Background: Protection against cold is vitally important in prehospital trauma care to reduce heat loss and prevent body core cooling. Objectives: Evaluate the effect on cold stress and thermoregulation in volunteer subjects byutilising additional insulation on a spineboard (I). Determine thermal insulation properties of blankets and rescue bags in different wind conditions (II). Establish the utility of wet clothing removal or the addition of a vapour barrier by determining the effect on heat loss within different levels of insulation in cold and warm ambient temperatures (III) and evaluating the effect on cold stress and thermoregulation in volunteer subjects (IV). Methods: Aural canal temperature, sensation of shivering and cold discomfort was evaluated in volunteer subjects, immobilised on non-insulated (n=10) or insulated (n=9) spineboards in cold outdoor conditions (I). A thermal manikin was setup inside a climatic chamber and total resultant thermal insulation for the selected ensembles was determined in low, moderate and high wind conditions (II). Dry and wet heat loss and the effect of wet clothing removal or the addition of a vapour barrier was determined with the thermal manikin dressed in either dry, wet or no clothing; with or without a vapour barrier; and with three different levels of insulation in warm and cold ambient conditions (III). The effect on metabolic rate, oesophageal temperature, skin temperature, body heat storage, heart rate, and cold discomfort by wet clothing removal or the addition of a vapour barrier was evaluated in volunteer subjects (n=8), wearing wet clothing in a cold climatic chamber during four different insulation protocols in a cross-over design (IV). Results: Additional insulation on a spine board rendered a significant reduction of estimated shivering but there was no significant difference in aural canal temperature or cold discomfort (I). In low wind conditions, thermal insulation correlated to thickness of the insulation ensemble. In greater air velocities, thermal insulation was better preserved for ensembles that were windproof and resistant to the compressive effect of the wind (II). Wet clothing removal or the use of a vapour barrier reduced total heat loss by about one fourth in the cold environment and about one third in the warm environment (III). In cold stressed wet subjects, with limited insulation applied, wet clothing removal or the addition of a vapour barrier significantly reduced metabolic rate, increased skin rewarming rate, and improved total body heat storage but there was no significant difference in heart rate or oesophageal temperature cooling rate (IV). Similar effects on heat loss and cold stress was also achieved by increasing the insulation. Cold discomfort was significantly reduced with the addition of a vapour barrier and with an increased insulation but not with wet clothing removal. Conclusions: Additional insulation on a spine board might aid in reducing cold stress inprolonged transportations in a cold environment. In extended on scene durations, the use of a windproof and compression resistant outer cover is crucial to maintain adequate thermal insulation. In a sustained cold environment in which sufficient insulation is not available, wet clothing removal or the use of a vapour barrier might be considerably important reducing heat loss and relieving cold stress.

Bakgrund: Trauma är ett världsomfattande problem. I Sverige avlider 4500 personer årligen av traumarelaterade skador. Lennquist (2007) menar att denna siffra kan minskas vid optimerad organisation och förhöjd/förbättrad kompetens inom traumavård. Syfte: Att undersöka operationssjuksköterskors självskattade kompetens inom traumavård utifrån Landstinget Västmanlands kompetensutvecklings modell, baserad på Benners kompetens- och utvecklingsstadier. Metod: Deskriptiv analys av kvantitativ data. Operationssjuksköterskor på en operationsavdelning i Sverige svarade på ett frågeformulär. Frågorna var utvecklade utifrån Landstinget Västmanlands kompetensutvecklings modell och Svensk sjuksköterskeförenings sex kärnkompetenser. Resultat: Vid studiens genomförande arbetade 36 operationssjuksköterskor vid operationsavdelningen, 15 operationssjuksköterskor deltog. Nio operationssjuksköterskor (n=15) befann sig på "expertnivå" men utförde arbetsuppgifter utifrån en lägre kompetensnivå. Majoriteten av operationssjuksköterskorna svarade "stämmer helt" på fyra av svensk sjuksköterskeförenings sex kärnkompetenser och "stämmer delvis" på resterande två. Alla deltagande hade deltagit i någon form av traumautbildning. Slutsats: Det finns behov av ökad struktur och klarare riktlinjer kring operationssjuksköterskans kompetensutveckling eftersom experterna utför arbetsuppgifter utifrån en lägre kompetensnivå. Operationssjuksköterskorna hade goda kunskaper inom fyra av de sex kärnkompetenserna men behövde förbättra sin kunskap inom två områden. / Background: Trauma is a worldwide problem. In Sweden 4500 people die annually of trauma-related injuries. Lennquist (2007) argue/mean that optimized organization and improved competence in trauma care could decrease the number of deaths due to trauma. Aim: To investigate operating nurses' own view of their competence in trauma care in relation to Landstinget Västmanland's model for competence, based on Benner's stages of clinical competence. Method: Descriptive analysis of quantitative data. Operating nurses working in a operative department were given questionnaires to respond to. The questions were based on Landstinget Västmanlands stages of competence and The Swedish Nurses Association's six core competencies. Results: Thirty-six operating nurses worked at the department during the week the questionnaires were distributed and fifteen chose to participate. Nine operating nurses (n=15) were classified as "experts", but performed duties at a lower competency level. The majority of the operating nurses responded "agree completely" to four of the six core competencies and "partly true" on the remaining two. All participants had participated in some kind of trauma education. Conclusion: There is a need for greater structure and better guidelines regarding operating nurses' competence development since experts preformed their duties at a lower competency level. Operating nurses had good knowledge in four of the six core competencies but needed to improve their knowledge in two areas.

Bakgrund. I Sverige utgör trauma den vanligaste dödsorsaken för vuxna, 18-45 år. Traumateamets utbildning och kompetens är av stor betydelse för den skadade patientens överlevnad. Anestesisjuksköterskan har en viktig roll som medlem i traumateamet i det initiala omhändertagandet av traumapatienter. Syfte. Syftet var att beskriva anestesisjuksköterskors uppfattning av den egna kompetensen inom traumavård. Metod. Studien var empirisk med kvantitativ data där en enkät delades ut till 45 anestesisjuksköterskor på en operationsavdelning på ett sjukhus i Sverige. Deltagarna skattade sin kompetens och svaren ställdes mot Benners kompetensstege och Svensk sjuksköterskeförenings sex kärnkompetenser. Resultat. Tjugo anestesisjuksköterskor deltog i studien varav tolv skattade sig som experter, en som kompetent och sju som noviser eller avancerad nybörjare. Samtliga deltagare skattade "stämmer helt" eller "stämmer delvis" vad gäller kompetens inom de sex kärnkompetenserna oberoende av arbetad tid på operationsavdelningen. Några expertsjuksköterskor arbetade inte med handledning, undervisning, kvalitetsutveckling och arbetsledning, medan några noviser och avancerade nybörjare arbetade med dessa expertuppgifter. Majoriteten av deltagarna hade fortbildning inom trauma. Slutsats. Lång arbetserfarenhet och utbildning inom traumavård var två orsaker som bidrog till den höga självskattade kompetensen bland deltagarna. Mer forskning behövs för att undersöka varför en del anestesisjuksköterskor på expertnivå inte arbetar med handledning, undervisning, kvalitetsutveckling och arbetsledning. / Background. In Sweden trauma is the leading cause of death of adults between 18 and 45 years of age. Therefore the education and competence of trauma teams is of vital importance. As members of trauma teams, nurse anesthetists have an important role to play in the initial care of trauma patients. Aim. The aim was to describe Swedish nurse anesthetists’s self-evaluations of their own competence in trauma care. Method. The study was an empirical study using quantitative data. A questionnaire was handed out to 45 nurse anesthetists working in a perioperative department in a Swedish hospital. The participants estimated their competence and the answers were compared to Benner’s stages of clinical competence and the six core competencies of the Swedish Nurses Association. Results. Twenty nurse anesthetists participated and of those twelve classified as experts, one as competent and seven as either novices or advanced beginners. All the participants answered either "agree" or "partly agree" in response to questions concerning the six core competencies regardless of how long they had worked in the perioperative department. Some experts did not work with tutoring, education, quality development or staff management, on the other hand, some of the novices and advanced beginners had been given such important responsibilities. The majority of the participants had continued education in trauma. Conclusion. Long work experience and high participation in trauma education were two important causes of the high competence of the participants. More research is needed to determine why some experts were not involved in tutoring, education, quality development or staff management.

This research focuses on injuries from all mechanisms, with particular focus on road traffic injuries in urban Gambia. Data from trauma registries established in two major trauma hospitals were used to address three aims: 1) examine the general characteristics of injured individuals and their injuries, and identify factors associated with discharge status from the hospital emergency room; 2) identify differences in road-user, collision, vehicle, and driver factors, among individuals hospitalized with a road traffic injury; and 3) examine personal, crash, and injury factors associated with transfer status among road traffic injured (RTI) patients, and identify limitations of the current trauma systems that might be improved for more efficient use of resources. Data used for this dissertation were from trauma registries established in two major trauma hospitals in The Gambia: Edward Francis Small Teaching Hospital (EFSTH) and Serrekunda General Hospital (SGH). At intake, the treating physicians and nurses completed an accident and emergency ward survey form for injuries from all mechanisms. For admitted road traffic injured patients (admission more than 24 hours), the road traffic injured admission form is completed. Data about risk factors contributing to crashes and injuries were collected from the patients. At hospital discharge, treating physicians used a 19-item questionnaire to collect data on the discharge status and disability at discharge of road traffic injured patients. Using the trauma registry data from March 1, 2014 to March 31, 2016, we found the leading mechanism of injury was road traffic. For place of occurrence, injuries mostly occur at home and on the road. Assault was higher among young females (19 to 44 years) than males. Males have increased odds for admission and disability due to road traffic injuries. We also found that among admitted road traffic injured patients, injuries to pedestrians, bicyclists, and motorcyclists were higher than other road users. Crashes involved risk factors at person, crash, and environment levels. Head/skull injuries were common, and concussions/brain injuries were higher among pedestrians, bicyclists, and motorcyclists than vehicle occupants. Finally, our results also suggest that vehicle occupants, and professionals/skilled personnel had increased odds of being transferred than directly admitted RTI patients. Fractures/dislocations, and concussions/brain injuries were frequent among transfers. Intravenous fluid was the most frequent treatment administered to patients transferred to the definitive-care hospitals. This project shows that injuries, especially road traffic, create a large burden of injury in The Gambia and the many contributing factors. It also provides evidence that there are many opportunities to intervene at personal, crash, and environment levels. Additionally, creating trauma registries across the country as well as trauma response system will have a greater impact to reduce burden of road traffic crashes in The Gambia.

Bakgrund Traumatiska händelser kräver resurser och tid av sjukvården och av det vårdteam som behandlar patienten. Sjuksköterskan har ett stort omvårdnadsansvar vid traumaomhändertagande vilket gör att det krävs rätt kompetens. För att välbefinnandet ska bevaras hos patienten är det av vikt att skapa trygghet, empati och att situationen hanteras personcentrerat. För att erhålla hög patientsäkerhet har vårdteamets samarbete och kommunikation betydande roll. Syfte Syftet med denna litteraturöversikt är att belysa sjuksköterskors känslomässiga erfarenheter av traumavård. Metod En systematisk och strukturerad litteraturöversikt. Kvalitativa och kvantitativa artiklar inkluderades där tretton artiklar valdes ut till resultatet. Resultat Översikten visar att utbildning och kommunikation står för en stor del av kompetens i traumavård och en förutsättning för god patientsäkerhet samt ett välfungerande omhändertagande av patienten. Utbildning och tidigare erfarenhet visar sig ha betydanderoll för hur sjuksköterskor upplever omhändertagandet vid trauma. Stress och otrygghet är några känslomässiga upplevelser hos sjuksköterskorna som framkom i resultatet. Slutsats Traumavård är känslomässigt påfrestande för sjuksköterskor då det bidrar till många olika känslomässiga reaktioner som rädsla, stress och oro. Sjuksköterskorna upplever kommunikation och samarbete som något positivt i ett traumaomhändertagande. / Background Traumatic events require comprehensive healthcare and the care team that cares for the patient. The nurse is responsible for nursing in trauma care, which means that the adequate and purposeful skills are required. In order to maintain the wellbeing of the patient preserved and maintained, it is of great importance to create security, empathy and that the situation is handled with a person centered approach. In order to obtain high patient safety, the care team's cooperation and communication play a significant role in trauma care. Aim The aim of this literature review is to describe nurses' emotional experiences of traumacare. Method A systematic and structured literature review. Qualitative and quantitative articles were included and quality was assessed. Thirteen articles were selected for the analysis. Results The overview shows that education and communication account for a large part of the care and form the basis for good patient safety and well-functioning care of the patient. Nurses' education and previous experience prove to play a significant role to nurses in trauma care. Stress and insecurity are some emotional experiences of the nurses that emerged in the results. Conclusions Trauma care is emotionally stressful for nurses as it contributes to many different emotional reactions such as fear, stress and anxiety. The nurses experience communication and collaboration as something positive in trauma care.

Bakgrund: Vid större trauma som kan vara livshotande så kopplas traumateam in. Detta kan innebära många specialiteter som arbetar parallellt med varandra för en snabb handläggning av livshotande skador. Sjuksköterskan har en viktig roll i att möta patientens fysiska behov men framför allt känslomässiga behov. Att vara med om trauma kan ge långvariga konsekvenser både fysiskt och psykiskt. Syfte: Att beskriva patientersupplevelser av traumaomhändertagande på akutmottagning. Metod: En litteraturöversikt där resultatet grundar sig på åtta vetenskapliga artiklar från databaserna PubMed och CINAHL. Resultat: Vid traumaomhändertagande kan flertalet specialiteter ingå, vilket kan vara skrämmande för patienten. Kommunikationen hade en betydande roll för patientens upplevelse, där det fanns en delad upplevelse som var både positiv och negativ. Trygghet för patienten skapades vid ett lugnt bemötande där vårdpersonalen var omhändertagande och respekterande. Slutsats: Komplexa vårdsituationer vid traumaomhändertagande och individuella behov ställer höga krav på hälso- och sjukvårdspersonal där bemötande och kommunikation är en central del av patientens upplevelse. / Traumas are life threatening in which a trauma team is involved. This can include many specialities working parallel with each other to work fast on life threatening injuries. The nurse has an important role in meeting the patients physical need but most  of all the emotional needs. Being involved in trauma can result in long-lasting consequences both physically and mentally. Aim: To describe patient ́s experiences of trauma care in emergency departments. Method: A litterature review where the result is based on eight scientific articles that were identified on PubMed and CINAHL. Results: In trauma care there can be several specialities that can be frightening for the patient. Communication had a meaningful role for the patient ́s experience but there was a divide in the experience that was both positive and negative. Safety for patients was created when the healthcare professionals were calm, caring and respectful. Conclusions: Complex care situations and individual needs sets a high demand on healthcare professionals where treatment and communication are a central part of patients experience.

SAMMANFATTNING Det dödliga våldet i Sverige har ökat de senaste åren. Mellan åren 2006 och 2014 ökade antalet skottskador med 32 procent. Förekomsten av penetrerande våld som orsak till trauman där patienten är svårt skadad är stigande. Om patienten utsatts för en penetrerande skada mot huvud, hals, bål eller extremiteter ovan armbåge/knä aktiveras akutmottagningens traumalarm och traumateamet samlas för att påbörja omhändertagandet. Sjuksköterskan är en av flera professioner i traumateamet som deltar vid traumaomhändertagandet av patienten. Syftet med studien var att beskriva sjuksköterskors erfarenheter kring traumaomhändertagandet av patienter med våldsrelaterade penetrerande skador. Metoden var en kvalitativ deskriptiv studie med induktiv ansats. Sju sjuksköterskor verksamma på en akutmottagning inkluderades och semistrukturerade intervjuer med dessa genomfördes. Intervjuerna transkriberades för att vidare analyseras utifrån en kvalitativ innehållsanalys. Resultatet av sjuksköterskornas beskrivna erfarenheter presenteras i sju kategorier: förberedelser, kompetens, teamarbete, ledarskap, professionalism, otrygghet och rädsla samt reflektion. Ur sjuksköterskornas erfarenheter framkom vikten av ett välfungerande teamarbete med ett tydligt ledarskap för ett optimalt traumaomhändertagande av patienter med våldsrelaterade penetrerande skador. Med hjälp av utbildning och teamträning ansåg sjuksköterskorna att teamarbetet kunde främjas och den egna rollen stärkas. Den ofta beskrivna känslan av rädsla och otrygghet under möten med denna patientgrupp skulle kunna minskas genom närvaro av polis och annan säkerhetspersonal och var avgörande för att sjuksköterskorna skulle känna sig trygga på sin arbetsplats. Sjuksköterskorna uttryckte att möjligheten till reflektion när omhändertagandet avslutats saknades men hade varit önskvärd för att tillsammans med teamet kunna bearbeta händelsen. Sjuksköterskorna visade sig ha både positiva och negativa erfarenheter kring traumaomhändertagandet av patienter med våldsrelaterade penetrerande skador. Själva traumaomhändertagandet upplevdes inte vara annorlunda vid omhändertagandet av patienter med våldsrelaterade penetrerande skador jämfört med övriga traumapatienter men känslorna som uppstod skilde sig. Utifrån resultatet anser författarna att rutiner gällande polisens närvaro vid traumaomhändertagande av patienter med våldsrelaterade skador, fortlöpande teamträning och kompetenshöjande utbildning samt möjligheten till att efter avslutat omhändertagande gemensamt i teamet få reflektera skulle kunna var en tillgång för sjuksköterskan. Genom detta skulle omhändertagandet av patienterna kunna optimeras och sjuksköterskans trygghet på arbetsplatsen stärkas.

Fall risk among older adult is a worldwide public health problem. As the older adult population is continuing to increase, addressing this issue is critical. Several fall risk assessment tools have been designed to help predict various risk factors. Among these assessment tools is the Hendrich II Fall Risk Model (HIIFRM). This tool uses evidence-based risk factors including mental status, sex, functional status, and whether the patient is taking antileptics and/or benzodiazepines. The purpose of this paper is to validate the HFRM, explore additional variables that increase the likelihood of falling including both past falls and the number of prescription medications a patient is taking. Our findings validate the HFRM; with each additional point on the HFRM score, holding all other explanatory variables constant, the odds of having multiple previous fall-related admissions increased by 38.3% (P < 0.001). The strongest predictor of future falls was previous falls. With confounders held constant, each additional previous fall predicted a 3.9-fold increase in the odds of experiencing a future fall (p < 0.001; 95% CI of OR: 3.131 to 4.961). When looking at prescription medications, for each additional increase in prescription medications, we observe a 11.8% increase in the number of falls experienced during the tracking period (p<0.001; 95% CI of IRR: 1.084 to 1.170). Although a validated tool, our research indicates additional variables that could further enhance its effectiveness.

Insurance is a vital factor in the billed cost to the patient, but to what degree does insurance explain the amount a patient is left to pay? Also, does obesity further influence patient’s billed cost? This thesis assesses the type of thoracic trauma patient, insurance status, and their billed cost. Database variables were analyzed in IBM SPSS 25. Table 1 characteristics were evaluated based on demographics and systematic hospital factors. Linear regressions used Private0_Government1 and BMI Obese n_y_ as independent variables while Total Patient Cost was the dependent variable. Private0_Government1 insurance explained .03% of Total Patient Charges. Private0_Government1 and BMI Obese n_y_ explained 1.4% of Total Patient Charges. Private0_Government1 and BMI Obese n_y_ explained a low percentage of Total Patient Charges. This shows that there are factors other than insurance type and obesity that are influential upon patient charges.

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