Bakgrund: Inom den somatiska akutsjukvården behandlas akuta tillstånd där vård och behandling prioriteras efter sjukdomens eller traumats allvarlighetsgrad. Psykisk ohälsa ökar i det västerländska samhället. Personer som söker för psykiatriska besvär på akutmottagningen riskerar att prioriteras lågt i triageringen av patienter. Sjuksköterskans omvårdnadsansvar innebär att inta ett holistiskt förhållningssätt i det akuta vårdmötet. Personcentrerad vård är en av sjuksköterskans sex kärnkompetenser som utgör ett stöd för att möta patienterna i omvårdnadsarbetet. Personcentrerad vård innebär att sjuksköterskan lyssnar till patientberättelsen, inbjuder till ett partnerskap med patienten och närstående samt dokumenterar den överenskomna vården. Syfte: Syftet är att beskriva sjuksköterskors upplevelse av att vårda patienter med psykisk ohälsa på den somatiska akutmottagningen. Metod: Litteraturöversikten utgår från en kvalitativ design med hermeneutik metod samt induktiv ansats. Tolv artiklar inkluderas efter kvalitetsgranskning. Dataanalysen utförs enligt Fribergs modell som innehåller fem steg i analysprocessen. Resultat: Resultatet visar att sjuksköterskorna upplever en ambivalens mellan negativa känslor som uppkommer i patientmötet samt viljan att ge god omvårdnad till patienterna. Begränsningar inom organisationen upplevs som hinder för att ge adekvat vård. Slutsats: Gemensam utbildning samt terapeutiska interaktioner mellan somatisk och psykiatrisk vård kan förslagsvis avstigmatisera psykisk ohälsa samt motverka en negativ  vårdkultur. / Background: Within somatic emergency healthcare, acute conditions are treated where care and treatment are prioritised according to the severity of the illness or trauma. Mental illness is increasing in Western society. People who apply for psychiatric problems at the emergency department risk being given low priority in the triage of patients. Nursing responsibility means taking a holistic approach in the acute care encounter. Person-centred care is one of the nurse's six core competencies which provide support for meeting patients in nursing. Person-centred care means that the nurse listens to the patient's story, invites a partnership with the patient and relatives and documents the agreed care. Aim: The aim is to describe nurses' experience of caring for patients with mental illness in the somatic emergency department. Method: The literature review is based on a qualitative design with a hermeneutic method and an inductive approach. Twelve articles are included after quality review. The data analysis is carried out according to Friberg's model, which contains five steps in the analysis process. Results: The results show that the nurses experience an ambivalence between negative feelings that arise in the patient encounter and the desire to provide good care to the patients. Limitations within the organisation are perceived as obstacles to providing adequate care. Conclusion: Joint education and therapeutic interactions between somatic and psychiatric care can suggest de-stigmatizing mental illness and countering a negative care culture.

Thesis(M.A.(Nursing)) -- University of Limpopo, 2019 / Background: Many deaths in hospitals occur within 24 hours of admission. Some of these deaths could be prevented if the patients were effectively triaged, identified quickly and treatment initiated without delay. Triage and emergency care have always been weak and under-emphasized components of healthcare systems in Africa and yet, if well organized, could lead to saving many lives and reducing the ultimate costs of care. Purpose: The purpose of this study is to develop strategies to enhance knowledge of triage amongst nurses working in the Emergency Departments of the Sekhukhune District, Limpopo Province, South Africa. Study method: By employing a quantitative, non-experimental research method, 84 nurses working in the Emergency Departments, completed and submitted structured questionnaires. Validity and reliability were insured by pre-testing the data collection instrument on respondents who were not part of the main study. Data were analyzed by using the SPSS and Excel computer programmes with the assistance of the University statistician. Results: Findings indicated that there is an association between triage knowledge and Job title (p-value = 0.046). Registered nurses, specialty nurses and enrolled nurses were found to have more knowledge than auxiliary nurses. However, from those nurses with the knowledge, the study discovered that most of the respondents (61%) exercised poor triage practice compared with those nurses (30%) exercising good practice. Conclusion: The results of this study show that having triage knowledge does not automatically equate with good triage practice. Therefore, it is recommended to integrate knowledge with experience and continued professional development to yield good triage practice.

Bakgrund: Akutmottagningar är avsedda för personer med akut sjukdom ellerskada och en sjuksköterska som arbetar på akutmottagningen är grund- eller specialistutbildad. En akutsjuksköterska har en specialistutbildning inom akutsjukvård och förväntas självständigt kunna göra korrekta medicinskabedömningar. På akutmottagningar utförs triage som är en process där patientens medicinska angelägenhetsgrad bedöms utifrån anamnes, subjektiva symtom samt objektiva tecken och detta är centralt för att patienten ska få adekvat vård i rätt tid. Stress, osäkerhet och att vara under press är känslor som triagerande sjuksköterskor ofta upplever. Syfte: Syftet var att beskriva akutsjuksköterskors upplevelser av triage på enakutmottagning. Metod: En kvalitativ intervjustudie med induktiv ansats, där tolv deltagare intervjuades. Intervjuerna analyserades enligt Graneheim och Lundmans innehållsanalys. Resultat: Tre kategorier framkom: medvetenhet om sina styrkor och svagheter, arbetsklimatet hindrar och främjar samt komplexitet i patientmötet. Kategorierna resulterade i det övergripande temat: Triage - en mångfacetterad utmaning i ständigt lärande, som innebär att triage upplevs vara en utmaning som kräver expertis samt flexibilitet och genom rätt förutsättningar, medkänsla och ständigt lärande kan patientens behov mötas. Slutsats: Resultatet visar att erfarenhet och utbildning är viktigt inom triage, för säkrare och tryggare bedömningar. Även som akutsjuksköterska är det viktigt med kontinuerlig utbildning för fortsatt personlig utveckling. Arbetsmiljön och samspelet med kollegor upplevs också påverka kvaliteten på triage där vissa faktorer hindrar och andra främjar. För att öka arbetsglädjen behöver tryggheten i bedömningar stärkas och hindrande faktorer ses över för att skapa en ännu bättre miljö kring triage. / Background: Emergency departments are intended for individuals with acute illness or injury, and a nurse working in the emergency department has a bachelor’s or master’s degree. An emergency nurse has a master’s degree in emergency care and is expected to independently make accurate medical assessments. Triage, performed in emergency departments, is a process where the patient's medical urgency is assessed based on medical history taking, subjective symptoms, and objective signs, and this is essential for the patient to receive timely care. Stress, uncertainty, and feeling under pressure are emotions frequently experienced by triaging nurses. Objective: The aim was to describe emergency nurses' experiences of triage in an emergency department. Method: A qualitative interview study with an inductive approach was conducted, where twelve participants were interviewed. The interviews were analyzed using Graneheim and Lundman’s content analysis. Results: Three categories emerged: awareness of strengths and weaknesses, the work environment hinders and promotes, and complexity in patient encounters. The categories resulted in the overarching theme: Triage - a multifaceted challenge in continuous learning, indicating that triage is perceived as a challenge requiring expertise and flexibility, and through the right conditions, compassion, and continuous learning, patient needs can be met. Conclusion: The results show that experience and education are important in triage for safer and more confident assessments. Even as an emergency nurse, continuous education is crucial for personal development. The work environment and interaction with colleagues are also perceived to affect the quality of triage, with certain factors hindering and others promoting. To enhance job satisfaction, the confidence in assessments needs to be reinforced, and hindering factors need to be addressed to create an even better triage environment.

Background: There is an increasing flow of patients seeking care at various facilites, such as Healt Centers, Family Doctor Emergency services, and emergency departments, where the pressure is already high. Through triage and urgent assessments, patients can be prioritized to the appropriate level of care so that those requiring immediate medical attention receive it promtly.  Aim: The aim of this study was to describe district nurses´experiences and perceptions of triage and urgent assessments.  Method: This study employs a descriptive design with a qualitative approach. Data collection was conducted through semi-structured interviews guided by an interview guide developed by the authors. The collected data were analyzed using qualitative content analysis. A total of nine district nurses participated.  Main results: Several participants reported that work experience, clinical acumen, education, and various triage systems facilitate the process of triage and assessments. However, some participants encountered various difficulties and challenges during assessment. With the right skills, experience, and knowledge, the duration of care and wait time can be reduced, thereby minimizing the risk of incorrect assessments. Conclusion: Several participants felt that the high patient flow and lack of time were challenges and could sometimes be experienced as stressful when performing accurate triage. The study described that district nurses with extensive experience, broad knowledge, and a clinical perspective felt confident in making assessments independently. However, the majority of participants stated that ongoing education is necessary to maintain good competence. / Bakgrund: Det förekommer ett ökat flöde av patienter som söker sig till olika delar av vården, såsom Hälsocentral, Familjeläkarjour och akutmottagning där trycket redan är högt. Genom akuta bedömningar och triage, kan patienterna prioriteras till rätt vårdnivå för att den patient som behöver snabbast vård ska få det.  Syfte: Syftet var att beskriva distriktssköterskors upplevelser och erfarenheter av triage och akuta bedömningar.  Metod: Denna studie har en deskriptiv design med en kvalitativ ansats. Datainsamlingen har skett genom semistrukturerade intervjuer med en intervjuguide sammanställd av författarna. Insamlade data har analyserats genom kvalitativ innehållsanalys. Totalt deltog nio distriktssköterskor.  Resultat: Flera av deltagarna berättade att med arbetslivserfarenhet, klinisk blick, utbildning och olika triagesystem kan triageringen och bedömningarna underlätta för den distriktsköterska som utför det. Dock upplevde några av deltagarna olika svårigheter och utmaningar vid bedömningarna. Med rätt kompetens, erfarenhet och kunskap kan vårdtider och vårdköerna kortas ner, och minska risken för felbedömningar.  Slutsats: Flera av deltagarna ansåg att det höga patientflödet samt tidsbrist var en utmaning och ibland kunde upplevas som stressigt för att utföra en korrekt triagering av patienten. Studien beskrev att distriktssköterskor med lång erfarenhet, bred kunskap samt en klinisk blick kände sig trygga i att göra bedömningar på egen hand. Flertalet av deltagarna uppgav dock att utbildning är nödvändigt för att bibehålla god kompetens.

Akutsjukvård är vård som finns tillgänglig för patienter dygnet runt för patienter som kräver omedelbar eller skyndsam tillsyn eller åtgärder. Inom svenska akutsjukvården används RETTS (Rapid Emergency Triage and Treatment System) i flera verksamheter för att prioritera patienterna. Prioriteringen av patienter utförs i flera fall av en sjuksköterska. Hälso- och sjukvårdslagen säger att vården i Sverige ska vara jämlik och på lika villkor, patienten med störst behov ska få vård först. Socialstyrelsen påvisar skillnader i väntetider mellan män och kvinnor på akutmottagningar där kvinnor väntar längre än män. Syftet var att belysa skillnader i omhändertagandet av manliga och kvinnliga patienter inom akutsjukvård. Litteraturöversikten är genomförd med en systematisk ansats. 15 artiklar har extraherats och utgör resultatet, samtliga är kvantitativa studier. Artiklarna är kvalitetsgranskade enligt Sophiahemmet högskolas modifierade granskningsverktyg. Resultatet syntetiserades till kategorier och underkategorier. Artiklarna till resultatet har ett etiskt övervägande beskrivet. Resultatet visar skillnader mellan hur män och kvinnor söker vård. Män och kvinnor kommer på olika sätt till sjukvården, män kommer i större utsträckning än kvinnor med ambulans, kvinnor beskriver oftare andra typer av symtom än män, Kvinnor får oftare en lägre prioritet än män, trots beskrivning av samma typ av symtom. Män får oftare en mer högspecialiserad vård än kvinnor. Slutsatsen är att brister i omhändertagandet att kvinnor gör att de får vänta längre än män och att kvinnor inte tas på allvar för sina symtom och då får en annan typ av behandling. / Emergency care is care available around the clock for patients who require immediate or urgent supervision or interventions. In Swedish emergency healthcare, RETTS (Rapid Emergency Triage and Treatment System) is used in several facilities to prioritize patients. Prioritization of patients is often performed by a nurse. The Swedish Health and Medical Services Act states that healthcare in Sweden should be on equal terms; the patient with the greatest need should receive care first. The National Board of Health and Welfare (Socialstyrelsen) indicates differences in waiting times between men and women in emergency departments, where women wait longer than men. The aim was to highlight differences in the care of male and female patients in emergency healthcare. The literature review was conducted with a systematic approach. 15 articles were extracted and constitute the results, all of which are quantitative studies. The articles were quality assessed according to a modified review tool from Sophiahemmet University. The results were synthesized into categories and subcategories. Ethical considerations for the articles included in the results were described in the articles. The results show differences in how men and women seek care. Men and women arrive at healthcare facilities in different ways, with men more likely to arrive by ambulance. Women more often describe other symptoms than men. More often women receive a lower priority than men, despite describing the same type of symptoms. Men more often receive more highly specialized care than women. The conclusion is that deficiencies in the care of women result in them waiting longer than men and not being taken seriously for their symptoms, leading to a different type of treatment.

Subject matter of the thesis is Use of the triage method in emergency events and its importance among selected bodies of the integrated rescue system. It contains both teoretical and research parts. Theoretical part includes definition of emergency events and definition of mass disaster. It also mentions organizations, which help to deal with these events. But the main point of the thesis is formed by triage issues in terms of its history, elementary distribution and putting the most frequently used methods. An important chapter is a description of the documentation associated with issues, especially triage and identification cards from the perspective of emergency medical services and fire protection units. The last point of the theoretical part is the mention of traumatology planning. The research part sets out three hypotheses, which focus on finding a theoretical readiness among selected bodies of the integrated rescue system. The first presupposition was that the knowledge of the staff of medical rescue services is better than knowledge of the members of other selected bodies. The remaining hypotheses put the same requirements, but in terms of lenght of employment of selected workers in integrated rescue system. Better knowledge is expected for the longer-acting staff and for staff, who have some experience with triage issues. Chapter also describes the statistical method which enabled the confirmation or refutation of the hypotheses - pair t-test. The methodology describes the method of data collection by using questionnaire, describes used statistical methods, provides basic empirical parameters and their comparison. The result of this comparison was expressed in percentage. The result of data processing from secondary sources was to determining that examined issue in the Czech Republic is very fragmented, in terms of used methods and documentation. Data needed to confirm hypotheses was collected from the staff of emergency medical services, fire rescue units and volunteer firefighters. Only a single hypothesis was confirmed. Theoretical knowledge of the staff of emergency medical services is not better than the knowledge of the other selected bodies. It is very similar to knowledge of staff of fire rescue units. However members of volunteer firefighters have the worst triage knowledge. Another finding was that lenght of employment of workers of ambulance components doesn´t affects the quality of their theoretical preparedness. Empirical research identified knowledges approximately the same. On the contrary, previous experience affects the degree of this knowledge. This assertion is based on the fact that workers from examined bodies, who had to solve real or training emergency events, by triage methods, have better degree of theoretical knowledge. The objective of the thesis was, besides process determination of the theoretical knowledge and hypotheses also identification of weaknesses in triage knowledge of workers from selected bodies and determination methods for their correction. Therefore, based on the results, was created a graphic manual procedure for triage in emergency events. It was created as a learning tool to deepen the knowledge or as a reminder tool of triage procedure for training or real situations. It is designed for all workers, especially for members of volunteer fire units, or other people, who are interested in this issue. Conclusion of the thesis includes suggestion for correction of some of the weaknesses identified in the theoretical readiness of employees or members of integrated rescue system, especially units of volunteer firefighters. This objective can be achieved by better access to educational materials, exchange of expertise focused on this issue and the possibility of greater participation of mass casualties training with other bodies of integrated rescue system.

Master of Landscape Architecture / Landscape Architecture/Regional and Community Planning / Mary C. Kingery-Page / Literature shows that walkable neighborhoods have the potential to significantly decrease the carbon footprint of cities by lessening the need to drive, as well as providing many health, economic, and social benefits to society. The goal of this research, therefore, was to devise a practical strategy to create walkable places in the car-oriented city of Wichita, Kansas. A necessary component of this strategy is an “urban triage,” described by Jeff Speck in Walkable City as identifying streets with the most existing potential and concentrating limited resources to their improvement (2012, 254). This report employed an urban triage of Wichita at two scales based on three central characteristics of walkability: urban fabric, dense street network and connectivity. Comparing block length and link to node ratio, I built a case for downtown, which is organized on a traditional grid of streets, over a typical shopping district organized around the more modern hierarchical pattern of streets. Within downtown, I further narrowed the study area primarily based on urban fabric, the degree to which streets are enclosed by buildings. I created a method to measure urban fabric, using aerial imagery and street views, taking into account the consistency of the street wall, height of buildings and foreground. The strongest complete corridor, in terms of urban fabric, and three potential links between that corridor and downtown’s largest event space, became the study area for further analysis. A rubric, based on characteristics of walkability extrapolated from literature, served as the instrument to measure the attributes of each block in the study area. Each attribute, as well as the characteristics that they create, yielded a map, contrasting strong and weak blocks. This analysis provided the detailed information necessary to create an informed conceptual strategy to resolve these weaknesses. Selective building infill resolved gaps in the urban fabric, road diets and improved crossings restored modal balance to the street, and a new pedestrian corridor completed a broken street and activated an existing park.

För att underlätta och kvalitetssäkra dettidiga/prehospitala medicinskaomhändertagandet har olika hjälpmedel, såkallade beslutsstöd utvecklats. RETTS är ettav dessa beslutsstöd som används inomprehospital medicin för att triagera patienten.Genom att arbeta med triage bedöms denmedicinska svårighetsgraden samt identifierasde patienter som har störst samt lägstvårdbehov. Syftet med studien var attundersöka specialistutbildadeambulanssjuksköterskors upplevelser av attarbeta med RETTS som beslutsstöd i sambandmed prehospital omvårdnad. Studiengenomfördes med kvalitativ design genomintervjuer med ambulanssjuksköterskor somvarit yrkesverksamma minst två år innanRETTS beslutsstöd infördes i Region Halland.I resultatet framkom följande fyra kategorier;strukturerat hjälpmedel, ett tryggtomhändertagande, bra kommunikation samtkräver erfarenhet. Vi rekommenderar attvidare forskning fokuserar på patienternasupplevelser av att bli triagerade utifrånRETTS, för att identifiera och belysaytterligare för- och nackdelar med RETTSbeslutsstöd.

Bakgrund: I takt med den ökande invandringen till Sverige möter distriktssköterskor allt oftare icke-svensktalande patienter, som söker hjälp i triaget på vårdcentraler. För att kunna gör en medicinsk bedömning och avgöra vårdnivå behöver det finnas en fungerande kommunikation mellan distriktssköterskan och patienten. Distriktssköterskan behöver dessutom kunna förmedla information bland annat i form av egenvårdsråd till dessa patienter. Syfte: Att undersöka distriktssköterskors upplevelser av kommunikationssvårigheter med icke-svensktalande patienter vid triage på vårdcentral. Metod: Studien är en intervjustudie baserad på tolv intervjuer. Dataanalysen genomfördes med kvalitativ innehållsanalys enligt Graneheim och Lundman . Resultat: I resultatet framkom två kategorier: En utmanande kommunikation och Att kunna kommunicera på andra sätt. Distriktssköterskor berättade att de upplevde osäkerhet och oro för att missa en allvarlig åkomma på grund av språksvårigheter. De uttryckte även att bristen på tid utgjorde ett hinder i kommunikationen. Dessutom uppgavs ett antal olika kulturella faktorer som försvårade kommunikationen med icke-svensktalande. Distriktssköterskorna använde sig av uppfinningsrikedom och fantasi för att kunna kommunicera. De tog även hjälp av anhöriga som tolkade eller professionella tolkar.  Konklusion: Att kommunicera med icke-svensktalande vid triage är en utmaning för distriktssköterskor och kräver att distriktssköterskorna kan kommunicera på andra sätt. Ökade resurser i form av tid och lättare tillgång till tolk hade kunnat underlätta för distriktssköterskor som möter dessa patienter. Utbildning i transkulturell, kulturanpassad omvårdnad på grund- och specialistutbildningar inom omvårdnad skulle kunna öka förståelsen och kunskapen och därigenom leda till bättre förutsättningar för kommunikation.

A triagem de emergência tem como objetivo dar prioridade aos pacientes mais graves e melhorar a prestação do serviço de emergência, garantindo atendimento no momento adequado, melhor fluxo e segurança. Os objetivos deste trabalho foram traduzir e validar a parte referente às emergências odontológicas do instrumento para triagem de emergência Manchester Triage System (MTS) na língua portuguesa, avaliar a confiabilidade interobservadores e o impacto da aplicação do MTS no Setor de Urgência Odontológica da Faculdade de Odontologia da Universidade de São Paulo. O MTS foi traduzido através do método padrão de tradução/ retrotradução. A versão foi submetida à validação semântica e idiomática e também conceitual e cultural, feita por um comitê de juízes. Em ambas, a concordância final observada após os ajustes realizados foi superior a 80%. Na concordância interobservadores, 200 pacientes participaram das entrevistas realizadas por 2 voluntários independentes com conhecimentos em odontologia e a pesquisadora. Os coeficientes kappa foram de 0.58 e 0.60. Inicialmente foram entrevistados 120 pacientes sem a aplicação do MTS e em seguida 139 pacientes categorizados de acordo com a prioridade clínica. Houve diminuição no tempo médio de espera para atendimento, de 79.96 min para 36.86 min (Mann-Whitney (MW), p=0.00) e aumento do tempo médio de duração do atendimento, de 29.11 min para 34.78 min (MW, p=0.05). Dentre os pacientes categorizados segundo o MTS, os não-urgentes eram mais velhos (MW, p=0.01), tiveram menor duração de atendimento (MW, p=0.00) e menor intensidade de dor (MW, p=0.00). A versão traduzida e validada do MTS mostrou-se adequada e sua aplicação e útil no atendimento de pacientes do Setor. / The emergency triage aims to assign clinical priority to the patients and to improve emergency services, ensuring attendance at the right time, better patient flow and safety. The objectives of this study were to translate and validate part of the Manchester Triage System (MTS) related to dental emergency in Portuguese, to assess the inter-rater reliability and to evaluate the impact of implementation of triage at Setor de Urgência Odontológica of Faculdade da Odontologia of Universidade de São Paulo. The MTS was translated using the standard translation/ back-translation method. The instrument was then submitted to semantic and idiomatic validation, as well as conceptual and cultural validation by a committee of judges. In both, the final concordance after the adjustments was higher than 80%. In the inter-rater agreement, 200 patients were interviewed by two independent volunteers with some knowledge of dentistry and the researcher. The kappa coefficients were 0.58 and 0.60. Then 120 patients were interviewed without the application of the MTS and 139 patients were categorized according to their clinical priority. There was a reduction in the mean waiting time, from 79.96 min to 36.86 min (Mann-Whitney test (MW), p=0.00) and an increase in the mean of treatment duration, from 29.11 min to 34.78 min (MW, p=0.05). Among triaged patients, the non-urgent were older (MW, p=0.01), had shorter duration of treatment (MW, p=0.00) and lower pain intensity (MW, p=0.00). The translated and validated version of the MTS showed to be appropriate and useful in categorization of patients with dental emergencies in this setting.