidad del cuidado son los principales retos de los enfermeros en su gerencia. Las estrategias para transponerlos incluyen cambios en el flujo de atención a los pacientes y en la estructura física de la unidad y la reorganización del sistema de salud para la atención a las urgencias. Esos resultados pueden colaborar con el trabajo de los enfermeros permitiendo que discutan y reflexionen sus prácticas, avanzando en la comprensión de la gerencia del cuidado como una herramienta para la mejora de la asistencia y de las prácticas de atención a la salud en los servicios de emergencia.