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Lampi, Maria. "TRIAGE : Management of the trauma patient." Doctoral thesis, Linköpings universitet, Avdelningen för kliniska vetenskaper, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-134595.
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Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient’s clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems. The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya. The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training.
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Ho, Chuen-tak Douglas. "Trauma Centre Prototype." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25947813.
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MacFie, Christine. "Work related trauma, culture and the police : towards an effective trauma management scheme." Thesis, University of Sussex, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270737.
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This action research based thesis focuses on work-related psychological trauma and its management, within the context of the British police service. A case study on one force facilitates detailed exploration of ways in which police occupational culture may impede the provision and acceptance of trauma management schemes. A national questionnaire-based survey of United Kingdom police forces establishes the scope and nature of their trauma management provisions and identifies strengths and weaknesses. Few trauma research studies have concentrated upon the affective domain of the British police service and there is limited understanding of how personal emotions are managed in the police organisation, or how its culture can affect the individual's experience of work-related trauma in an unhelpful way. The study aims to increase knowledge and understanding in this area and to assist British police forces in their attempts to reduce police sickness absences and ill health retirements, which may result from exposure to workrelated trauma. Two main study concerns are addressed by different means. The thesis is arranged as an introduction that includes discussion of the methodological approach adopted, seven chapters, conclusions and recommendations. Chapter one sets the scene by scrutinising the police service as a modern work organisation. Having clarified the basic principles of British policing, it outlines how the service has developed, exploring the difficulties and tensions police officers at all levels experience in trying to fulfil their current roles and responsibilities. Chapter two looks at the nature and potential effects of 'critical' incidents and traces the history of trauma recognition and critical incident debriefing, discussing the current debate on the efficacy of the latter and its value for police personnel. Chapter three examines current national and local police trauma management provisions and chapter four focuses on the identification and management of key risks posed to the police organisation, arising from work-related trauma. Chapter five explores police officers' experiences of trauma through descriptions of three 'service' roles and critical incident scenarios and by focusing on how certain aspects of police culture may intensify and prolong their initial distress. Chapter six shows the ways in which the police organisation seeks to manage its members' emotions through its selection, training and socialisation processes and how its success in doing so can impede the delivery and takeup of trauma management services. Chapter seven then outlines the main theoretical concepts underpinning the thesis, explaining why the police organisation requires officers to manage their emotions in particular ways and outlining mechanisms it has adopted as corporate defences against anxiety. A summary of conclusions follows and the thesis ends with recommendations to effect improvements to the quality and consistency of services being offered.
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Nicol, Andrew John. "The current management of penetrating cardiac trauma." Doctoral thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/11633.
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Includes bibliographical references.The vast majority of patients with penetrating cardiac injuries do not reach the hospital alive as the pre-hospital mortality rate for these injuries is in the region of 86%. The patients that do reach the hospital alive are potential survivors and it is obviously crucial that any cardiac injury is detected and managed appropriately. Most of these injuries present with either cardiac tamponade or hypovolaemic shock and are relatively straightforward to diagnose and require immediate surgery. There is, however, a group of patients that are relatively stable with an underlying cardiac injury and it is in these patients that a potential or occult cardiac injury needs to be identified.
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Curtis, Kathleen Anne Public Health & Community Medicine Faculty of Medicine UNSW. "Trauma nursing case management: impact on patient outcomes." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/33367.
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Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p<0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p<0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.
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何存德 and Chuen-tak Douglas Ho. "Trauma Centre Prototype." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31984575.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1959.
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Fagelson, Marc A. "Implementing Psychological Methods in the Management of Trauma-Associated Tinnitus." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1663.
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Dr. Fagelson, (Professor Audiology, ETSU) will discuss the unusual challenges facing patients and providers when tinnitus severity is linked to traumatic exposure. Interactions between neural mechanisms associated with tinnitus, posttraumatic stress-disorder (PTSD), and traumatic memory will be reviewed with particular attention to the way and degree to which such interactions affect tinnitus and disorders of sound tolerance. Conference attendees will be provided theoretical models of emotional memory consolidation that underscore trauma‘s durable effects on a patient‘s emotional state, reaction to the tinnitus signal, and to potentially-triggering environmental sounds. The putative benefits of tinnitus counseling will be presented in the context of trauma interventions that employ well-established counseling techniques as an element of patient-centered care. Audiologists must provide trauma patients a safe environment and opportunity for dialogue that contributes to a holistic understanding of the patient‘s situation and perceptions; the ultimate goal is to employ interventions and self-assessment instruments that can be used to evaluate patient needs and progress when tinnitus is related to trauma. The potentially-exacerbating effects of comprehensive audiologic assessment will also be addressed.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1659.
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Thomson, David Alexander. "The role of endoscopic retrograde pancreatography in the management of pancreatic trauma." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/14312.
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Background: Endoscopic retrograde pancreatography (ERP) has various applications in the diagnosis and management of pancreatic trauma. The utility of ERP in pancreatic trauma presenting to a level 1 equivalent trauma centre was analysed. Methods: Patients who sustained pancreatic trauma and underwent ERP were identified. Patient demographics, mechanism of injury, time to presentation, diagnostic modalities, associated injuries, clinical management, endoscopic interventions and their timing, surgical treatment and patient outcomes were recorded. Results: Forty-eight patients with pancreatic trauma were referred for ERP after blunt (26), gunshot (15), or stab (7) injury. The average time from injury to ERP was 38 days (range 2 – 365). An ERP visualized the duct in 47 patients. Twenty-four patients had a pancreatic fistula, 12 patients had a main pancreatic duct stricture or cut-off and 10 patients had a pseudocyst. Endoscopic interventions were pancreatic duct sphincterotomy (15), pancreatic duct stent (7) or pseudocyst drainage (6). Ten patients demonstrated minor injuries and no interventions were performed. One patient had a normal pancreatogram. Ten patients required pancreatic surgery following ERP (distal pancreatectomy n=6, pancreaticojejenostomy n=3 and cystjejenostomy n=1). One patient unable to tolerate ERP had a distal pancreatectomy. Conclusion: The majority of ERPs were performed post surgery or after a delayed presentation. Diagnostic success was high and in conjunction with therapeutic interventions 77% of patients avoided surgery for their pancreatic complications. ERP is an effective tool in the delayed management of the local complications of pancreatic trauma.
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Longo, Nadia. "Evaluation of geriatric trauma care in Quebec." Thesis, McGill University, 2004. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=81361.
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The purpose of this prospective cohort study was to describe the profile and outcomes of geriatric trauma care patients treated in level I trauma centers in Quebec. The study also evaluated the quality of care provided to geriatric trauma patients and identified predictors of outcomes which focused on mortality.A total of 4934 trauma patients over the age of 65 were admitted for the treatment of injuries in three level I trauma centers in Quebec. The majority of the patients were injured in falls and had a low injury severity score. Male gender, older age, thoracic and abdominal injuries, burns, and delayed emergency room stays were identified as significant predictors of mortality. Inferior quality of care was observed with increased age and fall-related injuries.
The observed association between longer emergency room stay and falls with increased risk of mortality along with inferior care for patients injured in falls would suggest that level I trauma centers are inefficient and potentially harmful in treating elderly trauma patients. Further studies would be helpful in confirming these conclusions.
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Watson, L. B. "The effect of a Trauma Risk Management (TRiM) programme on stigma and attitudes to stress and trauma in the police service." Thesis, University of Essex, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.605583.
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Police personnel exposed to potentially traumatic events as part of their operational duty may develop psychological problems. A number of UK Police Forces have made use of Trauma Risk Management (TRiM), developed by the Royal Navy, to address this issue. TRiM is a peer-support process that aims to support employees following trauma, reduce stigma and encourage help-seeking behaviour. Research within military populations has provided preliminary support for the beneficial effects, and importantly no detrimental effects of using TRiM. However, to date there has been little research into the use of TRiM with police populations. Five Police Forces took part in the online questionnaire study; three of these utilised the TRiM programme and comprised the TRiM group (n=693); two of these utilised Occupational Health support following trauma exposure and comprised the non-TRiM group (n=166). The questionnaire included measures of Post-traumatic Stress Disorder (PTSD) symptomatology, depression, attitudes to stress and PTSD, barriers to help-seeking, self-stigma and public-stigma, and post-traumatic psychological change. The results showed that the TRiM group reported lower levels of psychological distress than the non-TRiM group. Those in the TRiM group demonstrated less stigmatised views towards experiencing mental health difficulties, perceived fewer barriers to help-seeking, and reported greater positive psychological change following adversity, than the non-TRiM group. However, there were no significant differences between the two groups' attitudes towards PTSD and stress. Whilst TRiM appears a promising programme for encouraging help-seeking the results show that there is still some way to go to alter the stigmatising attitudes towards experiencing emotional difficulties in the Police.
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Thayer, Jenny P. "Evaluation of the Inland Counties trauma patient data collection, management, and analysis." CSUSB ScholarWorks, 1986. https://scholarworks.lib.csusb.edu/etd-project/378.
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Engelmann, Esmee Wilhelmina Maria. "Perspectives on the management of humerus fractures due to gunshot trauma: an inter- and intra-observer agreement and reliability study." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/24989.
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Background: Upper extremity fractures due to gunshot trauma are frequently treated at the level I trauma unit of Groote Schuur Hospital. There is no gold standard for the classification and management of such complex upper extremity fractures available to date and only few retrospective case studies on gunshots of the humerus were available. Interobserver agreement studies reported low levels of intra- and inter-rater reliability (IRR) for the classification of proximal humerus fractures using Neer and AO/OTA classification. The complexity of the fractures, the inconsistency of classification systems outcomes and the wide variety of treatment modalities demand evidence-based medicine. Aim: The primary aim was to assess the inter- and intraobserver agreement between surgeons in the classification and treatment of humerus fractures caused by gunshot trauma in a gunshot violence endemic area. The secondary aims were to analyse interobserver agreement with respect to debridement, removal of the bullet, the use of external fixators in patients with gunshot humerus fractures and to evaluate the effect of clinical scenarios surrounding surgical decision-making. Methods: This is an agreement study performed with a fixed panel of 32 observers who answered a set of 14 questions regarding classification and treatment by rating multiple X-ray views of a fixed set of 22 cases. The panel included junior registrars, senior registrars, orthopaedic trauma specialist and upper extremity specialists. Cases were extracted from the electronic Trauma Health Record between June 2014 and July 2016. Observers reviewed 16 midshaft and 6 proximal humerus fractures cases at 2 sessions with a 2-week interval. Descriptive statistics, Cohen's and Fleiss Kappa and rate of agreement were used to analyse data. Kappa was interpreted according to Landis and Koch guidelines. Results: There was slight yet significant overall interobserver agreement on the AO classification (k=0.20); the highest interobserver agreement ('fair') was achieved by the upper extremity specialists and senior registrars (k=0.28, 0.27). Overall interobserver reliability of agreement on preferred treatment was similar to classification agreement (k=0.18). Only trauma specialists achieved fair agreement with a significant difference compared to senior registrars and upper extremity specialists (k=0.26, 95%CI 0.21-0.32). Overall intraobserver reliability was fair for classification and moderate for treatment (k=0.39, 0.42). There was fair overall agreement on debridement of the wound (k=0.26) and removal of the bullet (k=0.31) and close to poor agreement for the use of temporary external fixators (k=0.03). Vascular injury was rated as influential factor on decision-making by the majority of observers (53.7%), followed by bilateral (37.1%) and other fractures (26.8%). Conclusions: This is the first intra- and interobserver agreement study that evaluated classification and treatment of gunshot humerus fractures in the light of a broader spectrum of patient- and fracture-related factors. Consistent with previous studies, there was low interobserver agreement for the classification and treatment of proximal humerus fractures, thereby contributing to the field of knowledge with specific evidence regarding gunshot trauma. Future research should further assess predictive factors in surgical decision-making and analyse global preferences in order to develop evidence-based classification and treatment guidelines for the management of patients with humerus fractures.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1956.
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Trauma-provoked tinnitus challenges patients and clinicians. Effects of trauma may exacerbate tinnitus, and patients with both tinnitus and posttraumatic stress disorder rate distress levels as higher than patients who experience only one or the other. This presentation will highlight links between tinnitus and trauma histories relevant to clinical audiologists.
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Raatiniemi, L. (Lasse). "Major trauma in Northern Finland." Doctoral thesis, Oulun yliopisto, 2016. http://urn.fi/urn:isbn:9789526213330.
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Abstract Trauma patients are a significant patient group for emergency medical services (EMS). Not only are injuries a significant cause of death, they also have a significant long-term impact on functionality and quality of life. Previous studies have shown that the injury-related mortality rate is higher in sparsely populated areas and that the majority of patients die before the arrival of EMS. Intensive care mortality is significant, and half of seriously injured patients develop multiple organ dysfunction. Airway management is one of the most important procedures that EMS provide for a critically injured patient, but making high-quality care available in a sparsely populated area is challenging. Seriously injured patients also appear to benefit from being transported directly to a trauma centre. In recent years particular attention has been given to the level and availability of EMS. Hospitals’ readiness to provide acute surgery is also being reorganised. More information is needed about the frequency, circumstances, outcome and acute care of serious and fatal injuries so that health care resources can be allotted appropriately and requirements for prevention can be identified. The purpose of this research was to investigate the frequency and circumstances of injury-related deaths in Northern Finland and the prognosis of trauma patients encountered by the Finnish helicopter emergency services (FinnHEMS). A particular objective was to examine differences between rural and urban areas. The National Advisory Committee for Aeronautics (NACA) severity score’s ability to predict 30-day mortality was also examined. The fourth part of the study aimed to investigate the pre-hospital airway management performed by non-physicians in Northern Finland. The study material was comprised of trauma deaths that occurred in Northern Finland in 2007–2011, trauma patients encountered by FinnHEMS units in Northern Finland in 2012–2013, patients encountered by HEMS in Northern Norway in 1999–2009 and a questionnaire regarding pre-hospital airway management to non-physicians. The study concluded that the rate of trauma deaths is high in Northern Finland, and the influence of alcohol was found in nearly half of pre-hospital trauma death cases. A larger portion of pre-hospital deaths also took place in rural areas. Trauma patients encountered by FinnHEMS units in urban areas who survived to hospital, appeared to have higher 30-day mortality than patients injured in rural areas. The most probable explanation for this difference is that patients injured in urban areas survive to hospital, while trauma patients in rural areas die pre-hospital. The NACA score was found to reliably predict 30-day mortality. Due to its simplicity, the NACA score can be used to compare patient material from different HEMS bases. It was found that non-physicians seldom performed airway management. On average, the frequency of performing airway management was low, and there is a need to improve maintenance of skillsTiivistelmä Vammapotilaat ovat merkittävä ensi- ja tehohoidon potilasryhmä. Paisi, että vammautumiset ovat merkittävä kuolinsyy, aiheuttavat ne myös merkittäviä pitkäaikaisvaikutuksia toimintakykyyn ja elämänlaatuun. Aikaisemmissa tutkimuksissa on osoitettu, että vammakuolleisuus on yleisempää harvaanasutuilla seuduilla ja valtaosa potilaista kuolee jo ennen ensihoidon saapumista paikalle. Tehohoitokuolleisuus on merkittävää ja puolet vaikeasti loukkaantuneista potilaista kärsii monielinvauriosta. Ensihoidon tärkeimpiä tehtäviä kriittisesti vammautuneilla on hengitystien varmistaminen, mutta korkeatasoisen hoidon saatavuus harvaanasutulla seudulla on haasteellista. Vaikeasti vammautuneet potilaat näyttävät myös hyötyvän kuljetuksesta suoraan lopulliseen hoitopaikkaan. Viime vuosina ensihoidon tasoon ja saatavuuteen on kiinnitetty erityistä huomiota. Lisäksi sairaaloiden päivystysvalmiuden uudelleenorganisointi on käynnissä. Lisätietoa tarvitaan vakavien ja kuolemaan johtavien vammojen esiintyvyydestä ja olosuhteista, ennusteesta sekä akuuttihoidon toteutumisesta, jotta terveydenhuollon resursseja voitaisiin kohdentaa tarkoituksenmukaisesti ja ennaltaehkäisyn tarpeet voitaisiin tunnistaa. Tämän tutkimuksen tarkoituksena oli selvittää vammakuolemien esiintyvyyttä ja olosuhteita Pohjois-Suomessa sekä suomalaisten lääkintä- ja lääkärihelikopteriyksikköjen (FinnHEMS) kohtaamien vammapotilaiden ennustetta. Erityisenä tavoitteena oli tutkia maaseutu- ja kaupunkialueiden eroja. Lisäksi tutkittiin National Advisory Committee for Aeronautics (NACA)- vaikeusasteluokittelun kykyä ennustaa 30 päivän kuolleisuutta. Neljännen osatyön tavoitteena oli tutkia ensihoitajien suorittaman hengitystien varmistamisen käytäntöä Pohjois-Suomessa. Tutkimusaineisto koostui vuosina 2007‒2011 Pohjois-Suomessa tapahtuneista vammakuolemista, FinnHEMS:in yksiköiden kohtaamista vammapotilaista Pohjois-Suomessa vuosina 2012‒2013, Pohjois-Norjan pelastushelikopterin kohtaamista potilaista vuosina 1999‒2009 sekä ensihoitajille tehdystä kyselytutkimuksesta hengitystien hallintaan liittyen. Tutkimuksessa todettiin, että kuolemaan johtaneiden vammojen esiintyvyys on korkea Pohjois-Suomessa. Lisäksi havaittiin, että lähes puoleen sairaalan ulkopuolella tapahtuneisiin vammapotilaiden kuolintapauksiin liittyi alkoholi. Maaseudulla myös suurempi osa menehtyi sairaalan ulkopuolella. FinnHEMS:in yksiköiden kaupunkialueella kohtaamilla vammapotilailla, jotka selvisivät sairaalaan, havaittiin viitettä korkeampaan 30 päivän kuolleisuuteen verrattuna maaseudulla vammautuneihin. Ero johtuu todennäköisemmin siitä, että kaupunkialueella vammautuneet ehtivät sairaalaan kun taas maaseudulla vammapotilaat kuolevat jo ennen ensihoitopalvelun saapumista. NACA-vaikeusasteluokittelun todettiin ennustavan luotettavasti 30 päivän kuolleisuutta. Yksinkertaisuutensa vuoksi se soveltuu potilasmateriaalin vertailemiseen eri tukikohtien välillä. Ensihoitajan suorittama hengitystien varmistaminen havaittiin olevan harvinaista. Keskimääräisesti suoritteita tapahtui harvoin, ja taitojen ylläpitämisessä oli parantamisen varaa
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Chipman, Katie Jane. "Terror Management Theory and the Theory of Shattered Assumptions in the Context of Trauma." Kent State University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=kent1308328435.
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Hickman, DaShawn Antwane. "Platelet-inspired Nanomedicine for the Hemostatic Management of Bleeding Complications in Thrombocytopenia and Trauma." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1537017099431262.
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McEntire, Lili. "Reducing the Trauma: Alternative Dispute Resolution in Disaster Relief Efforts." Thesis, University of Oregon, 2016. http://hdl.handle.net/1794/20530.
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Title: Reducing the Trauma: Alternative Dispute Resolution in Disaster Relief Efforts
Despite careful planning and preparation, natural disasters leave behind destruction and trauma in their wake. The Federal Government established the National Response Framework as a resource to help communities prepare for, recover from, and respond to these situations. Conflicts arise as a direct result of disasters as well as an indirect consequence. Using Galveston, TX as a case study because of its repeated experience with recovery from hurricanes, qualitative interviews were conducted to explore what is being done to help with conflicts that cause additional trauma. Alternative dispute resolution skills such as conflict styles, active listening, and reframing and summarizing are explored as a means of reducing the traumas amplified by conflicts that are revealed during a disaster.
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Fagelson, Marc A. "Audiologic Counseling for Tinnitus Patients with Trauma Exposures." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/1667.
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Fagelson, Marc A. "Tinnitus and Trauma: Challenges for Patients and Providers." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/1954.
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Fagelson, Marc A. "Therapeutic Approaches for Individuals with Trauma-Provoked Tinnitus." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/1688.
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Battle, Ceri Elisabeth. "The development and validation of a prognostic model that assists in the management of blunt chest wall trauma patients." Thesis, Swansea University, 2013. https://cronfa.swan.ac.uk/Record/cronfa43035.
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Introduction: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. The first aim of this study was to investigate the risk factors for the development of complications following blunt chest wall trauma. Using these risk factors, the second aim was to develop and validate a prognostic model that can be used to assist in the management of this patient group. Methods: The risk factors for the development of late complications following blunt chest wall trauma were investigated using a number of methodologies. These included a systematic review and meta-analysis, a questionnaire study and a retrospective observational study. Following identification of the risk factors, a prognostic model was developed using multivariable logistic regression. This model was then externally validated in a prospective multi-centre study. Results: The systematic review, questionnaire study, retrospective study and development study results highlighted that the risk factors for the development of complications following blunt chest wall trauma were an increasing patient age, the existence of chronic lung disease, an increasing number of rib fractures, the use of pre-injury anti-coagulants and a decreasing oxygen saturation level on presentation to the Emergency Department. These risk factors were included in the final model. Results of the validation study indicated an overall model accuracy of 87%, a sensitivity of 75% and a specificity of 97%. A concordance index of 0.96 highlighted an excellent discriminatory ability of the model. Conclusions: The prognostic model developed in this study demonstrated good predictive capabilities in the derivation sample and excellent discrimination in the validation sample. The model demonstrates clinical usefulness as it includes risk factors not normally considered in the management of blunt chest wall trauma patients in the clinical setting.
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Schafer, Miranda. "Management of high-grade blunt hepatic trauma : clinical complications and the role of concomitant injuries /." Bern : [s.n.], 2009. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Jones, Sherry Lynn. "Nurses' Occupational Trauma Exposure, Resilience, and Coping Education." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2360.
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Nursing education courses and professional development (PD) do not include coping and resilience training for registered nurses (RNs) who work in emergency departments (EDs). Exposure to traumatic events, death, and dying may lead to health issues, substance abuse, stress symptoms, nursing staff turnover, and compassion fatigue among ED RNs. Without training, the pattern of adverse outcomes may continue. The purpose of this study was to explore ED RNs' experiences with occupational traumatic stress (OTS), and their recommendations for change to nursing PD programs, using a qualitative bounded intrinsic case study. The conceptual framework for this study included social learning and experiential learning theories. Data were collected through semi-structured interviews with 7 licensed and employed ED RNs with more than 1 year in EDs and who volunteered to participate in the study. Data were examined analytically using descriptive, emotion, and patterns coding strategies and In Vivo to identify categories and themes. Based on nurses' experiences, ED RNs require a collaborative team training approach in learning and sharing opportunities regarding preparatory, de-escalation, and self-care strategies to overcome OTS. Based on the findings, a 3-day interactive PD workshop program was created for ED nurses to address those needs. These endeavors may contribute to positive social change by increasing wellness, cohesive ED teamwork, healthy stress management practices, better patient care, and reduced turnover for ED RNs. Furthermore, nurse educators may benefit from adding coping and resilience training to the nursing education curriculum to address and possibly mitigate the effects of OTS.
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Carpenter, Tyler, and Kate Beatty. "Demographic Fall Predictors in a Rural Level One Trauma Center." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6865.
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Falls are the number one mechanism of injury for The Trauma Center and Johnson City Medical Center (JCMC TC). JCMC TC is one of two level one trauma centers in the region and one of only six in the state. The main method for trauma prevention is outcome specific education and awareness. Injury prevention education is a critically needed area in the field of trauma and emergency care. Falls are the number one cause of injury in populations age >65. Socioeconomic status, age, gender, and race are all mitigating factors in the likelihood of greater length of stays, death in hospital, and death within one year of discharge for those who fall in a home setting. According to the CDC, people over the age of 75 are four to five times more likely than people under 75 to be admitted to a long-term care facility for more than a year. What is the relationship between patient characteristics and fall related outcomes in a level one trauma center? We looked at associations between patient demographics and associated outcomes for those admitted to the trauma center secondary to a ground level fall (GLF) in the home. Dataset: De-identified National Trauma Databank information was compiled by the JCMC Registrar for the past 8 years for the metrics: Injury Severity Score (ISS), length of stay, 48hr readmission, and disposition (home, nursing home, skilled nursing facility (SNF)).Demographic information, along with mechanism of fall, was collected for each patient. Patient age, gender, and date of injury was all used for statistical analysis and trend recognition. Statistical Analysis: Bivariate analyses included independent samples t-tests and Oneway ANOVA to find differences between groups. Results: T-test results show women are significantly more likely than men to be admit for a ground level fall (p<.001) and those with a higher ISS are more likely to have an extended stay in an inpatient setting (p<.001). One-Way ANOVA analysis of collected data shows an annual increase from 2006-2013 of trauma admissions for ground level falls (p<.01). Eight year analysis showed a two-fold increase in these admissions. Over 30% of patients admitted with a GLF are discharged to a SNF leading to higher societal costs due to Medicare reimbursement rates. Diagnosis related groups codes (DRG) dictate Medicare reimbursement rate of $14,091 per patient with an average facility cost of $14,196 per patient with no readmissions (Unplanned readmission within 180 days occurred at a rate of 8.3%). Conclusion: Fall education programs are necessary and needed in rural level one trauma centers to educate citizens on causes and methods of preventing falls in their homes. A decrease in these falls would lead to an increase in productive years of life and a reduction in strain on the hospital system.
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Wentworth, Ayesha. "Resilience in families that have experienced heart-related trauma." Thesis, Link to the online version, 2005. http://hdl.handle.net/10019/1305.
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Enochs, Shannon. "Bridging the Gap between Emotional Trauma Practice Guidelines and Care Delivery in the Primary Care Setting." Thesis, Brandman University, 2019. http://pqdtopen.proquest.com/#viewpdf?dispub=13428017.
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When patients present with complaints of anxiety or depression, providers in the primary care setting often prescribe anxiolytics or antidepressants without conducting an early emotional trauma or adverse childhood experiences assessment. Several studies demonstrate the link between early emotional trauma (EET) or adverse childhood experiences (ACEs) and the increased risk of anxiety or depression as adults. This Clinical Scholarly Project (CSP) implemented the use of the Adverse Childhood Experience (ACE) Questionnaire with patients who had a diagnosis of anxiety or depression in the primary care setting to increase patient access to resources and align clinical practice with practice guidelines. Participants included eight primary care providers, 30 patients and 21 chart review patients. The CSP utilized a quasi-experimental design to determine if the use of the ACE Questionnaire by patients with anxiety or depression would result in patients receiving more community resources (to include counseling), strengthen the provider-patient relationship, increase provider comfort in discussing ACEs with their patients and result in patients receiving care that was evidence based. Patient sample participants received significantly more resources (M = 8.27, SD = 2.27) than the chart audit sample (M = 0.90, SD = 0.30). Patient sample members received an average of eight resources (M = 8.27) and utilized an average of five resources (M = 5.07). Use of the ACE Questionnaire resulted in more trust in provider-patient relationship by patients (80.0%) and the majority of the provider sample more comfortable discussing ACEs after the project (85.7%).
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White, Juanita Lynne. "Shared Trauma: A Phenomenological Investigation of African American Teachers." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/1218.
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In the wake of increasing community disasters such as hurricanes, neighborhood violence, and terrorist attacks, schools are usually deemed places where youth can find safety and stability. Research about community trauma related to the role of teachers and schools has predominantly focused on younger populations, concerned about disturbances in their developmental processes. School teachers' responsibilities related to these community disasters have also increased and now include supporting their traumatized students. However, there has been limited attention on the direct effect of community traumas on the teachers who work and live in affected districts. The construct of shared trauma describes this duality of roles. For African American teachers, racial trauma plays a role in their everyday lives and might affect their behaviors and responses to tragic events. Critical race theory and Vygotsky's sociocultural theory formed the framework for this phenomenological study, which explored the experiences of 6 female African American teachers who had experienced community disasters. Data were collected through face-to-face interviews, which were transcribed and analyzed using an enhanced version of the Colaizzi 7-step analysis method. Key findings were that race played only a limited role for the teachers when significant traumas occurred in their communities. Also, the experiences they described were indicative of vicarious trauma, which is inconsistent with the construct of shared trauma. This study contributes to social change by informing educational, political, and social institutions about the needs of teachers in the wake of community disasters and how those needs could be conceptualized as vicarious trauma for purposes of planning preventive and concurrent interventions for teachers.
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Clements, Andrea D., Becky Haas, Randi G. Bastian, and Natalie Cyphers. "Addressing Intimate Partner Violence: Development of a Trauma Informed Workforce." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7230.
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Moloko, Salaminah S. "Nursing outcome standards for polytrauma patients with traumatic brain injuries in the Mafikeng district." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52372.
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Thesis (MCUR)--University of stellenbosch, 2001.ENGLISH ABSTRACT: In trauma the priority is given to identifying the life-threatening injuries and immediately implementing treatment (Demetriades, 1993:3). Severe trauma resuscitation and assessment often have to be carried out simultaneously to detect and treat conditions that are rapidly fatal if not attended to immediately and according to priority. Urgent priorities in trauma management include maintaining a clear and patent airway to facilitate respiration and cervical spine protection by avoiding rough manipulation of the head and neck by supporting the neck with a neck immobiliser. Any external bleeding has to be controlled by applying direct pressure to the wound. Cardiovascular problems, for example shock or myocardial infarction, respiratory problems and hypoxia which are detrimental, particularly in the case of head injury, should be excluded. A detailed head-to-toe examination which includes the head, neck, chest, abdomen, back, musculo-skeletal system, rectum and vagina has to be performed. For the head-injured patient, correct any condition, which may complicate the existing head injury, for example hypoxia, shock, pneumothorax and fractures of long bones or pelvis. Implement the A (airway), B (breathing), C (circulation), D (disability, neurological and drugs) and E (environment) for structured management of the patient. Muller's, (1996) two-phase model was utilised to formulate and validate nursing outcome standards. In phase one literature was explored to develop provisional standards on polytrauma patients with traumatic brain injuries. In phase two the provisional standards were validated by experts (doctors and nurses) in critical care, trauma and emergency nursing including nurses and a doctor working in the casualty department of a provincial hospital in Mafikeng. Final standards were formulated and adapted accordingly. Standards for the management of a polytrauma patient with traumatic brain injuries included: A safe environment for patients, nurses and doctors Primary survey in casualty department which includes the maintenance of airway, breathing, circulation, disability/ neurological, drugs and exposure The secondary survey that includes the head to toe examination, definitive orthopaedic care and stabilisation before transfer to the intensive care unit A standard on all relevant equipment which might be needed in case the patient goes into cardiac arrest on the way to the intensive care unit, was also formulated. The standard on documentation included the primary and secondary survey in the casualty department, transport to the intensive care unit, activities and the condition of the patient. The final standards dealt with the accurate handing over of the patient to the intensive care personnel. The following recommendations were made: • Implement the outcome standard by means of a quality improvement programme through a top-down approach. • Provide training: Nurses and doctors have an obligation to render quality care, therefore they have the right to be trained in emergency procedures. • All registered nurses working in the casualty or emergency departmentsshould be trained in at least Basic Life Support (CPR), Advanced Cardiac Life Support (ACLS), Advanced Paediatric Life Support (APLS) and Advanced Trauma Life Support (ATLS) while waiting to be sent for the trauma-nursing course. • Improve infection control measures in the casualty department • Emergency drugs must always be available. • Improve the on-call system. • Formulate a policy on sharing of the equipment by both casualty and ICU staff. • Motivate for the necessary equipment. Implement procedures for debriefing of staff, the evaluation of actions during resuscitation and implement measures for psychological support of the family. • For further research, implement and test a training programme whereby nurses can formulate their own standards. • Evaluate whether the standards have improved the quality of trauma care, and develop standards for leu nursing of the brain injured patient and the rehabilitation of polytrauma patients with traumatic brain injuries The uniqueness of the study lies in the fact that no formal outcomes standard for trauma patients with traumatic brain injuries have been developed in any of the North West Provincial hospitals.
AFRIKAANSE OPSOMMING: Die identifisering van lewensbedreigende beserings en die onmiddellike implementering van behandeling, is in trauma 'n eerste prioriteit (Demetriades, 1993: 3). Resussitasie en die beraming van erge traumagevalle noodsaak in baie gevalle, gelyktydige hantering. Sou hierdie hantering nie gelyktydig en onmiddellik volgens prioriteit plaasvind nie, kan dit noodlottige gevolge inhou. Belangrike prioriteite in traumabehandeling sluit in, die instandhouding van 'n patente lugweg om asemhaling te onderhou asook die beskerming van die servikale rugmurgkolom, deur die ruwe manipulasie van die kop en nek te vermy deur die implementering van 'n nekimmobiliseerder. Kardiovaskulere probleme, byvoorbeeld skok of miokardiale infarksie, asook respiratoriese probleme wat lewensbedreigend vir die pasient met 'n hoofbeseering is, moet uitgesluit word. 'n Gedetailleerde van kop-tot-tone ondersoek, wat die kop, nek, borskas, abdomen, rug, muskulo-sketale stelsel, rektum en vagina insluit, moet uitgevoer word. In die pasient met hoofbeserings moet enige toestand byvoorbeeld frakture van die langbene of die pelvis, skok of 'n pneumothorax, eers behandel word. Implementeer die A (Iugweg - "airway"), B (asemhaling - "breathing"), C (sirkulasie -"circulation"), D (gestremdheid - "disability", neurologies- "neurological" en drogerye-"drugs") en E (omgewing - "environment") vir die gestruktureerde behandeling van die pasient. Die twee fase model van Muller (1996) is gebruik vir die formulering en validering van die verpleeguitkomsstandaarde. In fase een is die literatuur verken om die voorlopige standaarde vir polytrauma pasiente met traumatiese breinbeserings te ontwikkel. In fase twee is die voorlopige standaarde gevalideer deur kundiges (dokters en verpleegkundiges) in kritieke sorg, trauma en noodverpleging. Die verpleegkundiges en dokter wat werksaam is in die ongevalle-eenheid van 'n plaaslike provinsiale hospitaal in Mafikeng is ook ingesluit. Finale standaarde is geformuleer en dienooreenkomstig aanvaar. Die standaarde vir die politrauma pasient met traumatiese breinbeserings, sluit in: 'n Veilige omgewing vir pasiente, verpleegkundiges en dokters. Die prirnere beraming in ongevalle ten opsigte van instandhouding van die lugweg, asemhaling, sirkulasie, gestremdheid, drogerye en blootstelling. Die sekondere beraming: wat behels die kop-tot-tone ondersoek. Definitiewe ortopediese behandeling en stabilisering voor oorplasing na die intensiewe-sorg-eenheid. 'n Standaard met betrekking tot die nodige toerusting wat benodig mag word tydens 'n hart stilstand, oppad na die intensiewe-sorg-eenheid, is ook geformuleer. Die standaard ten opsigte van dokumentasie sluit die primere, en sekondere beraming, vervoer na die intensiewe-sorg-eenheid, aktiwiteite en toestand van die pasient, in. Die finale standaarde is gebaseer op die oorhandiging van die pasient aan die intensiewe-sorg-personeel. Die volgende aanbevelings word gemaak: • Implementeer die uitkomsstandaarde deur middel van 'n gehalteverbeteringsprogram deur gebruik te maak van 'n "top-down" benadering -, • Voorsien opleiding: Verpleegkundiges en dokters het 'n verpligting om gehaltesorg te lewer, hulle het dus 'n reg om onderrig te ontvang in noodprosedures, en verder het die pasient die req op gehalter noodbehandeling. • Aile geregistreerde verpleegkundiges wat in die ongevalle en die noodafdeling werk, behoort opgelei word in ten minste basiese lewensondersteuning (CPR), Gevorderde Trauma Lewens Ondersteuning (ACLS), Gevorderde Pediatriese lewensondersteuning (APLS) en Gevorderde Trauma lewensondersteuning (ATLS), terwyl gewag word om die trauma verpleegkundigekursus te deurloop. • Verbeter mteksiebeheermaatreels in ongevalle. • Noodmedikasie moet ten aile tye beskikbaar wees. • Verbeter die op-roepstelsel ("on cali"). • Formuleer 'n beleid oor die gesamentlike gebruik van toerusting deur beide ongevalle- en intensiewe-sorg-eenheid-personeel. • Motiveer vir die nodige toerusting. • Implementeer prosedures om personeel to te laat vir ontlonting (debriefing), die evaluering van aksies tydens die resusitasie prosedure en implementeer metodes vir die sielkundige ondersteuning van die familie. • Ten opsigte van verdere narvorsing behoort 'n opleidingsprogram qeunplernenteer en getoets te word met betrekking tot verpleegkundiges wat hulle eie standaarde will formuleer. • Evalueer of die standaarde die gehalte van traumasorg verbeter het en ontwikkel standaarde vir intensierwe-sorg-verpleging van die breinbeseerde pasient asook die rehabilitasie van politrauma pasiente met traumatise breinbeesering. Die unieke bydra van die studie word gevind in die feit dat daar nog geen gerformaliseerde uitkomstandaarde vir traumapasiente met breinbeseerings in enige van die Noord Wes Provinsie se hospitale ontwikkel is nie.
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Fagelson, Marc A. "Traumatic Exposures and Interprofessional Management of Tinnitus." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1656.
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Cross, Kasey, and Kasey Cross. "A Proposal for a Best-Practice Protocol for the Management of Patients with Suspected Cervical Spine Injury." Diss., The University of Arizona, 2017. http://hdl.handle.net/10150/626650.
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Background: Research suggests that cervical spine CT examination is over used for potential injury due to blunt trauma. Education of emergency providers regarding evidence-based guidelines can help reduce the over-use of CT examination, and the development of an evidence-based protocol for the management of patients with suspected cervical spine trauma may help promote more appropriate clinical use of radiologic imaging for cervical spine clearance.
Purpose: The ultimate goal of this project is to develop a best-practice, evidence-based protocol for the management of patients with suspected cervical spine injury, in order to promote safe and efficient clinical clearance, as well as promote judicious and appropriate use of diagnostic imaging for suspected cervical spine injury.
Methods: A retrospective chart review of emergency radiographic imaging studies obtained over a three-month timeframe for suspected cervical spine injury at a 300-bed hospital in Tucson, Arizona was performed to compare ordering practices with the ACR-AC. Descriptive statistics were used for data analysis. A web-based survey was conducted of facility stakeholders including emergency physicians, nurse practitioners and physician assistants regarding their views about clinical guidelines and protocols for radiographic and clinical clearance of cervical spine injury. Descriptive statistics and thematic analysis was used for survey responses.
Results: Analysis of 263 imaging studies over a three-month timeframe demonstrated that 24.3% of cervical spine imaging studies obtained in three-month timeframe would be considered not appropriate based on the ACR-AC. The survey of emergency clinicians revealed that none of those who responded have a preference for referring to the ACR appropriateness criteria, and the majority of respondents did not support the implementation of a hospital protocol for the management of patients with suspected cervical spine trauma.
Recommendations: An institutional protocol for suspected cervical spine injury developed from the ACR-AC with incorporation of clinical clearance criteria is recommended. To promote clinician acceptance, overcome resistance to implementation, and promote individualized patient care, the protocol should also include provider education and should allow for variance based on individual patient circumstances.
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Ogle, Christopher. "Expressions of cultural worldviews in psychotherapy with clients who have experienced trauma| A qualitative study from a terror management perspective." Thesis, Pepperdine University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3597222.
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People who have experienced trauma involving serious threats to physical integrity can react in accordance with various response trajectories, including posttraumatic growth (PTG). PTG is characterized by positive psychological change following trauma that goes beyond a return to pre-trauma functioning as the result of reorganizing one's conceptualization of his or her phenomenological world (Tedeschi & Calhoun, 2004). This study was interested in factors that contribute to PTG from a terror management theory (TMT) perspective. TMT, based on existential philosophy, posits that people defend against the knowledge that everyone must eventually die and the accompanying anxiety by investing in cultural worldviews and deriving self-esteem by adhering to the standards and values prescribed by those worldviews (Solomon et al., 2004). Based on TMT research that suggests that when people are reminded of their mortality they tend to place increased faith in their cultural worldviews (Burke et al., 2010) as well as the assumption that reminders of previous trauma would likely make mortality salient, this study employed a directed content analysis to examine cultural worldview expressions among therapy clients who had experienced trauma.
Qualitative analysis using the directed coding system created for this study resulted in coding 77 cultural worldviews across the 5 sessions from 5 coding categories: other (explicit) (n=32), other (implicit) (n=20), nationality (n=13), religion (n=8), and ethnicity (n=4). The clients referred to cultural worldviews throughout their sessions, even though only one therapist directly facilitated cultural discussion. Worldview expressions amidst trauma discussions were considered potential contributors to PTG as they served a meaning making function. Also, many worldviews and cultural affiliations referenced were different than those commonly studied in previous TMT research (i.e. referenced cultural affiliations other than religion, ethnicity, nationality, or political affiliation such as gender and age/generation; did not discuss political affiliation). Multiple factors such as differences among clients, contextual factors of the sessions, and therapists' style were considered to potentially have influenced the variance in worldviews expressed. The findings described in this study can contribute to ongoing psychotherapy training and research bridging the gaps among PTG and TMT theory, research and clinical practice with trauma survivors.
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Cordero, Melissa. "A guide for mental health practitioners working with collective trauma victims from Latin America| An experiential approach." Thesis, Pepperdine University, 2014. http://pqdtopen.proquest.com/#viewpdf?dispub=3631035.
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A resource guide for mental health practitioners working with Latino victims of collective trauma was developed based on a review of the literature. The development of the resource was also informed by two structured interviews with experts in the field of collective trauma within the Latino population. Review of the literature and structured interviews were used to develop culturally sensitive treatment approaches for victims of collective trauma from Latin America. The resource guide offers clinicians culturally adapted interventions, including PTSD measures, a table to identify culture bound syndromes, PTSD psychoeducation handouts (provided in Spanish and English), relaxation skills (e.g. breathing techniques, progressive muscle relaxation, the use of music, meditation), interoceptive exposure protocols, and tools to help clients live a life of meaning as well as restore their roles in the community and within their family. An additional two experts in the field evaluated the resource guide for validity, content, and applicability to the Latino population. Feedback from the evaluators will be used for future versions of the resource guide. Results indicated that the resource guide may be advantageous for Latino victims of collective trauma and may therefore serve as an adjunct to current treatment protocols. The resource guide may assist mental health practitioners in modifying their approach to treatment as well as offer culturally appropriate interventions in order to enhance cultural sensitivity, thus leading to a stronger therapeutic alliance.
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Duckworth, Andrew David. "Proximal forearm fractures : epidemiology, functional results and predictors of outcome." Thesis, University of Edinburgh, 2016. http://hdl.handle.net/1842/23495.
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Proximal forearm fractures account for over 10% of all upper limb fractures. There is limited epidemiological data available and much of the literature focuses on the more complex fracture patterns, with the role of non-operative management for the isolated proximal forearm fracture still to be defined. Prospective short and long-term patient reported outcome data for simple isolated fractures of the radial head and olecranon would help define the indications for the non-operative management of these injuries. This thesis aims to test the hypothesis that non-operative management provides a comparable outcome to operative intervention for defined fractures of the proximal forearm. A large prospective database of 6872 fractures collected over a one-year period was used to define the epidemiology of proximal forearm fractures. A separate large prospective study carried out over an eighteen-month period using a pre-defined management protocol for all isolated radial head and neck fractures was analysed to determine the short and long-term outcome. Additional retrospective databases were collected and analysed to determine the short and long-term outcome for the non-operative and operative management of olecranon fractures, as well as the operative management of complex radial head fractures. Finally, two prospective randomised controlled trials (PRCTs) of isolated displaced fractures of the olecranon were carried out to compare 1) tension band wire (TBW) versus plate fixation in younger patients (< 75 years) and 2) operative versus non-operative management in elderly patients (≥75 years). The primary outcome measure for these studies was the upper limb specific patient reported Disabilities of the Arm, Shoulder and Hand (DASH) score. Secondary outcome measures included surgeon reported outcome scores, complication rates and cost. The incidence of proximal forearm fractures was 68 per 100,000. Radial head fractures fit a type D distribution curve (unimodal young man, bimodal woman) and radial neck type A (unimodal young man, unimodal older woman). Proximal ulna and olecranon fractures were both a type F (unimodal older man, unimodal older woman), with an increasing incidence after the 6th decade. Over 90% of proximal radial fractures were isolated stable fractures. Prospective analysis of 201 isolated proximal radius fractures found that the patient and surgeon reported outcome following primary non-operative management for Mason type 1 and type 2 (n=185) fractures was excellent in the short and long-term, with < 2% of patients undergoing secondary surgical intervention. At a mean of 10 years post injury (n=100), the mean DASH score was 5.8 and 92% of patients were satisfied. Factors associated with a poorer short and long-term patient reported outcome included increasing fracture displacement (≥5mm) and socio-economic deprivation. Retrospective analysis of 105 acute unstable complex radial head fractures found that the mean short-term functional outcome was good (mean Broberg and Morrey Score 80) following radial head replacement. In the long-term (mean 7 years), 28% of patients required removal or revision of the prosthesis, with younger patients and silastic implants independent risk factors (both p < 0.05). Retrospective analysis of 36 operatively managed isolated displaced olecranon fractures found satisfactory short and long-term outcomes, with the symptomatic metalwork removal rate 47% and the mean DASH 2.5 at a mean of seven years post injury. In the PRCT of plate (n=34) versus TBW (n=33) fixation, comparable functional and patient reported outcomes (DASH 8.5 vs 13.5; p=0.252) were found at one year following injury. Complication rates were significantly higher in the TBW group (63.3% vs 37.5%; p=0.042), predominantly due to a significantly higher rate of symptomatic metalwork removal (50.0% vs 21.9%; p=0.021), resulting in equivocal costs for both techniques (p=0.131). In older lower-demand patients, short and long-term retrospective analysis found very satisfactory outcomes following non-operative management of isolated displaced fractures of the olecranon, with patient satisfaction 91% and no patients requiring surgery for a symptomatic non-union. The preliminary results of the PRCT of non-operative (n=8) versus operative (n=11) management demonstrated comparable functional and patient reported outcomes at all points over the one-year following injury (all p≥0.05), with a higher rate of complications (81.8% vs 14.3%; p=0.013) and cost (p=0.01) following surgical intervention. The association found between fragility and the epidemiology of proximal forearm fractures highlighted the importance of considering non-operative management for these injuries. These findings support non-operative management for isolated stable radial head and neck fractures. For more complex injuries when radial head replacement is indicated, there is a high rate of removal or revision, with younger patients most at risk. In younger active patients with an isolated displaced fracture of the olecranon, TBW and plate fixation provide comparable short-term results, with TBW fixation as cost effective despite an increased rate of metalwork removal. In older lower demand patients, this data provides strong evidence for the non-operative management of isolated displaced olecranon fractures.
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Kahle, Lauren M. "Testing the impact of post-traumatic stress on existential motivation for ideological close- and open-mindedness." Cleveland State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=csu1494702077677688.
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Carney, Erin E. "Suicidal Ideation in Patients Hospitalized for Emergency Medical Treatment Related to Physical Trauma: Effects of Posttraumatic Stress and Depression." TopSCHOLAR®, 2016. http://digitalcommons.wku.edu/theses/1592.
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Survivors of physical trauma may be at increased risk for developing suicidal ideation and behavior both during and after their inpatient hospitalization for medical treatment of wounds. It remains to be understood why a population hospitalized for nonpsychiatric reasons may ultimately develop a desire to take their own life. The current study sought to answer this question by hypothesizing that symptoms of posttraumatic stress (PTS) and depression during the recovery period individually mediated the relationship between physical pain and suicidal ideation. Researchers assessed these relationships in 246 patients who were receiving emergency medical treatment for wounds associated with a physically traumatic event. Patients were interviewed using a battery of assessments, including the PTSD Checklist-Civilian, Beck Scale for Suicidal Ideation, Medical Outcomes Study Short Form, and the Patient Health Questionnaire. Regression analyses provided support for the role of PTS and depression as mediators of the relationship between physical pain and suicidal ideation. These findings suggest that it may be important for behavioral health professionals to monitor symptoms of PTS and depression during a trauma survivor’s painful recovery period, as this may provide a crucial window of intervention during which the escalation of suicidal feelings can be prevented.
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Kossurok, Anke. "Making the invisible visible : a grounded theory study of female adult trauma survivors reconstructing reality with supportive others." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/31218.
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Violence against women and children is a pervasive challenge across the globe. Research has shown that survivors of interpersonal violence, such as child maltreatment and intimate partner violence, may develop a complex form of post-traumatic stress disorder accompanied by, for example, difficulties in regulating emotions and relating to others. Additional mental health and social problems contribute to survivors' long-term impairment. Therefore, it is imperative that we understand the key elements and processes that facilitate trauma recovery. The majority of research places survivors as individuals at the core of understanding trauma and recovery, which makes it an intrapsychic problem focused on, for example, the individual's cognitive bias, maladaptive interpersonal behaviour, or emotion dysregulation which need repairing, rather than considering appropriately the role of context, external factors and social processes. Thus, trauma recovery may be more complicated. The current study explored key elements and processes of trauma recovery in female adult survivors with a focus on emotional and interpersonal skills, within the narratives of individuals constructing their own recovery within an interpersonal context. Fifteen female adult survivors were recruited from a statutory clinical service and a third-sector community project. Participants were interviewed individually, and data were analysed qualitatively using grounded theory. The study constructed a framework of four key components. Women survivors initially disengaged from feelings, other people and themselves (1), gradually made hidden experiences visible (2) and examined these (3), and eventually reconstructed their reality (4). Although not always a linear process, this framework revealed a transition from self-guided to supported self-management. Women survivors sought out relationships, were impacted by relationships, and these relationships changed the way survivors responded. Thus, female trauma survivors reconstructed abuse, trauma and identity through various supportive others. Similarly, female survivors reframed emotional and interpersonal difficulties and gradually managed these through relationships. Future research as well as theories, practices and policies need to consider the multifaceted and relational nature of interpersonal trauma recovery. Guidelines and practices, for instance, could include community-focused strategies that provide a larger network of support to survivors and, thus, would offer multiple opportunities to experience positive interactions. Equally, mandatory training of health care staff about interpersonal violence and subsequent trauma as well as training in relating positively to survivors would make a real difference.
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Siegmann, Stefanie. "Primäre bildgebende Diagnostik von polytraumatisierten Patienten mittels Spiralcomputertomographie." Doctoral thesis, Humboldt-Universität zu Berlin, Medizinische Fakultät - Universitätsklinikum Charité, 2002. http://dx.doi.org/10.18452/14787.
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Die Behandlung polytraumatisierter Patienten stellt in ihrer Komplexität hohe Anforderungen an die aparativen und personellen Voraussetzungen einer Klinik. Dies bedingt einen erheblichen Kostenaufwand sowohl für die primäre Diagnostik und Therapie als auch für die Rehabilitation. Im Unfallkrankenhaus Berlin sieht der Algorithmus der Polytraumaversorgung nach klinischer Erstversorgung und sonographischer Untersuchung von Abdomen und Thorax die weitere primäre radiologische Diagnostik von Schädel, Halswirbelsäule, Thorax, Abdomen und Becken mittels Spiral-Computertomographie nach einem standardisiertem Untersuchungsprotokoll vor. Im Zeitraum von September 1997 bis Juli 1999 wurden 334 aufeinander folgende Patienten erfasst, bei denen unter dem Verdacht auf ein Polytrauma eine CT-Untersuchung im Rahmen des klinikinternen Algorithmus durchgeführt wurde. Unter Kenntnis aller Untersuchungsbefunde erfolgte die retrospektive Gruppenbildung mit Unterscheidung in polytraumatisierte (n=116) und nicht polytraumatisierte (n=220) Patienten. Der durchschnittliche ISS lag bei 32 (+/- 10) in der Gruppe der tatsächlich polytraumatisierten Patienten und bei 15 (+/- 9,4) in der Gruppe der nicht polytraumatisierten Patienten. In der weiteren Auswertung wurden die in der primären CT-Untersuchung erhobenen Diagnosen anhand des klinischen Verlaufs, operativer und anderer therapeutischer Maßnahmen sowie der weiteren Bildgebung überprüft. In der vorliegenden Untersuchung konnte gezeigt werden, dass die Spiral-Computertomographie in der Lage ist, das Verletzungsmuster eines polytraumatisierten Patienten, abgesehen von Extremitätenverletzungen, nahezu vollständig und mit großer Sicherheit zeiteffizient zu erfassen. Dabei konnte auf Grund der Verkürzung der Untersuchungszeit die Indikationsstellung auf Patienten mit kritischen Kreislaufsituationen ausgedehnt werden. Als strukturelle Voraussetzung muss jedoch die unmittelbare Nachbarschaft von Schockraum und CT-Untersuchungsraum sowie ein routiniertes Team gewährleistet sein. Insgesamt profitierten insbesondere die tatsächlich polytraumatisierten Patienten von der Durchführung des standardisierten Untersuchungsprotokolls bei der Aufdeckung von Verletzungen. Der große Anteil der nicht polytraumatisierten Patienten profitierte vorwiegend vom Verletzungsausschluss. Hier muss die Indikationsstellung überaus kritisch erfolgen.The complex treatment of patients with multiple traumas requires a high standard of staff and equipment causing considerable expense at the point of primary diagnosis and treatment as well as at the rehabilitation stage. Conforming to a standardised examination routine, the algorithm of treating patients with multiple traumas at the Unfallkrankenhaus Berlin includes, after primary clinical treatment and ultrasound examination of abdomen and thorax , the further primary radiological diagnosis of the skull, the cervical spine, the thorax, the abdomen and the pelvis via spiral CT. Between September 1997 and July 1999 we registered 334 successive patients with suspected multiple traumas who underwent a CT examination according to our clinical algorithm. In the knowledge of all diagnoses the patients were subdevided into two groups: patients suffering from multiple traumas (n=116) and patients without multiple traumas (n=220). The average ISS was 32(+/- 10) for the group of patients actually suffering from multiple traumas and 15 (+/- 10) for the group of patients without multiple traumas. The diagnoses based on the primary CT examination were analysed in the light of the clinical course, surgical and other therapeutic measures as well as compared with other imaging methods (modalities). This study shows that, apart from injuries of the extremities, the spiral CT can reveal the injuries of a patient suffering from multiple traumas efficiently and quickly. Because of the shorter time needed for examination the diagnosis can be extended to patients with critical haemodynamical conditions. Yet it is important that the emergency romm and CT examination rooms are in close vicinity and that the team of examiners is well trained. Especially patients with multiple traumas benefit from this standardised routine of examinations. The majority of patients without multiple traumas benefit from the exclusion of injuries. Here the medical indication has to be carefully considered.
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Smart, N. J. "Anxiety, depression, stress and trauma in couples attending an Assisted Conception Unit and reasons for their reluctance to participate in a Stress Management Program." Thesis, University of Edinburgh, 2002. http://hdl.handle.net/1842/30767.
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Introduction: Infertility has a major impact on the emotional well being of a couple. As many as one quarter of couples could experience some delay in starting a family (Green and Vassey, 1990). However, many of these couples are reluctant to attend therapy sessions intended to help them with the stresses involved in experiencing infertility. Objectives: To investigate the levels of anxiety, depression, stress and trauma in couples attending an Assisted Conception Unit (ACU) compared to the general population and to investigate the ACU patients' reluctance to participate in a Clinical Psychologist-led stress management group. Design: A between subjects design was employed to compare results from participants attending an ACU to a matched control group from the general population. Members of the control group were matched for age, gender, relationship status and level of qualifications with individual ACU participants. Methods: All subjects were invited to complete a short questionnaire consisting of assessments of anxiety, depression, stress and trauma along with demographic questions. Couples attending the ACU were also asked to complete a questionnaire designed specifically for this study to elicit their reasons for non-participation in a stress management program. Results: As hypothesised the results indicate that the ACU group was more stressed than the general population and that the women in this group appeared to be more severely affected. Their reasons for reluctance to participate in stress management varied as a function of the distress levels experienced. All results are discussed in relation to previously published findings. Conclusions: Although the experience of infertility is stressful infertile couples are reluctant to attend stress management groups. The introduction of any psychosocial intervention should take these findings into consideration. Clinical implications and suggestions for future research are discussed.
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Bertolini, Débora Brandão. "Avaliação dos gastos com traumas motociclísticos: um estudo epidemiológico e de custos hospitalares parciais em um hospital terciário universitário." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/17/17157/tde-08122015-154610/.
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Esta dissertação buscou avaliar os custos hospitalares parciais decorrentes de internações por traumas causados por ocorrências motociclísticas bem como o perfil epidemiológico destas vítimas. Foi feito um estudo retrospectivo de usuários do Sistema Único de Saúde, de 460 vítimas do trauma com motocicletas, internados na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, divididos de acordo com o mecanismo do trauma e gravidade dos casos. Para efeito de análise, os usuários foram categorizados por faixa etária, estado civil, escolaridade, sexo, local de ocorrência do trauma e dia da semana em que houve este evento. Para consecução deste trabalho foram utilizados o banco de dados do Núcleo Epidemiológico Hospitalar, o sistema de informação interna e dados da seção de custos do mesmo hospital. Como resultado foi identificado que as maiores vítimas de eventos motociclísticos são jovens, solteiros, com baixa escolaridade e do sexo masculino. Também foi identificado que os eventos ocorrem com mais frequência nos finais de semana, além da quarta feira, e que ocorrem próximo do horário da saída do expediente de trabalho e no período da noite. As principais lesões ocorrem nos membros (lesões moderadas e graves) e na cabeça (lesões graves e críticas), sendo múltiplas lesões característica deste tipo de paciente. O custo hospitalar foi principalmente relacionado ao tempo de internação em enfermarias e no CTI e a gravidade do trauma. O valor final do custo avaliado no estudo foi de R$ 5.315.357,15, com média geral de R$11.555,12 por paciente. Para os casos mais graves (ISS > 15) a média de custo foi de R$ 33.259,50 por pacienteThis dissertation evaluates the partial hospital costs of hospitalizations for injuries caused by motorcycle accidents and the epidemiological profile of these victims. A retrospective study based on Unified Health System patients was done. 460 motorcycles trauma victims admitted to the Emergency Unit of the Hospital of Ribeirão Preto Medical School Clinical, University of Sao Paulo, were included in the study. Data were collected based on Epidemiological Nucleus database of the Hospital, the internal information system and data from the same hospital costs section, including: mechanism and severity of trauma, epidemiological and socioeconomic data such as age, sex, marital status, education, local, date, and time of occurrences. tThe majority of motorcycle accidents victims were young, single, with low level of education, and male. Accidents occurred more frequently on weekends and Wednesday. Usually from 12 pm to midnight. . The major injuries occurred in the limbs (moderate and severe lesions) and head (severe and critical injuries), being typical of this type of accident several injuries. The hospital costs were mainly related to the wards and ICU length of stay, and the trauma severity. The final value of costs was R$ 5,315,357.15, and in average R$ 11.555,12 per patient. To severe cases (ISS>15) the average cost was R$33,259.50 per patient
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Clarke, Rochelle S. "Uncovering Meanings of Death, Trauma, and Loss as Experienced by Hospice Bereavement Coordinators: A Phenomenological Study." NSUWorks, 2015. http://nsuworks.nova.edu/shss_dft_etd/12.
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This study examined the experiences of Hospice Bereavement Coordinators (HBCs) and Hospice Chaplains working with grief narratives from patient-family units exhibiting signs of anticipatory or complicated grief. While a significant amount of research has been conducted on Hospice employees, no qualitative studies have examined the interpretation of meaning from employees whose primary role focused on the psychosocial-spiritual aspects of clients exhibiting anticipatory or complicated grief. The researcher identified shared meaning of death, trauma, and loss from six participants in the context of a high stress and high loss environment. This study‘s findings revealed ten central themes: Death is an earthly transition to immortality; Death is an intense progression; Trauma is an interpretive response to a bad experience; Trauma highlights quality of life; Loss is an adaptation to change; Loss highlights self-awareness about mortality; Cases impact views of death, trauma, and loss; Influences of spirituality; Stressful aspects of working in hospice settings; and Methods of coping.
Through this study, the researcher captured five elements of the shared phenomena: the conflicting nature of anticipatory or complicated grief with the participant‘s interpretation of death; the acknowledgement of loss as the next stage for survivors of the deceased; the instability patient-family units exhibiting anticipatory or complicated grief faced; the role of faith; and the proactive efforts of participants to create a balance between work and their personal life. These meanings contributed to the continued need for future qualitative studies whereby the lived experiences of Hospice employees could be expressed to assist with the development of structured training programs specific to the requirements outlined by the nature of their work.
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Hrouda, Debra R. "Factors Associated With Readiness For Treatment In A Sample Of Substance-Dependent, Trauma-Exposed Incarcerated Women." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1401824178.
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Hale, Susan. "Communicating a Crisis: The Public Information Officer's Perspective." unrestricted, 2007. http://etd.gsu.edu/theses/available/etd-11282007-150038/.
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Thesis (M.A.)--Georgia State University, 2007.Title from file title page. Greg Lisby, committee chair; Yuki Fujioka, Merrill Morris, committee members. Electronic text (69 p.) : digital, PDF file. Description based on contents viewed Mar. 27, 2008. Includes bibliographical references (p. 53-57).
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Bötel, Martina. "Der Einfluss des Blutglukosespiegels auf den frühen intensivmedizinischen Verlauf und der Benefit einer intensivierten Insulintherapie bei Patienten mit mittelschwerem und schwerem Schädel-Hirn-Trauma." Doctoral thesis, Universitätsbibliothek Leipzig, 2017. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-222307.
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Seit Veröffentlichung der Studien von G. Van den Berghe et al. im Jahre 2001 galt es die strikte Blutzuckereinstellung in normoglykämische Bereiche bei Schwerverletzten anzustreben. Die intensivierte Insulintherapie wurde daraufhin von verschiedensten Fachgesellschaften in Leitlinien und Therapieregimen integriert, so auch auf der neurochirurgischen ITS der Universitätsklinik Leipzig. Kurze Zeit später erschienen große multizentrische Studien, die den Benefit der intensivierten Insulintherapie in Frage stellten und sogar von einer signifikant höheren Letalität bei strikt normoglykäm eingestellten Patienten berichteten.
Daher wird in dieser Studie die zwiespältige aktuelle Datenlage zum Anlass genommen, die Beziehungen zwischen Blutzuckereinstellung und ITS-Regime sowie die Auswirkungen hyperglykämischer Stoffwechselsituationen und mögliche Bedeutung des Blutglukosespiegels respektive der intensivierten Insulintherapie speziell für Patienten mit isoliertem mittelschwerem und schwerem Schädel-Hirn-Trauma zu evaluieren.
Mit Hilfe der Integration wird erstmalig ein Verfahren zur Blutglukosedarstellung verwendet, dass durch die Flächenberechnung (Area under the Curve (AUC-BG)) ein Abbild von Höhe und Dauer der Hyperglykämie schafft.
Es konnte gezeigt werden, dass die Blutzuckereinstellung mit dem klinischen Verlauf, krankheitsspezifischen Therapiekonzepten, Komplikationen und dem Outcome der Patienten korreliert und positiv Einfluss nimmt. Von besonderem Interesse war die Auswirkung auf den Hirndruck und die Notwendigkeit von Dekompressionskraniektomien, als auch auf Infektionsereignisse, die kontrollierte Beatmung, Ernährungsform und das Outcome.
Nach Einführung der intensivierten Insulintherapie wurde ein Vergleich mit konventionell therapierten Patienten herbeigeführt. Es wurden vergleichende Analysen zwischen der retrospektiven (n = 65, konventionelle Insulintherapie, Blutzucker < 10,0 mmol/l [< 180 mg/dl]) und prospektiven Gruppe (n = 65, intensivierte Insulintherapie, Blutzucker 4,4 – 6,1 mmol/l [80 – 110 mg/dl]) bezüglich Blutzuckerfläche, Intensivverlauf und Outcome durchgeführt. Nach 1:1-Matching hinsichtlich Alter und Geschlechterzugehörigkeit waren die beiden Therapiegruppen homogen und es zeigten sich keine Unterschiede bezüglich der Aufnahmecharakteristik. Schädelhirntraumatisierte Patienten profitierten von einer intensivierten Insulintherapie im Vergleich zur Kontrollgruppe, auch wenn es nicht gelang, den Blutzuckerspiegel entsprechend der initiierten Therapierichtlinie signifikant hin zur Normoglykämie zu senken. Die positiven Effekte zeigten sich deutlich in Bezug auf die Infektionsrate und Ernährungsform. Die intensivierte Insulintherapie senkte den Hirndruck und die Rate risikobehafteter Dekompressionskraniektomien mit einem deutlicheren Trend zu besseren Outcomemesswerten. Vor allem Patienten mit einem besseren initialem GCS und Nicht-Diabetiker scheinen von einer guten Blutzuckereinstellung zu profitieren. Hypoglykämien (Blutzucker ≤ 3 mmol/l) traten entgegen der Vermutung dabei nicht gehäuft auf und stellten somit kein Gegenargument einer derartigen Therapie dar.
Die Senkung des Blutzuckers in einen moderaten, therapeutischen Bereich sollte das Mindestziel in der Gesamttherapie von Patienten mit einem mittelschweren und schweren Schädel-Hirn-Trauma sein, wobei ein Konsens über den optimal therapeutischen Blutzuckerzielbereich bisher noch nicht gefunden wurde und somit weitere Untersuchungen gerechtfertigt sind.
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Pryor, Julie Anne, and mikewood@deakin edu au. "A grounded theory of nursing's contribution to inpatient rehabilitation." Deakin University. School of Nursing, 2005. http://tux.lib.deakin.edu.au./adt-VDU/public/adt-VDU20051110.112022.
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There is growing awareness of the benefits of rehabilitation both in Australia and overseas. While the provision of rehabilitation services is not new, recognition of this type of health service as an integral part of health care has been linked to changes in the provision of acute care services, advances in medical technology, improvements in the management of trauma and an ageing population. Despite this, little attention has been paid to nursing's contribution to patient rehabilitation in Australia. The aim of this grounded theory study, therefore, was to collect and analyse nurses' reports of their contributions to patient rehabilitation and to describe and analyse contextual factors influencing that contribution.
Data were collected during interviews with registered and enrolled nurses working in five inpatient rehabilitation units in New South Wales and during observation of the nurses' everyday practice. A total of 53 nurses participated in the study, 35 registered nurses and 18 enrolled nurses. Grounded theory, informed by the theoretical perspective of symbolic interactionism, was used to guide data analysis, the ongoing collection of data and the generation of a substantive theory.
The findings revealed six major categories. One was an everyday problem labelled incongruence between nurses' and patients' understandings and expectations of rehabilitation. Another category, labelled coaching patients to self-care, described how nurses independently negotiated the everyday problem of incongruence. The remaining four categories captured conditions in the inpatient context which influenced how nurses could contribute to patient rehabilitation. Two categories, labelled segregation: divided and dividing work practices between nursing and allied health and role ambiguity, were powerful in shaping nursing's contribution as they acted individually and synergistically to constrain nursing's contribution to patient rehabilitation. The other two categories, labelled distancing to manage systemic constraints and grasping the nettle to realise nursing's potential, represent the mutually exclusive strategies nurses used in response to segregation and role ambiguity.
From exploration of the relationship between the six categories, the core category and an interactive grounded theory called opting in and opting out emerged. In turn, this grounded theory reveals nursing's contribution to inpatient rehabilitation as well as contextual conditions constraining that contribution. The significance of these findings is made manifest through their contribution to the advancement of nursing knowledge and through implications for nursing practice and education, rehabilitation service delivery and research.
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Larson, Wanda J. "Team Member Characteristics Contributing to High Reliability in Emergency Response Teams Managing Critical Incidents." Diss., The University of Arizona, 2011. http://hdl.handle.net/10150/145418.
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Emergency response team (ERT) member characteristics that contribute to High Reliability performance during patient care resuscitation events or other Critical Incident Management Situations are poorly understood. Findings from this study describe individual characteristics that experienced interprofessional ERT members perceive as contributing to High Reliability performance within the critical incident management context. This study supports the need for interprofessional research about emergency response teams’ High Reliability in hospital-based settings. ERT High Reliability, or “better than expected” team performance has been linked to overall patient care and safety. The purpose of this study was to identify and describe individual team member characteristics that contribute to High Reliability performance of ERT members and the overall emergency response team in a naturalistic setting during Critical Incident Management Situations. Using a qualitative descriptive design, data collection included participant observations, field notes, and interviews. Narrative data were audio-taped, transcribed and coded using Ethnograph v6©. Data content were analyzed thematically using inductive interpretive methods. Two major domains derived from the data were Self-Regulation and Whole-Team Regulation. The overarching theme, Orchestrating High Reliability at the Edge of Chaos, encompassed characteristics contributing to High Reliability performance of the ERT during Critical Incident Management Situations.
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Oliveira, Sara Galleni de. "Desenvolvimento de um sistema web para a notificação e vigilância epidemiológica de trauma com monitorização e análise de indicadores de qualidade do atendimento." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/82/82131/tde-03102017-083524/.
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O trauma é uma das principais causas de morte no mundo. Estima-se que mais de cinco milhões de pessoas morrem anualmente por algum tipo de trauma e que outras milhões que sobrevivem aos ferimentos ficam com sequelas temporárias ou permanentes, o que implica em custos diretos e indiretos de bilhões de reais. Desta forma, o problema do trauma envolve questões de ordem epidemiológica, social, assistencial, financeira e de gestão. Uma das maneiras de minimizar este problema é avaliar as fases do atendimento por meio de programas de melhoria de qualidade. O Comitê de Trauma do Colégio Americano de Cirurgiões criou uma base de dados única de registros de traumas de diversos centros nos Estados Unidos e Canadá na base de dados única do National Trauma Data Bank (NTDB). Após coletados, os dados são processados e transformados em relatórios anuais com indicadores que fornecem uma visão da situação geral do atendimento ao trauma em todo o país. Muitos países investem recursos para construir registros de trauma ou base de dados regionais, que são importantes fontes de dados para construção de indicadores de qualidade. No Brasil não existe a notificação sistemática dos pacientes traumatizados nos serviços de saúde. O presente estudo tem por finalidade desenvolver um software com módulo de notificação e vigilância epidemiológica dos traumas associado à monitorização e análise dos dados consolidados utilizando indicadores de qualidade. Para teste do software foi utilizado o banco de dados de pacientes traumatizados atendidos na Unidade de Emergência do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - Universidade de São Paulo (UE-HCFMRP/USP) no período de 2006 a 2014. No software desenvolvido há duas maneiras de inserir dados de trauma: manualmente por meio do preenchimento do formulário eletrônico de notificação ou por meio da importação direta de arquivo Excel com a mesma sequência de dados. Desta forma, os indicadores são gerados automaticamente e podem ser visualizados em gráficos e tabelas. Os resultados obtidos através do uso da ferramenta foram utilizados para analisar a situação da assistência ao trauma na região de Ribeirão Preto. A análise destes resultados também foi essencial para verificar a capacidade da ferramenta em prover informações relevantes para a gestão hospitalar. A partir da análise dos resultados obtidos, concluímos que a ferramenta pode auxiliar a avaliação da qualidade do atendimento ao trauma. Uma possibilidade de expansão do sistema é incluir novos indicadores e coletar dados de outras instituições para permitir benchmarking externo.Trauma is a leading cause of death worldwide. It is estimated that more than five million people die annually from some sort of trauma and millions more who survive their injuries are left with temporary or permanent sequelae, which leads to billions of Reais in direct and indirect costs. Thus, the question of trauma involves epidemiological, social, healthcare, financial and management issues. One way to lessen such problems is to evaluate the phases of medical care through quality improvement programs. The American College of Surgeons Committee on Trauma has created a unique aggregation of trauma registry data from several centers in the United States and Canada in a single database, the National Trauma Data Bank (NTDB). After collected, the data are processed into annual reports with indicators that provide a view of the overall situation of trauma care nationwide. Many countries invest resources on gathering trauma registries or building regional databases, which are important sources of data for generating care quality indicators. In Brazil there is no systematic notification of trauma patients in health services. The present study aims to develop a software with a trauma notification and epidemiological surveillance module associated with the monitoring and analysis of the consolidated data using care quality indicators. To test the software we used the database of trauma patients treated at the Emergency Unit of the Clinics Hospital at the Ribeirão Preto Medical School - University of São Paulo (UE HCFMRP/USP) from 2006 to 2014. There are two ways to feed the software with the trauma data: manually, by completing an electronic notification form or by directly importing an Excel file with the same data stream. The indicators are then generated automatically and can be viewed in charts and tables. The results yielded from the software were used to assess the situation of trauma healthcare in the Ribeirão Preto region. The analysis of such results was also crucial to determine the software capacity to provide relevant information for hospital management. The results analysis led us to conclude that the software can help assess the quality of trauma healthcare. A possibility of system expansion is to include new indicators and collect data from other institutions to allow external benchmarking.
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Chilaka, Carol C. "Exploring Restorative Factors for Trafficked and Sexually Exploited Women." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5993.
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Abstract
Many women who survived sex trafficking continue to suffer from severe and persistent psychological distress even after the traditional treatment and rehabilitation program. The lingering psychological symptoms that these survivors suffer make reintegration into their families and communities difficult. This phenomenological study identified the restorative factors that helped some women who were earlier engaged in sex trafficking to recover, readjust, and reintegrate into their families and communities. Six female survivors of human trafficking and six program directors/counselors at different rehabilitation centers were individually interviewed in in-depth with semi-structured questionnaires and audio recorded. I kept diary of my readings and observation of the participants during the interviews to maintain the rigor and established trustworthiness of the study. With NVivo 11 plus Software, the information were coded to identify the different patterns. The Manen's hermeneutic descriptive phenomenological interpretative approach was employed to sort out the emerging themes. The findings were grouped under the perspectives of survivors and program directors/counselors. Both survivors and program directors/counselors agreed that factors such as supports from family/friends, medical treatments, counseling, and individual characteristics promoted recovery. The theories of social support, self-efficacy, and resilience guided the understanding of the recovery process of the survivors. For positive social change, this study provides information that families, communities, and society can become more aware of the ways to improve survivors' support systems and build a sustainable community that cares and supports survivors for a successful integration into families and communities.