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OBJECTIVE: to evaluate the degree of reliability, accuracy and timing to perform the Manchester Triage System in electronic and manual records. METHOD: exploratory-descriptive research. Case series corresponded to a total of 20 validated simulated clinical cases applied to a sample of 10 nurses. For data collection each participant received 4 clinical cases in 2 different phases of the study, using manual and electronic registration. The variables related to the triage were: incomplete data filling, discriminator, flowchart, priority level, vital signs and triage timing. RESULTS: moderate reliability for choosing flowcharts and substantial reliability for determining discriminators in both records; substantial and moderate, for priority, respectively, in manual and electronic registration. For vital signs, it was weak in manual recording and substantial in electronic. Accuracy showed a statistically significant difference related to vital signs. The average timing on triage was shorter with the use of electronic registration. CONCLUSION: the use of electronic registration has advantages regarding reliability, accuracy and timing to perform the triage, pointing to the importance of adopting technologies in the management and care work process in health services.

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OBJECTIVE: To analyze the reliability of the Manchester Triage System to determine the priority of patients in emergency services. METHOD: This is a reliability study with a sample of 361 nurses. The data were collected in three stages and the questionnaires were applied using the electronic software. The agreement was measured by the evaluation of clinical cases. The outcomes evaluated were agreement with the gold standard and intra-observer in the indication of the flowchart, discriminator, and level of risk. Data were submitted to univariate and bivariate analyses. The agreement was measured by the Kappa index. RESULTS: The external and internal reliability of the protocol ranged from moderate to substantial (Kappa: 0.55-0.78). The time of professional experience as a nurse, in emergency services and in the classification of risk were associated with external and internal reliability. The correct choice of the discriminator influenced the correct indication of the risk level (R² = 0.77, p <0.0001) more than the correct choice of the flowchart (R² = 0.16, p <0.0001). CONCLUSION: The reliability of the Manchester Triage System ranged from moderate to substantial and it was influenced by the clinical experience of the nurse. The protocol is safe for defining clinical priorities using different classification flowcharts.

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STUDY OBJECTIVE: We assess accuracy and variability of triage score assignment by emergency department (ED) nurses using the Emergency Severity Index (ESI) in 3 countries. In accordance with previous reports and clinical observation, we hypothesize low accuracy and high variability across all sites. METHODS: This cross-sectional multicenter study enrolled 87 ESI-trained nurses from EDs in Brazil, the United Arab Emirates, and the United States. Standardized triage scenarios published by the Agency for Healthcare Research and Quality (AHRQ) were used. Accuracy was defined by concordance with the AHRQ key and calculated as percentages. Accuracy comparisons were made with one-way ANOVA and paired t test. Interrater reliability was measured with Krippendorff's α. Subanalyses based on nursing experience and triage scenario type were also performed. RESULTS: Mean accuracy pooled across all sites and scenarios was 59.2% (95% confidence interval [CI] 56.4% to 62.0%) and interrater reliability was modest (α=.730; 95% CI .692 to .767). There was no difference in overall accuracy between sites or according to nurse experience. Medium-acuity scenarios were scored with greater accuracy (76.4%; 95% CI 72.6% to 80.3%) than high- or low-acuity cases (44.1%, 95% CI 39.3% to 49.0% and 54%, 95% CI 49.9% to 58.2%), and adult scenarios were scored with greater accuracy than pediatric ones (66.2%, 95% CI 62.9% to 69.7% versus 46.9%, 95% CI 43.4% to 50.3%). CONCLUSION: In this multinational study, concordance of nurse-assigned ESI score with reference standard was universally poor and variability was high. Although the ESI is the most popular ED triage tool in the United States and is increasingly used worldwide, our findings point to a need for more reliable ED triage tools.

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RESUMO Objetivo: caracterizar o perfil e identificar as atividades desenvolvidas por enfermeiros do Serviço de Atendimento Móvel de Urgência de um estado da região sul do Brasil. Método: estudo exploratório descritivo. Os dados foram coletados por meio de questionário com 63 enfermeiros. Resultados: o perfil mostrou uma força de trabalho predominantemente feminina, jovem e com formação especializada. As atividades desenvolvidas foram organizadas nas dimensões cuidar, gerenciar e educar, verificando-se o predomínio da primeira. As ações de cuidado envolveram múltiplos procedimentos, mas não houve menção ao uso da Sistematização da Assistência de Enfermagem (SAE) no desenvolvimento das atividades de cuidado. A seguir, destacou-se a dimensão gerencial com predomínio de atividades burocráticas. As ações educativas tiveram menor destaque. Conclusão: as ações de cuidado são o foco principal das atividades dos enfermeiros, predominando o atendimento ao prescrito institucionalmente sem uso de instrumental como a SAE que poderia contribuir para maior visibilidade do seu trabalho profissional.

RESUMEN Objetivo: caracterizar el perfil e identificar las actividades desarrolladas por enfermeros del Servicio de Atención Móvil de Urgencia de un estado de la región sur de Brasil. Método: estudio exploratorio descriptivo. Los datos fueron recogidos por medio de cuestionario con 63 enfermeros. Resultados: el perfil mostró una fuerza de trabajo predominantemente femenina, joven y con formación especializada. Las actividades desarrolladas fueron organizadas en las dimensiones cuidar, gerenciar y educar, verificándose el predominio de la primera. Las acciones de cuidado envolvieron múltiples procedimientos, pero no se hizo mención al uso de Sistematización de la Asistencia de Enfermería (SAE) en el desarrollo de las actividades de cuidado. A seguir, se destacó la dimensión gerencial con predominio de actividades burocráticas. Las acciones educativas tuvieron menor destaque. Conclusión: las acciones de cuidado son el foco principal de las actividades de los enfermeros, predominando la atención al prescrito institucionalmente sin uso de instrumental como la SAE que podría contribuir para mayor visibilidad de su trabajo profesional.

ABSTRACT Objective: to characterize the profile and identify the activities developed by nurses from the Mobile Emergency Care Service of a state of southern Brazil. Method: an exploratory, descriptive study. Data were collected through a questionnaire with 63 nurses. Results: the profile showed a workforce predominantly female, young and having specialized training. The activities were organized in the dimensions of caring, managing and educating, verifying the predominance of the first one. Care actions involved multiple procedures, but the use of the Systematization of Nursing Care (SNC) was not mentioned in the development of care activities. Then, the managerial dimension with a predominance of bureaucratic activities was emphasized. Educational activities were less prominent. Conclusion: care actions are the focus of the activities of nurses, predominantly the prescribed institutional care without the use of instruments such as SNC that could contribute to the greater visibility of their professional work.

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This study analyzes the feasibility of implementing the Nursing Care Systematization in an emergency and urgency hospital department. This is a field study, descriptive, qualitative structured according to the content analysis described by Bardin (2009). It was performed in a hospital specialized in emergency care. The sample consisted of eight practical nurses, five nurses and two assistants, all of them with experience of at least six months in the emergency room. The difficulties referred to the implementation of the NCS are: complexity in their steps; disinterest of the institution; theoretical unpreparedness of nursing, its devaluation by other professionals, inadequate sizing of employees and inadequacy of the hospital physical structure. In this context, it was note that the nurse loses representation in the health team and the application of SAE turns out to be often underestimated.

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Esta pesquisa objetivou analisar a viabilidade de implantação da SAE em um serviço de urgência e emergência hospitalar. Tratase de um estudo de campo, descritivo, qualitativo, estruturado pela análise de conteúdo de Bardin (2009). Foi realizado em um hospital especializado em atendimento de emergência. A amostra constituiu-se em oito técnicos de enfermagem, dois auxiliares e cinco enfermeiros, com experiência de no mínimo seis meses no pronto-socorro. As dificuldades referidas para a implantação da SAE são: complexidade nas suas etapas; desinteresse da instituição; despreparo teórico da enfermagem; sua desvalorização por outros profissionais; dimensionamento inadequado de funcionários e desajuste da estrutura física. Nesse contexto, nota-se que o enfermeiro perde representatividade na equipe de saúde e a aplicação da SAE acaba sendo freqüentemente subestimada.

This study analyzes the feasibility of implementing the Nursing Care Systematization in an emergency and urgency hospital department. This is a field study, descriptive, qualitative structured according to the content analysis described by Bardin (2009). It was performed in a hospital specialized in emergency care. The sample consisted of eight practical nurses, five nurses and two assistants, all of them with experience of at least six months in the emergency room. The difficulties referred to the implementation of the NCS are: complexity in their steps; disinterest of the institution; theoretical unpreparedness of nursing, its devaluation by other professionals, inadequate sizing of employees and inadequacy of the hospital physical structure. In this context, it was note that the nurse loses representation in the health team and the application of SAE turns out to be often underestimated.

En este trabajo se analiza la viabilidad de la aplicación de la SAE en un servicio de urgencia y emergencia hospitalarias. Se trata de un estudio de campo, descriptivo y cualitativo, estructurado según el análisis de contenido descrito por Bardin (2009). Se realizó en un hospital especializado en atención de emergencia. La muestra estuvo conformada por ocho técnicos de enfermería, dos auxiliares y cinco enfermeras con experiencia de al menos seis meses en la sala de emergencias. Las dificultades a que se refieren para la aplicación de la SAE son: complejidades en sus pasos, falta de interés de la institución, falta de preparación teórica de enfermería, su devaluación por otros profesionales, dimensionamiento insuficiente de los empleados y insuficiencia de la estructura física. En este contexto, nota-se que la enfermera pierde representación en el equipo de salud y la aplicación de la SAE resulta ser a menudo subestimada.

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Believing that the organization form of work and the quantity of time given to the assistance work in the hospital can become a cause of violence that affects workers'and usuaries'life, this article analyzed the workers'perception about the time they have for their activities and the violence demonstration in the context of emergency and urgency work of a public hospital of Mato Grosso. It's a qualitative research done close to the members of the nursing staff, with data collected through participative observation and interviews. The data thematically analyzed revealed that the insufficient time makes part of the violence genesis at the nursing work and it is characterized as: classical, structural, repressive and alienation violence.

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Acreditando-se que a forma de organização e a quantidade de tempo destinada ao trabalho assistencial hospitalar podem se constituir em causa de violência que afeta a vida de trabalhadores e usuários analisou-se a percepção dos trabalhadores sobre o tempo disponibilizado às suas atividades e as manifestações de violência no contexto de trabalho de emergência e urgência de um hospital público de Mato Grosso. Trata-se de uma pesquisa qualitativa realizada junto aos membros da equipe de enfermagem, com dados coletados por meio de observação participante e entrevistas. Os dados analisados tematicamente revelaram que o tempo insuficiente de trabalho faz parte da gênese da violência no trabalho de enfermagem e se apresenta tipificada em violência: clássica, estrutural, repressiva e alienação.

Believing that the organization form of work and the quantity of time given to the assistance work in the hospital can become a cause of violence that affects workers' and usuaries' life, this article analyzed the workers' perception about the time they have for their activities and the violence demonstration in the context of emergency and urgency work of a public hospital of Mato Grosso. It's a qualitative research done close to the members of the nursing staff, with data collected through participative observation and interviews. The data thematically analyzed revealed that the insufficient time makes part of the violence genesis at the nursing work and it is characterized as: classical, structural, repressive and alienation violence.

Creyéndose que la forma de organización y la cantidad de tiempo, destinada al trabajo asistencial hospitalario, pueden constituirse en causa de violencia que afecta la vida de trabajadores y usuarios, fue analizada la percepción de los trabajadores sobre el tiempo disponibilizado a sus actividades y a las manifestaciones de violencia en el contexto de trabajo de emergencia y urgencia de un hospital público de Mato Grosso. Trátase de una pesquisa cualitativa realizada junto a los miembros del equipo de enfermería, con datos colectados por medio de observación participante y encuestas. Los datos analizados temáticamente revelaron que el tiempo insuficiente de trabajo hace parte de la génesis de la violencia en el trabajo de enfermería y se presenta tipificada en violencia: clásica, estructural, represiva y alienación.

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This study aimed to identify the correspondence of opinions between nurses and nursing staff members who work at the emergency unit regarding the leadership style performed by nurses and the style nurses must adopt considering the maturity level of nursing staff members and the care provided at the unit. Situational Leadership was adopted as a theoretical reference framework. In order to achieve these goals, instruments were elaborated and applied to 24 research participants. Results demonstrated that the leadership style nurses most frequently perform was E3 (participating), and that nurses should adopt leadership style E4 (delegating) in view of the nursing staff's level of maturity, suggesting that staff members present a high level of maturity (M4).

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This study identified situations indicating medication errors or near misses by analyzing medication orders and the nursing staff's performance. It also implemented a cycle of lectures and a course on safety in medication administration for professionals at the emergency room in a hospital in the northeastern region of Brazil. The results showed that of 1,585 orders under analysis, 83,9% did not clearly express the medication presentation and 84.6% did not define the dosage from prescribed medication, in 34.2%, the administration time was unchecked; in 22.5%, the time had been circled. Among the non-administered medication, 26% were antibiotics and anticoagulants and 15% analgesics. The professionals participated in the implemented strategies with good attendance levels.

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The study had as objectives to verify the professional conduct and feelings of nurses from Emergency Department when they are faced with an adverse event related to medication therapy and to verify its associations with such factors as age, time of completion of college degree, time of experience in the field and previous history with this type of event. The sample was composed of 116 nurses working in various general hospitals in the municipality of Sao Paulo who answered a questionnaire about a fictitious situation related with a medication error. The results revealed the following conducts in order of priority: communicate the physician (69.8%), intensify patient care (55.1%) and make proper annotations in the patient's chart. The most prevailing affective manifestation was to worry (79.3%), followed by impotence and rage (22.4% each) and insecurity (22.4%). The variable analysis showed a relationship between the professional conduct and the time of completion of college degree, while the feelings were related to age and previous experience with this type of event.

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This qualitative study aims to characterize nurses' actions in care for children during emergency situations, at a pediatric unit from a hospital in the interior of São Paulo State, Brazil, by means of semi structured interviews with eight nurses. The interview included questions about professional profile and, next, the research question. The analysis was guided by Bardin's content analysis (1997), which resulted in the theme: the nurses as a mediator in child care in the emergency room, based on four subthemes: child care planning, child's admission and evaluation, acting in child and family care and care training. Nursing actions in emergency situations with children and their families demand knowledge, technical and technological training, ability and agility, decision-making and teamwork, transmitting security, tranquility, empathy and rationality.

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Trata o presente artigo de um relato de experiência desenvolvida durante a realização do Trabalho de Conclusão de Curso de Enfermagem da Universidade Federal de Santa Catarina, no segundo semestre de 2000. Discute a importância do Serviço de Atendimento Pré-hospitalar e Remoção Aeromédica e a necessidade de preparação da Enfermagem para atender as demandas crescentes desses serviços. Apresenta uma revisão histórica destas formas de atenção á saúde no Brasil e no mundo. Discute alguns aspectos relacionados a administração dos recursos humanos e materiais, no tocante a sua especificidade em serviços dessa natureza. Por fim, aponta para a importância do papel do Enfermeiro, bem como da necessária ampliação de suas competências para atuação na área de atendimento pré-hospitalar e remoção aeromédica.

The present article is a description of an experience developed during the Conclusive Monography of the Nursing Course from Santa Catarina´s Federal University, in the second semester year 2000. It discuss the importance of the Pre-hospital Attendiment Service and Airmedical Removal, and the need of nurses preparation to atend the increasing requests of those services. It presents a historical review on these kind of atention method in health, in Brazil and in the world. It discuss some aspects related to management of human and material resources, concerning its specificity in those kind of services. It also points out the importance of the Nurse roll, and the necessity of widing theirs skills to act in the field of pre-hospital attendiment and airmedical removal.

Trata o presente artículo de un relato de experiencia desarolado durante la realización del Trabajo de Conclusión de Curso de Pre-grado en Enfermería. Discute a importancia de lo Servicio de Asistencia pré-hospitalaria e remoción aeromedica, bem como la necesidad de la preparación de los profisionales de la enfermería para atender las demanda crecientes de estos servicios. Presenta uma revisión historica de esta forma de atención a la salud en Brasil y en mundo. Discute algunos aspectos relacionados a la administración de los recursos humano y materiales, no tocante a su especificidad en los servicios pré-hospitalarios. Por fin aponta la importancia del rol del enfermero y la necesaria ampliación de sus competencias para la atuación em la area de atendimento pre-hospitalario e remoción aeromédica.

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Los autores describen el método del Triage para priorizar y optimizar el uso de los recursos, principalmente el factor tiempo y humano, a fin de que aquellos pacientes que realmente necesitan una atención rápida, la obtengan, contribuyendo además a una atención de mayor calidad (AU)

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Los autores describen el método del Triage para priorizar y optimizar el uso de los recursos, principalmente el factor tiempo y humano, a fin de que aquellos pacientes que realmente necesitan una atención rápida, la obtengan, contribuyendo además a una atención de mayor calidad

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The present article is a description of an experience developed during the Conclusive Monography of the Nursing Course from Santa Catarina's Federal University, in the second semester year 2000. It discusses the importance of the Pre-hospital Attendiment Service and Airmedical Removal, and the need of nurses preparation to attend the increasing requests of those services. It presents a historical review on these kind of attention method in health, in Brazil and in the world. It discusses some aspects related to management of human and material resources, concerning its specificity in those kind of services. It also points out the importance of the Nurse roll, and the necessity of widening their skills to act in the field of pre-hospital attendiment and airmedical removal.

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AIM: To evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries. METHODS: All infants aged 7 days to 5 years presenting to an accident and emergency department were simultaneously triaged and assessed by a nurse and a senior paediatrician. Nurse ETAT assessment was compared to standard emergency advanced paediatric life support (APLS) assessment by the paediatrician. Sensitivity, specificity, and predictive values were calculated and appropriateness of nurse treatments was evaluated. RESULTS: The ETAT algorithm as used by nurses identified 731/3837 patients (19.05%); 98 patients (2.6%) were classified as needing emergency treatment and 633 (16.5%) as needing priority assessment. Sensitivity was 96.7% with respect to APLS assessment, 91.7% with respect to all patients given priority by the paediatrician, and 85.7% with respect to patients ultimately admitted. Specificity was 90.6%, 91.0%, and 85.2%, respectively. Nurse administered treatment was appropriate in 94/102 (92.2%) emergency conditions. CONCLUSIONS: The ETAT algorithm and treatment instructions, when carried out by nurses after a short specific training period, performed well as a screening tool to identify priority cases and as a treatment guide for emergency conditions.

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