Care management instruments used by nurses in the emergency hospital services

ABSTRACT Objective: To describe the instruments used by nurses for the management of care in face of the demands of the emergency hospital service. Method: This is a qualitative study, with triangulation of data from interviews, focus groups, and documents, conducted with nurses from an Emergency Hospital Service in a state in southern Brazil. Data were subjected to thematic content analysis. Results: Seventeen nurses participated in the study. The categories emerging from this study were view of the whole picture, definition of priorities, and physical instruments. These instruments are used by nurses to manage multiple tasks and provide adequate care to patients with different levels of complexity, in the face of an intense and unpredictable work process due to the constant demand for care. Conclusion: The instruments used by nurses in their work process are mainly skills and attitudes developed as a coping strategy at an intense and complex work environment.

Investigating the Prevalence and Etiology of Accidents Recorded at Emergency Management Center of Gonabad City Using the Pareto Chart in 2018

Aims: Accidents are the leading causes of hospitalization and death. This study investigates the prevalence and causes of accidents recorded in Gonabad City emergency hospital service using the Pareto chart from 2016 to 2018. Methods & Materials: This descriptive and analytic study reviewed about 12281 emergencies recorded during 2016-2018, and the key variables such as the number of incidents, causes of incidents, age, gender, and time of incidents were collected for transport and non-transport incidents. Data analysis was performed using a Pareto chart in Minitab v. 16, SPSS v. 18, and EXCEL 2010. Findings: Based on the results, the highest rate of the incidents (542 cases) was related to falling and the lowest related to chemical and electrical burns with one case. Also, most complaints were related to accidents. In the present study, the rate of road accidents was higher than the street and urban accidents (8142 and 4208 cases, respectively). The most frequent accidents were related to motorcycles (748 cases) and then light vehicles (744 cases). The number of accidents that occurred in September and April is higher. Most male victims of accidents were between 16 and 20 years old. Conclusion: Since incidents related to the fall and clash with the mechanical force have the highest prevalence, it is necessary to allocate more financial and human resources to prevent such accidents. Because most admissions to emergency hospital services are related to accidents, and the rate of road accidents is high, it is essential to investigate the causes of accidents. Then, it is possible to raise public awareness to respect the safety regulations while driving and increasing the quality of roads.

Predictors associated with absenteeism-disease among Nursing professionals working in an emergency hospital service

ABSTRACT Objective: To verify the predictors associated with sick leave from 15 days onwards among Nursing professionals of an emergency hospital service. Method: A cross-sectional, retrospective, and descriptive-analytical study. The sample consists of the records of sick leave (n=2,403) due to diseases of the Nursing professionals (n=197) working in an emergency hospital service in southern Brazil, from 2013 to 2018. Descriptive and statistical analysis was used, as well as the multivariate regression model. Results: There was predominance of females (72.6%), white-skinned (86.3%), with a mean age of 45.05 (SD=9.77) years old, and nursing technicians (74.6%). The prevalent cause of sick leave was related to clinical diseases (62.5%). The predictors associated with sick leave from 15 days onwards were the following: Age (OR: 0.97; 95% CI=0.95-0.99) and Musculoskeletal Diseases (OR: 8.95; 95% CI=5.30-15.11). Conclusion: Age and musculoskeletal diseases were predictors of sick leave from 15 days onwards of the Nursing team.

Manchester Triage System: assessment in an emergency hospital service

ABSTRACT Objectives: to analyze demographic data, clinical profile and outcomes of patients in emergency services according to Manchester Triage System’s priority level. Methods: a cross-sectional, analytical study, carried out with 3,624 medical records. For statistical analysis, the Chi-Square Test was used. Results: white individuals were more advanced in age. In the red and white categories, there was a higher percentage of men when compared to women (p=0.0018) and higher prevalence of personal history. Yellow priority patients had higher percentage of pain (p<0.0001). Those in red category had a higher frequency of altered vital signs, external causes, and death outcome. There was a higher percentage of exams performed and hospitalization in the orange category. Blue priority patients had a higher percentage of non-specific complaints and dismissal after risk stratification. Conclusions: a higher percentage of altered vital signs, number of tests performed, hospitalization and death were evidenced in Manchester protocol’s high priority categories.

APPENDECTOMY IN THE TIMES OF COVID-19: COMPARATIVE STUDY OF TWO GROUPS OF PATIENTS BETWEEN SIMILAR PERIODS OF TIME - 2019 VS 2020

Acute pathology of the cecal appendix - appendicitis, is a condition that does not take into account the pandemic period. The aim of this study is to retrospectively analyze the relationship of care for two groups of patients who underwent appendectomy in COVID-19 period and one year before, same period of time, in emergency hospital service. We performed a retrospective analysis on the patients admitted in our surgery center by comparing two groups for each period analysed: group A, for the period March-May 2019 and group B for the period March-May 2020 (corresponding to COVID-19 pandemic). We compared the groups analysing features that prove the change in age, incidence, grade (severity) of appendicitis, delay of surgery, length of surgery, postoperative complications and hospitalization time. CT scan was made for each patient. In the group B, PCR COVID-19 testing was made (all patients were negative for COVID-19). Our study consisted of 52 patients, group A-32 patients (61.53%) and group B-22 patients (38.47%). The Covid-19 pandemic influenced the incidence of appendicitis and we noted a delayed presentation which led to more complicated appendicitis than same period of the previous year. The impact also was noted on length of surgery, due to use of PPE (personal protective equipment) and also modified anatomy of the region related to inflammation. The severity of appendicitis was higher in the COVID-19 period when compared to 2019 similar period of time. Further research is required to draw more conclusions on this period.

Nurses' work process in an emergency hospital service

ABSTRACT Objectives: to analyze the nurses' work process in an Emergency Hospital Service. Methods: a qualitative, exploratory and descriptive research conducted with 17 nurses from the emergency service of a high complexity hospital in southern Brazil. Data were collected through interviews, focus group and document analysis. Data analysis followed the thematic content analysis framework. Results: four categories emerged: Work environment characteristics; Assistance dimension; Management dimension; Care management. Final Considerations: the nurses' work process in Emergency Hospital Service is characterized by the peculiarities of the setting, with centrality in care and care management aiming at quality care and safety to patients.

Embracement of the person with mental illness at an emergency hospital service: a qualitative research

ABSTRACT Objectives: to understand actions of nurses who care for people person with mental illness at a Referenced Emergency Unit in a university hospital. Methods: a qualitative research based on Alfred Schütz’s social phenomenology. Data collection was performed between December 2015 and January 2016 through phenomenological interviews with 13 nurses from an Emergency Unit. Results: nurses embrace according to their previous experiences. They easily identify biological complaints and, when they recognize psychiatric signs and symptoms, refer them to the psychiatrist. They raise doubts about what to do, so they expect to be qualified for such action, believing that a protocol could help as well as they need more time. Final considerations: the understanding of the lived type of nurse who embraces people with mental distress made possible in this study need recognition for research and interventions that focus on biological, psychic and social dimension articulation at embracement.

The accuracy of the Manchester Triage System in an emergency service

ABSTRACT Objective: To verify the accuracy of the Manchester Triage System (MTS) and the outcomes of adult patients in an emergency hospital service. Method: Cross-sectional study, conducted through an inspection of records of risk classification of adult patients treated in the emergency service of a hospital. Results: The patients (n = 400) were classified according to priority levels, in red (0.8%), orange (58.2%), and yellow (41.0%). The accuracy levels between auditors and nurses were substantial for the flowchart (K = 0.75), and moderate for discriminating factors (k = 0.46) and priority levels (k = 0.42). The accuracy of the MTS was 68.8% with regard to priority levels. Regarding outcomes, 60% of patients were discharged, 37% were transferred to other units, and 3% died. Conclusion: The MTS proved to be a good predictor of the assessed outcomes, showing that 65.9% of Low Urgency patients progress to discharges, and 3.8% of High Urgency patients progress to death. The accuracy of the MTS was moderate, which suggests the need to implement inspections in emergency services.

Functional independence of elderly patients who fell: a follow-up study

ABSTRACT Objective: to evaluate, in emergency hospital service and at home, the functional independence of elderly people who fell. Method: longitudinal study with 151 elderly. Functional Independence Measure (FIM) was used. Statistical tests were performed with univariate and bivariate analysis. Results: mean of total FIM value in the hospital was 70.4; and at home 84.3 (p <0.001). Independence was lower in the motor domain, in “self-care”, “mobility” and “locomotion” dimensions, in the two evaluations (p <0.001). Dependence reduced from 97.3% elderly in the hospital to 82.8% at home (p <0.001). There was a negative correlation between total FIM and age, number of medications, number of diseases and hospitalization time in both evaluations. Femoral and hip fractures were associated with lower total FIM values (p <0.001). Conclusion: the elderly had less independence in the hospital compared to at home, with greater impairment in the motor domain and “self-care”, “mobility” and “locomotion” dimensions, in the two moments evaluated.