Acil serviste ruh sağlığı triyaj yaklaşımının etkinliği
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Tarih
2019
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Sağlık Bilimleri Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Çalışma, acil serviste ruh sağlığı triyaj yaklaşımının etkinliğini belirlemek amacıyla yapılmıştır. Yöntem: Çalışma metadolojik, tek gruplu(hemşire) ve randomize olmayan(hasta) gruplu yarı deneysel ve analitik bir özelliktedir. Mayıs 2018 – Mart 2019 tarihleri arasında bir Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Kliniği'nde yürütülmüştür. Çalışmaya eğitim programına katılan 30 hemşire(katılım oranı %68,18); eğitim öncesi dönemde 200 hasta, eğitim sonrası dönemde ise 165 hasta dahil edilmiştir. Araştırma verileri; acil servis hemşirelerinin ruhsal sıkıntısı olan hastalara yönelik tutum belirleme formu, eğitim bilgi formları, ruhsal durum değerlendirme formu, hasta memnuniyeti formu ve hastane bilgi sistemindeki verilerle elde edilmiştir. Çalışmada öncelikle Avustralya Ruh Sağlığı Triyaj Skalası'ını Türk kültürüne uyarlama çalışması yapılmıştır. Daha sonra hemşirelere "Acil serviste ruhsal sıkıntısı olan hastaya yaklaşım ve ruh sağlığı triyaj skalası (RSTS)" konulu eğitim verilmiş ve hastalara RSTS uygulanmış olup; RSTS uygulamasının geçerlik ve güvenirliğine ve hemşirelere verilen eğitimin etkinliğine ilişkin bulgulara ulaşılmıştır. Verilerin analizinde SPSS 22 programında parametrik ve nonparametrik testler kullanılmıştır. Bulgular: Çalışmaya katılan hemşirelerin %73,3'ü kadındır, yaş ortalaması 28,53±4,77; acil serviste çalışma yılı ortalaması 4,57±3,83'tür. Avustralya Ruh Sağlığı Triyaj Skalası'nın kapsam ve yüzey geçerliği açısından Türk kültürüne uygun olduğu (p<0,05); ayrıca Türkiye'de kullanılmakta olan genel triyaj skalasının alt kategorileriyle içerik ve tanım olarak iyi düzeyde uyumlu olduğu saptanmıştır (Kappa 0,738 p<0,05). Çalışmada eğitim sonrasında RSTS uygulamasının inter rater güvenirliği Kappa değerinin 0, 631olduğu (p<0,05), geçerliliği açısından hastaların triyaj bekleme süresinin 26,56 dakika olduğu (p<0,05) ve hemşirelerin doğru triyaj kodunu belirleyebildiği saptanmıştır. Bununla birlikte eğitim sonrasında, RSTS uygulamasının geçerliliği açısından hastaların tedavi ve bakım için acil serviste kalma süresi, toplam acil serviste kalma süresi, acil serviste hemşirelik hizmetlerinden memnuniyet durumu üzerine olmadığı belirlenmiştir(p>0,05). Aynı zamanda RSTS uygulamasının geçerliliği açısından acil servise tekrar başvuru durumu, hemşirelerin verdikleri triyaj kodu ile hastaların triyaj bekleme süresi arasındaki uygunluk durumu üzerine etkinliğinin olmadığı belirlenmiştir. Diğer taraftan hemşirelere verilen eğitimin etkinliğine ilişkin bulgular incelendiğinde, eğitim sonrasında hemşirelerin bilgi düzeylerinin ve ruhsal sıkıntısı olan hastalara yönelik iş doyumunun arttığı, iş yükünün azaldığı, hastalara bakım verirken hemşirelerin kendilerine güvenme durumlarının arttığı, bakım verirken daha az güçlük yaşadıkları bulunmuştur. Hasta bakımı ile ilgili güçlüklerin hastalarla ilgili değil acil servisin fiziki koşulları ile ilgili olduğu ve hastaların uygun koşulları olan genel acil serviste bakım almaları gerektiği konusunda farkındalık geliştiği saptanmıştır. Ayrıca hemşirelerin bakım verirken hissettikleri temel duyguların eğitim öncesinde öfke, kaygı, çaresizlik iken; eğitim sonrasında kaygı, çaresizlik, üzüntü ve korku olduğu belirlenmiştir. Sonuç: Çalışmada Avustralya Ruh Sağlığı Triyaj Skalası Türk kültürüne uyarlanmıştır. Ruh sağlığı triyaj skalası uygulamasının güvenirliği ve hemşirelerin doğru triyaj kodu verme ve hastaların triyaj bekleme süresi üzerine geçerliği kanıtlanmıştır. Eğitim programının genel olarak hemşirelerin ruhsal sıkıntısı olan hastalara bakım vermeye yönelik duygu, düşünce ve tutum konusunda olumlu bir etkisi vardır. Ruh sağlığı triyaj skalası uygulaması konusunda daha geniş bir örneklemde uzun süreli ve çok sayıda çalışmaya gereksinim olduğu düşünülmektedir.
Aim:The aim of this study was to determine the effectiveness of triage approach in mental health in emergency department. Method:The study is a methodological, single group(nurse) and non-randomized (patient) quasi-experimental and analytical features.It was conducted between May 2018-March 2019 at a University Medical Faculty Hospital Emergency Medicine Clinic. Thirty nurses (participation rate 68.18%), 200 patients in the pre-training period and 165 patients in the post-training period were included in the study.The data of the study were obtained by the attitude determination form of the emergency service nurses for the patients with mental disorders, education information forms, mental status assessment form and patient satisfaction form and hospital information system.In the study, first of all, the adaptation of Australian Mental Health Triage Scale to Turkish culture was conducted.Then, the nurses were given training on yaklaşım "Approach to the patient with mental disorder in the emergency department and mental health triage scale (RSTS)" and RSTS was applied to the patients; findings related to the validity and reliability of RSTS and the effectiveness of the training given to nurses were reached. In the analysis of the data, parametric and nonparametric tests were used in SPSS 22 program. Results: 73.3% of the nurses participated in the study were women, the mean age was 28.53±4.77 years;mean working year in emergency department is 4.57±3.83.The Australian Mental Health Triage Scale was found to be suitable for Turkish culture in terms of scope and surface validity(p<0.05);general description of the content and further sub-categories triage scale has been used in Turkey are found to be good level compatible(Kappa 0.738 p<0.05).The interrater reliability of the RSTS application after training was found to be Kappa value of 0.631(p<0.05), and the triage waiting time of patients was 26.56 minutes(p<0.05) in terms of validity, and the nurses could accurately determine the triage code.However, in terms of the validity of RSTS application, it was determined that the duration of stay in the emergency room, total emergency stay, and satisfaction with the nursing service in the emergency department were not found to be significant(p>0.05).However, in terms of the validity of RSTS application, it was determined that the duration of stay in the emergency room, total emergency stay,and satisfaction with the nursing service in the emergency department were not found to be significant(p>0.05).At the same time, it was determined that RSTS application had no effect on the status of re-admission to the emergency department, the suitability between the triage code given by the nurses and the duration of triage waiting of the patients.On the other hand, when the findings regarding the effectiveness of the training given to nurses were examined, it was found that after the training, the level of knowledge of the nurses and job satisfaction for the patients with mental distress increased, the workload decreased, the nurses' self-confidence increased while giving care to the patients, and they experienced less difficulty while giving care.It was found that the difficulties related to patient care were not related to the physical conditions of the emergency department, but that the patients needed to receive care in the general emergency room, which is the appropriate conditions. In addition, the basic emotions that nurses feel when giving care before training are anger, anxiety, and helplessness;after the training, anxiety, helplessness, sadness and fear. Conclusion:The Australian Mental Health Triage Scale was adapted to Turkish culture. The reliability of the mental health triage scale application and the validity of the triage code of the nurses and the triage waiting time of the patients have been proved. In general, the training program has a positive effect on emotion, thought and attitude towards nursing care for patients with mental health problems. It is considered that long-term and large number of studies are needed in a wider sample of mental health triage scale application.
Aim:The aim of this study was to determine the effectiveness of triage approach in mental health in emergency department. Method:The study is a methodological, single group(nurse) and non-randomized (patient) quasi-experimental and analytical features.It was conducted between May 2018-March 2019 at a University Medical Faculty Hospital Emergency Medicine Clinic. Thirty nurses (participation rate 68.18%), 200 patients in the pre-training period and 165 patients in the post-training period were included in the study.The data of the study were obtained by the attitude determination form of the emergency service nurses for the patients with mental disorders, education information forms, mental status assessment form and patient satisfaction form and hospital information system.In the study, first of all, the adaptation of Australian Mental Health Triage Scale to Turkish culture was conducted.Then, the nurses were given training on yaklaşım "Approach to the patient with mental disorder in the emergency department and mental health triage scale (RSTS)" and RSTS was applied to the patients; findings related to the validity and reliability of RSTS and the effectiveness of the training given to nurses were reached. In the analysis of the data, parametric and nonparametric tests were used in SPSS 22 program. Results: 73.3% of the nurses participated in the study were women, the mean age was 28.53±4.77 years;mean working year in emergency department is 4.57±3.83.The Australian Mental Health Triage Scale was found to be suitable for Turkish culture in terms of scope and surface validity(p<0.05);general description of the content and further sub-categories triage scale has been used in Turkey are found to be good level compatible(Kappa 0.738 p<0.05).The interrater reliability of the RSTS application after training was found to be Kappa value of 0.631(p<0.05), and the triage waiting time of patients was 26.56 minutes(p<0.05) in terms of validity, and the nurses could accurately determine the triage code.However, in terms of the validity of RSTS application, it was determined that the duration of stay in the emergency room, total emergency stay, and satisfaction with the nursing service in the emergency department were not found to be significant(p>0.05).However, in terms of the validity of RSTS application, it was determined that the duration of stay in the emergency room, total emergency stay,and satisfaction with the nursing service in the emergency department were not found to be significant(p>0.05).At the same time, it was determined that RSTS application had no effect on the status of re-admission to the emergency department, the suitability between the triage code given by the nurses and the duration of triage waiting of the patients.On the other hand, when the findings regarding the effectiveness of the training given to nurses were examined, it was found that after the training, the level of knowledge of the nurses and job satisfaction for the patients with mental distress increased, the workload decreased, the nurses' self-confidence increased while giving care to the patients, and they experienced less difficulty while giving care.It was found that the difficulties related to patient care were not related to the physical conditions of the emergency department, but that the patients needed to receive care in the general emergency room, which is the appropriate conditions. In addition, the basic emotions that nurses feel when giving care before training are anger, anxiety, and helplessness;after the training, anxiety, helplessness, sadness and fear. Conclusion:The Australian Mental Health Triage Scale was adapted to Turkish culture. The reliability of the mental health triage scale application and the validity of the triage code of the nurses and the triage waiting time of the patients have been proved. In general, the training program has a positive effect on emotion, thought and attitude towards nursing care for patients with mental health problems. It is considered that long-term and large number of studies are needed in a wider sample of mental health triage scale application.
