International Emergency Nursing

Editorial board

2013-04-01

Publisher’s Announcement

2013-04-01

Emergency nurse practitioners’ perceptions of their role and scope of practice: Is it advanced practice?

Donna McConnell, Oliver D. Slevin, Sonja J. McIlfatrick — 2012-04-26

Abstract: There are multiple interpretations of the nurse practitioner role which appear to be shaped by discourses within and outside the profession and its regulatory body. This study aimed to explore and clarify the role and scope of practice of emergency nurse practitioners in a region in the United Kingdom and determine if they fulfil the proposed criteria for Advanced Nurse Practitioners. A survey approach using questionnaires (n=42) was adopted. The sample included all emergency nurse practitioners working in Accident and Emergency Departments and Minor Injury Units in the region. Statistical data was analysed using SPSS for Windows and qualitative data was content analysed for themes. Results revealed a variation in education. Investigation of role typology and scope of practice revealed a relatively homogenous group where the clinical aspect of the role dominated. The scope of practice was perceived to be influenced by internal factors such as competence; however protocol use, referral rights and prescribing authority could be considered ways that nursing management and medical staff indirectly control the role. Findings suggested that emergency nurse practitioners were working at a level significantly beyond registration, yet do not fulfil the Nursing and Midwifery Council proposed criteria for Advanced Nurse Practitioner.

The classification and management of skin and soft tissue infections

Louise Cross — 2012-07-23

Abstract: Skin and soft tissue infections (SSTIs) are a common problem in patients presenting to the emergency department, varying from mild local inflammation to necrotizing fasciitis. SSTI were the 2nd most common indication for antibiotic use in Europe in 2006. Currently, the National Institute of Clinical Excellence (a UK based independent organization responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health) has not published any guidelines for the classification and management of these patients. This is a review of the evidence around attempts at developing classification systems for SSTI and their management. It also considers the financial implications for both the patient and the healthcare system and the personal ramifications for patients.

Triage assessment of registered nurses in the emergency department

Torunn Kitty Vatnøy, Mariann Fossum, Nina Smith, Åshild Slettebø — 2012-07-16

Abstract: Standardised triage systems have been implemented in emergency departments (EDs) to improve the efficacy of assessment strategies as performed by registered nurses (RNs). However, the exact effect the standardised triage systems have on the decision-making process remains unclear.Aim: To evaluate decision making in the triage setting before and after implementation of the Medical Emergency Triage and Treatment System Adult in one hospital’s ED.Methods: A descriptive intervention design with a quantitative approach. A total of 655 patients before and 413 patients after the intervention were included. A questionnaire was used to evaluate how the RNs assessed the patients before intervention while the emergency patient records were used for data collection after intervention.Results: Before the intervention, a majority of the assessments were founded on signs and symptoms and medical diagnoses, whereas vital parameters were rarely used. After the intervention, nearly two thirds of the patients were assessed according to a triage system with vital parameters and standardised algorithm for symptoms and signs included in the assessment procedure.Conclusion: Implementing a standardised triage system, including vital parameters and standardised algorithms for signs and symptoms, increased the use of vital parameters and signs and symptoms for decision making and acuity assignment.

The application of theory to triage decision-making

Gudrun Reay, James A. Rankin — 2012-06-18

Abstract: Theory in nursing is frequently thought of as being a mainly academic exercise with little relevance to the everyday practice of nursing. In nursing there is disagreement about what theory is and what it is not. Scientific theory is an abstract systematic explanation of how concepts are related to each other. Many nursing theories do not fit this description and should therefore, in the opinion of the authors, be thought of as models. Nursing knowledge has been described as the knowledge that is useful to nurses, whether it is derived from the discipline of nursing or other disciplines.Decision-making (DM) and triage nursing have been investigated by several nurse researchers, however, most have not clearly articulated a theoretical or conceptual framework. The recognition primed decision (RPD) model is based on research about DM under uncertain conditions such as time pressure, limited time available, high stakes, and changing cues. The context of emergency triage nursing DM is congruent with the RPD model. The authors propose that the RPD model can serve as a foundation for research that seeks to understand DM by triage nurses with the aim of yielding new knowledge that is useful for their practice.

Comparing triage evaluation of adult dyspneic patients between emergency nurses and doctors using simulated scenarios

Beng Leong Lim, Zhi Rui Eunice Tay, Alicia Vasu, Wei Jian Kenneth Heng — 2012-08-10

Abstract: Objective: Although registered nurses frequently perform triaging in many emergency departments (EDs), little is known regarding the agreement between nurses and doctors in triaging dyspneic patients. The aim of our study was to compare the effectiveness of trained ED nurses with doctors in the evaluation of dyspneic patients at triage using the SimMan 3G simulator.Methods: We compared eight nurses who underwent a structured training/accreditation program with eight doctors. Two assessors evaluated them through seven common and/or important cardiorespiratory simulated scenarios. Each scenario had an evaluation instrument that scored participants on triage assessment and management. Each nurse was also surveyed over a six-point Likert scale (0–5) on their confidence in triaging dyspneic patients after the study. Data was analyzed using descriptive statistics with statistical significance set at p<0.05.Data/results: There were no statistically significant differences between the mean assessment or management scores across all scenarios between doctors versus nurses (p ranging from 0.070 to 0.798). Six nurses felt they could evaluate ED dyspneic patients alone (score of 4) and the remainder with supervision (score of 2–3).Conclusion: Trained ED nurses; when compared to doctors; could triage and evaluate dyspneic patients effectively on a simulator.

Using a theory to understand triage decision making

Anita Smith — 2012-04-06

Abstract: The purpose of this discussion is to present triage decision making research within the context of the Revised Cognitive Continuum Theory. Triage is an essential clinical skill in emergency nursing. Understanding the best way to facilitate this skill is vital when educating new nurses or providing continuing education to practicing nurses. Delineating research evidence within a theory allows clinical educators to understand practices that foster successful triage skills and permits the grounding of educational strategies within a theoretical framework.

Trauma care in South Africa: From humble beginnings to an afrocentric outreach

Timothy Craig Hardcastle, Petra Brysiewicz — 2012-06-25

Trauma can be the result when humans interact with each other or the environment. In South Africa, trauma care has been associated inextricably with the development of surgery and nursing, as well as the development of the current pre-hospital care system (). Throughout both World Wars, as well as during the struggle for democracy, and particularly in a more formal manner from the early 1980s, trauma care has developed in South Africa, with the country leading the way in many areas ().

Nurses experiences in chemical emergency departments: Iran–Iraq war, 1980–1988

2012-04-09

Abstract: Background: Nurses have played a major role in taking care of the wounded across the centuries. One of the most important roles of Iranian nurses in wartime has been working in chemical emergency departments. This study investigated the nature of nursing practice in chemical emergency departments created in the context of the Iran–Iraq War fought during 1980–1988.Method: This is a history methodology design with oral history and in-depth interview to detect nurses ‘actual experiences in chemical emergency departments while taking care of the chemically injured military forces.Findings: Today’s nurses emphasize finding new ways to fulfill the present nursing needs and to combine theory and practice in an appropriate framework.Having a retrospective approach to utilize nurses’ experience can well clarify the future way to achieve this goal.Conclusion: This study revealed the way the nurses prepared to take care of the chemically injured in miserable situations and their practice in chemical emergency departments. It highlighted their awareness of wartime nursing and the challenging experiences it brings.

Challenges developing evidence-based algorithms for the trauma reception and resuscitation project

Geraldine A. Lee, Angela Murray, Rosie Bushnell, Louise E. Niggemeyer — 2012-03-14

Abstract: A project based at the Alfred Emergency and Trauma Centre in Melbourne, Australia aimed to standardise trauma resuscitation, documentation and interventions by developing best practice algorithms. The primary study objective was to demonstrate a reduction in management errors using a real-time computer based algorithm (the study group) compared to the control group in an open randomised controlled interventional study. A baseline control group was also used for comparison with usual (current) practice. In order to examine the existing evidence and algorithms in trauma care, nine teams of emergency nurses and doctors were formed. Specific literature searches performed by each team revealed a paucity of evidence supporting clinical practice in the trauma setting for procedures. Subsequently, the multidisciplinary teams worked together and developed algorithms based on best practice. The process revealed three main areas of challenges in the development of algorithms: (i) clinical, (ii) research and (iii) nursing challenges. The completion of the project demonstrated benefits in the real-time computer based algorithm with a reduction in the error rate per patient from the baseline control group to the intervention study group (2.30 vs. 2.13, p=0.04) and error-free resuscitations increasing from 16% to 21.8% (p=.049). This project supported the implementation of a real-time computer based algorithm system with improved protocol compliance and reduced errors and morbidity.

The public’s perception of prehospital emergency care in the County of Skane, southern Sweden

Kristina Blomstedt, Helena Nilsson, Anders Johansson — 2012-07-16

Abstract: Introduction: The prehospital emergency care has had a rapid progress in Sweden in terms of technology, treatments and personnel education demands. In the County of Skane there is at least one specialized nurse in every ambulance. Possible misuses of the resources by the public have been acknowledged.Aim: To investigate the public’s use, knowledge and expectations of the prehospital emergency care in Skane, southern Sweden.Method: A cross sectional descriptive survey, using a stratified sampling. Inclusion criteria were: 18year or older and currently living in Skane.Results: Of 735 people who were asked 54.4% (n=400) chose to participate in the study. 44.0% of the respondents had been transported with ambulance. 34.5% of the respondents believed that the lowest educated personnel responsible for the patient was the paramedic. The results show that the respondents trust the personnel’s knowledge and work skills. Older informants expected faster treatment by a physician when arriving by ambulance to the hospital, regardless of medical condition.Conclusion: The public had confidence in the ambulance personnel’s knowledge, ability to make assessment and give treatment despite not being updated on the current competence of the personnel. A positive experience of contact with the ambulance service was distinct.

Reliability of a Swedish pre-hospital dispatch system in prioritizing patients

Bosse Ek, Pontus Edström, Anders Toutin, Marianne Svedlund — 2012-01-03

Abstract: The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.

Julia Booth — 2012-08-13

Now in its 7th edition this two volume American text continues to be heralded as one of the Major literary resources of emergency medicine and remains unrivalled by any current British equivalent. The editors and authors, all specialists in the field of Emergency medicine, claim to offer a general evidenced based reference and clinical roadmap on a wide variety of conditions and procedures a claim that is clearly upheld. At first glance one may consider this book to be aimed purely at a medical readership however on closer scrutiny it is apparent that nursing and allied health professionals with a passion for emergency medicine will also benefit from accessing its contents.

Samantha J. Brace — 2011-12-26

This book is part of a highly successful ‘At a Glance’ series of illustrated texts that are designed for use by students whilst studying to pass exams. The success of this book will be the short, visually stimulating, format that allows the student or practitioner to focus their learning by giving essential information on the key aspects of rheumatology, orthopaedics and trauma. This title is a highly visual introduction to the basic principles and practice of the emergency application of Orthopaedics and Rheumatology. Each topic is covered in a single two-page section which includes one page of diagrams supplemented by a second page of explanatory text which spans the basic principles of the anatomy and physiology through to the examination techniques and the practical procedures that might be required.

Research review

Alastair Gray — 2013-04-01

Anderson J.C., Sheridan D.J., 2012 Female genital injury following consensual and non-consensual sex: state of the science. Journal of Emergency Nursing 38 (6), 518–522. This paper opens by helpfully setting out the prevalence and nature of sexual assault on females in the United States. It highlights that after such assaults many patients are assessed in the emergency department. The role of sexual assault nurse examiners (SANEs) is explored. The assessment of patients following sexual assault is fraught with difficulties, not least the ability to accurately identify and evaluate genital injuries in order to support legal testimony regarding the nature of the injuries sustained. This paper examines the role of assessment for legal purposes and the extent to which this is useful. Prosecutors need evaluation of injury to address the twin questions of whether injuries identified are consistent with the history provided by the patient, and of whether sexual assault has actually taken place. The issue raised is whether this can be achieved with current knowledge of the nature of injuries sustained.