The time from onset of a cardiac arrest to defibrillation is crucial hence access to and use of a defibrillator by all nurses essential. The purpose of this study was to use an established theoretical framework to examine and describe the defibrillation practices and beliefs of rural registered nurses in the Australian state of Queensland. The Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB) guided the research processes for this two phase study. In the first phase, focus group (n = 13) discussions identified the salient beliefs of the population. By eliciting nurses' beliefs, the subsequent quantitative study (n = 434) was conducted to determine the influences of these beliefs on nurses' use or non-use of defibrillators. The results showed that: (1) less than half of the cohort of participants were permitted to defibrillate; (2) the defibrillation beliefs of those nurses permitted to defibrillate were significantly more positive than those not permitted to do so; (3) the direct measures of TPB and selected variables external to the model predicted a significant portion of the variance in the measure of nurse-initiated defibrillation intention; and, (4) subjective norm emerged as the strongest predictor of intention. In conclusion, Queensland rural hospital nurses and employers still have some distance to travel down the path of nurse-initiated defibrillation. The TPB is a viable framework on which to base interventions designed to promote defibrillation by rural nurses. Understanding the role of social norms is of central importance to ensure all nurses can initiate the chain of survival expeditiously whenever the need arises.

Akutsjukvård bedrivs dygnet runt och inkluderar ett brett spann av olika åkommor vilka ej kan anstå. Smärta är mycket vanligt förekommande på en akutmottagning och är ofta underbehandlad. Bedömning av smärta genomförs medelst utförlig smärtanamnes samt självskattning av smärtan. Personcentrerad vård syftar till att se individens behov och ta tillvara dennes resurser för att gemensamt planera och genomföra vården, vilket utmynnar i ett partnerskap med två jämbördiga parter. Akutsjuksköterskan förväntas ta ett större ansvar för behandlingar och egna bedömningar kontra den grundutbildade sjuksköterskan. Akutsjuksköterskan ska kunna bedöma och initiera avancerad omvårdnad samt farmakologisk behandling. Sjuksköterskan är i regel den första professionen patienten möter på en akutmottagning och kan därför anses vara en lämplig initiativtagare till att påbörja smärtlindring. På flera platser i världen används protokoll med generella direktiv på smärtstillande läkemedel syftande till att användas för att minska patientens smärta och lidande innan dess att läkarbedömning har genomförts. Syftet med denna litteraturöversikt var att undersöka effekterna av sjuksköterskeinitierad smärtlindring.   Metoden som använts är en litteraturöversikt med ett systematiskt tillvägagångssätt. Totalt 15 artiklar inkluderades efter sökningar i databaserna CINAHL samt PubMed. Artiklarna kvalitetsgranskades och sammanställdes i en artikelmatris. En integrerad analys mynnade ut i fyra kategorier samt fem underkategorier. Resultatet visar att patienterna snabbare fick smärtlindring efter införande av sjuksköterskeinitierad smärtlindring. Fler patienter erhöll smärtstillande läkemedel och fler patienter inkluderades i sin vård genom ökad frekvens av smärtskattning. En ökad nöjdhet med behandlingen kunde ses, det fanns även tendenser till att fler patienter blev adekvat smärtstillade.  Inga patienter drabbades av några allvarliga biverkningar. Slutsatsen är att sjuksköterskeinitierad smärtlindring är ett bra verktyg specialistsjuksköterskan kan använda med flera positiva effekter och utan allvarliga negativa effekter för patienter. Smärtlindringen ges snabbare och till synes med god effekt. / Emergency care is provided around the clock and includes a wide range of different ailments which cannot wait to be treated. Pain is commonly present in an emergency department and is often undertreated. Assessment of pain is carried out by means of detailed pain medical history taking and self-assessment of the pain. Person-centered care aims to see the individual's needs and make use of his or her resources to jointly plan and implement the care, which results in a partnership with two equal parties. The specialist emergency nurse is expected to take greater responsibility for treatments and own assessments compared to a registered nurse. The specialist emergency nurse must be able to assess and initiate advanced care and pharmacological treatment. The nurse is usually the first profession the patient meets in an emergency department and can therefore be considered a suitable initiator to start pain relief. In several places in the world, protocols are used with general directives on painkillers intended to be used to reduce the patient's pain and suffering before a medical assessment by a doctor has been carried out. The aim of this literature review was to investigate the effects of nurse-initiated pain protocols in emergency departments. The method used is a literature review with a systematic approach. A total of 15 articles were included after searches in the databases CINAHL and PubMed. The articles were quality checked and compiled in an article matrix. An integrated analysis resulted in four categories and five subcategories. The results show that the patients received pain relief more quickly after the introduction of nurse-initiated pain relief. More patients received painkillers and more patients were included in their care through increased frequency of pain assessment. An increased satisfaction with the treatment could be seen, there were also tendencies towards more patients experiencing adequate pain relief. No patients suffered any serious side effects. The conclusion is that nurse-initiated pain protocols are a good tool the specialist nurse can use with several positive effects and without serious negative effects for patients. The pain relief is given more timely and seemingly with good effect.

Department of Public Health / MPH

MPH / Department of Public Health / Antiretroviral treatment (ART) roll-out presents new opportunities and challenges for nurse-initiated-andmanaged antiretroviral treatment (NIMART) trained nurses in the primary health care (PHC) facilities. Nurses have had central role in the management of the human immunodeficiency virus (HIV) since the disease was first reported. The purpose of this study was to explore and describe the challenges confronting professional nurses implementing the NIMART programme in PHC facilities under Thulamela B Municipality, Vhembe District. This study used a qualitative approach in which the interview was used as a data collection technique. The target population comprised professional nurses who were trained in NIMART and who were implementing the programme. Probability sampling, in particular its sub-type, the simple random sampling technique, was used to select fifteen PHC facilities within the sub-District. The non-probability purposive sampling technique was used to select the NIMART-trained professional nurses in Thulamela B sub-District. The sample size was determined by data saturation. Data were collected from the participants through semi-structured interviews, observations and field notes to assist in transcription. A digital recorder was used to log individual responses during the interview sessions. Data from the digital recordings were transcribed verbatim. Results were analysed and interpreted thematically. This study establsihed that nurses were facing several challenges such as shortages of infrastructure and medication, lack of support from management and non-NIMART-trained nurses and discrimination. The NIMART programme was poorly supported in terms of nurse training as nurses indicated that they faced problems in performing tasks such as obtaining blood from children. Doctors were also reported to not fully supporting the NIMART programme. NIMART-trained nurses were optimistic with the implementation of the programme dispite the challenges they faced. To overcome some of the challenges faced at workplaces, nurses devised mechanisms such as allocating different times for collecting tablets and review, and group education for those consulting. It was also established that nurses provided support to each other. Nurses were reported to be using their own transport to collect drugs from the local pharmacy store. Recommendations that emanated from the discussion of the findings and the conclusions of this study are likely to have implications and applications for supporting and advancing the NIMART programme.