The emergency department is assigned to treat patients with emergency conditions in different specialties. A large influx of patients, slow throughput and outflow creates long waiting times and Emergency department crowding can occur. Emergency department crowding can have consequences in several areas of the patient care. Patients risk getting worse care and longer time for pain relief. It creates long waiting times which in turn leads to dissatisfied patients and relatives. Emergency department crowding can also create reduced productivity and increased frustration among healthcare professionals. Nurses working on emergency reception during emergency department crowding is influenced in their professional practice.

The purpose of the study was to describe nurses' experiences of emergency department crowding. The method was a qualitative descriptive interview study with inductive approach. Semi-structured interviews were conducted with six nurses working on two different emergency departments. The interviews were transcribed verbatim and then analyzed on the basis of a qualitative content analysis. The result is presented in three categories: A crowded workplace, constant concern about patient safety, and strategies to managing the situation. The experiences of the nurses found that they felt that the environment of emergency response at congestion was adversely affected. They wanted more time to create a good meeting with the patient and experienced that nursing was difficult to cope with on these occasions. They argued that privacy could not sustain with emergency department crowding. The informants felt that there were risks in uj,jpatient safety and identified three areas as extra risky: patients with low priority and long waiting time, patients waiting for care in wards and the number of crew at emergency departments at nightshift. Professional practice was influenced by constant interruptions and they developed with experience own practices to make the work efficient. They were worried about missing the deterioration / serious condition in patients and felt a lack of powerlessness. Nurses stated that they found support in their team and that they could delegate tasks and felt confident that the team could most often handle the workload. In order to improve patient flow, they wanted closer cooperation with primary care, that the physicians had a closer foundation in the team and that there were more decision-making doctors on duty and wanted to be relieved from administrative tasks that they experienced took time from patient work. Thus, the study can show that crowding affects all nursing domains and although the nurses understood the patient's situation, they could not always meet, for example, the patients' right to privacy and integrity, which created conscience stress. Nurses developed strategies to facilitate work that created more stress over time, and even the experienced nurse experienced worries about missing impairment / serious conditions in patients. Failure to address the alleged deficiencies in patient safety and the conditions during emergency department crowding can create a sense of powerlessness. However, support from colleagues and the team gives the opportunity to experience the work as positive and feeling satisfied.

Keywords:

Crowding; Emergency department; Nurse; Patient safety

The ambition of palliative care is to relieve symptoms of uncurable diseases and to support the quality of life for both the patients and their families regarding physical, psychological, social and existential needs. Towards end of life patients with complex symptoms who can’t get enough relief of refractory symptoms but through sedation, can get treatment performed by the specialized palliative care. A controlled decrease of consciousness will eliminate the suffering and allow the patient to die peacefully and with dignity. The nurse has the responsibility of the practical assignments regarding the palliative sedation and the care until death occurs. 

The aim of this study was to describe the reflections and reasoning of the nurses concerning palliative sedation in the end of life.

The method in the study was semi-structured interviews in focusgroups. The inclusion criteria were registered nurses working in palliative ward care with personal experience of being involved in decision-making, preparing and administration of the treatment with the purpose palliative sedation. The present study is concerning continuous sedation. The analysis was conducted using a qualitative manifest content analysis.

The result consists of the five main categories the decision-making process, handling medications, the perspective of family and loved ones, the role of the nursing profession och education. The main findings were the nurses’ insecurity and lack of knowledge concerning the difference between the purpose of the treatment and the side-effects of a symptomreducing treatment. Clear guidelines, accurate documentation and explicit support from the team reduced the mental stress of palliative sedation among nurses at a great extent.

In conclusion, nurses have a need of education concerning palliative sedation, both internal in the workplace and external in a wider forum. One way to raise awareness and increase knowledge could be to arrange an event about palliative sedation with workshops in the south of Sweden. Another approach is getting the possibility of reflection in the team. The discussions with colleagues could increase security in nursing when responsible of palliative sedation. Reflecting is significant and facilitates the possibility to dare to pose questions and admit insecurity about palliative sedation.

Background

Globally pressures ulcers are commonly seen as hospital acquired injuries with negative consequences for the persons such as pain, suffering and also incurring high costs for society. Preventing the occurrence of pressure ulcers is an important part of nursing care and a professional responsibility for registered nurses. Person-centered care is one of the core competencies for registered nurses. Involving the person in their care and increasingthe person’s knowledge about preventive strategies, person-centered care is of great value in the prevention of pressure ulcer.

Aim

The aim of this study was to describe registered nurses’ experiences of preventing theoccurrence of pressure ulcers in persons receiving care in a hospital setting in Peru.

Method

A qualitative method was used with semi-structured interviews which were conducted at a hospital in Peru. Seven registered nurses participated in this study. The data was analyzed with a qualitative content analysis.

Findings

The findings of this study are presented under three categories formed during the data analysis: Incorporating pressure ulcer prevention into general nursing care, recognition of the need to develop knowledge about pressure ulcers and awareness of professional responsibilities in nursing care.

Conclusion

Providing nursing care, following closely hospital guidelines, provides a systematic way to prevent the occurrence of pressure ulcers in persons receiving hospital care. It is important that the nurse includes the person in the care process. The registered nurses underlined the importance of education in prevention strategies.

Demenssjukdomar är progressiva sjukdomar som inte går att bota. Det är vanligt förekommande att personer med demenssjukdom drabbas av beteendemässiga och psykiska symtom (BPSD). Omvårdnadsmål inom demensvården är att lindra symtom, öka välbefinnande och livskvalitet samt stärka hälsa utifrån ett holistiskt synsätt. Musiken har tidigare visat positiv inverkan på livskvalitet och välbefinnande inom hälso- och sjukvård. Vid demenssjukdom kan symtom av sjukdomen vara ett hinder för livskvalitet och välbefinnande.