International Emergency Nursing

Editorial board

2012-04-01

The Future of Nursing for Emergency Care

Heather McClelland — 2012-04-01

The recent publication of the report on The Future of Nursing generated by the Institute of Medicine and the Robert Wood Johnson Foundation () has been welcomed by the healthcare community in the United States of America. Their aim was to ‘assess and transform the nursing profession’ in light of recent government policy which has the potential to greatly increase the demand for healthcare, and as such, nursing. They examine the barriers for nursing and set out recommendations to enhance the profession in the future. Some readers may feel the report describes a limited context, but these are global issues for the nursing profession, and closely reflect similar recommendations in Australia () and Europe (). The demands are the same; an aging population, shrinking workforce and increasing costs so it is not surprising our global communities are looking for future direction.

Personal Reflection – Laughter and Tears

2012-04-01

Managing patient flow with triage streaming to identify patients for Dutch emergency nurse practitioners

Christien van der Linden, Robert Lindeboom, Naomi van der Linden, Cees Lucas — 2011-07-15

Abstract: Introduction: We developed a stream system to the current triangle system in order to manage patient flow at the emergency department and to clarify ENP role boundaries.Methods: Data on admission and death rates – indicating injury severity – and data on length of stay – indicating resource utilisation – were collected from 48,397 patients triaged in the Netherlands in 2009.Results: A total of 24,294 (50.2%) patients were triaged as ‘suitable for treatment by an ENP’ (ENP-stream). Remaining patients were triaged ‘medium care’ or ‘high care’. In the medium and high care groups, significantly more admissions took place (6100, 25.3%) and significantly more patients died (31, 0.1%) compared to the patient group in the ENP-stream (admissions: 840, 3.5%, p<0.001 and deaths 0, 0.0%, p<0.001). The ENP-streaming is an accurate predictor of not needing to be admitted (PPV=97%) and of ED survival (PPV=100%). Mean length of stay was significantly shorter for patients in the ENP-stream compared to the other patients (back transformed values: 74 vs. 147min, p<0.001).Conclusion: This study showed excellent correlation between the ENP-streaming and patients’ injury severity and resource utilisation, suggesting high internal validity of our triage streaming system. It clarifies the ENP role, minimising the subjectivity of patient allocation.

The everyday work at a Swedish emergency department – The practitioners’ perspective

Henrik Andersson, Eva Jakobsson, Carina Furåker, Kerstin Nilsson — 2011-07-18

Abstract: In the everyday work at emergency departments (EDs), the patients being cared for have different needs and perceived symptoms. To meet their need for emergency care, knowledge of the work is important. The aim of this study is to explore the everyday work at a Swedish ED from a practitioner’s perspective.Method: This study has a qualitative, exploratory design with observations and interviews at two EDs. Data were analysed by content analysis.Findings: The everyday work is characterised by a rapid, short and standardised encounter with limited scope to provide individualised care, which leads to a mechanical approach. It is also characterised by an adaptive approach in which practitioners strive to be adaptable by structuring everyday work and cooperation to achieve a good workflow.Conclusions: The study shows that the practitioners’ encounter with patients and relatives is rapid and of limited duration. The care activities that practitioners mainly perform comprise standard medical management and are performed more mechanically than in a caring way. The practitioners strive to balance the requirements and the realisation of the everyday work through structures and in cooperation with other practitioners, although they work more in parallel than in integrated teams.

Violence in the emergency department: An ethnographic study (Part I)

Jacqui Bee Chuo Lau, Judy Magarey, Richard Wiechula — 2011-08-29

Abstract: Violence in the emergency department (ED) is a significant problem and it is increasing. Nevertheless the problem remains inadequately investigated as most studies that have investigated this issue are descriptive in nature. Although these studies have provided important preliminary information, they fail to reveal the complexities of the problem, in particular the cultural aspects of violence which are crucial for the ED. This paper is part I of a 2-part series which will provide an overview of the background, aims and methods of an ethnographic study about violence in the ED. The study aimed to explore the cultural aspects of violence in the ED. Contemporary ethnography was adopted to frame the study’s methodology. The study was carried out at a major metropolitan ED over 3 months using observations, questionnaires and interviews. Initially, the questionnaires were analysed using SPSS before incorporating into the qualitative data. Then, a data analysis framework was adopted to assist in the analysis of data at item (domain), pattern (taxonomic and componential) and structural levels. A brief description of the cultural scene will also be highlighted before leaving the findings of the study along with its discussions to the part II of the 2-part series.

Group supervision as a means of developing professional competence within pre-hospital care

Peter Brink, Siv Bäck-Pettersson, Ninni Sernert — 2011-05-30

Abstract: Background: Ambulance care has its foundations in experience-based knowledge relating to the care provider’s flexibility and humility in the encounter with patients. The group supervision model used in this study is retrospective and experience orientated and it is designed to promote and develop the group’s overall competence by facilitating the group process, as well as extending and improving levels of professional knowledge.Aim: The aim was to evaluate the experience of group supervision and to explore its impact on the participants’ personal and professional development.Method: This study uses an inductive qualitative approach where data collection was performed in the form of a focus group interview and analysed by a model of content analysis.Conclusion: Group supervision appears to have had a positive impact on the participants’ personal and professional development. The structure of the model appears to make it easier for the inexperienced co-worker more rapidly to develop expertise within his/her working area, which can be seen as an important tool in today’s financially focused and time-pressurised health-care service. It is to be hoped that the results of this study will interest health managers and encourage them to consider group supervision as a tool for professional development not only within the area of the ambulance service.

Pre-hospital pain management patterns and triage nurse documentation

Margaret Fry, Jennifer Hearn, Therese McLaughlin — 2011-08-05

Abstract: Introduction: Little is known about the public’s preferences for pain management prior to attending an Emergency Department (ED). Therefore, the aim of the study was to explore (i) triage documentation of pre-hospital analgesic patterns for patients presenting in pain; (ii) patient documented explanations for not self administering an analgesic in the pre-hospital setting; (iii) triage nurse documentation of pain descriptors and or pain scores; and (iv) the disposition of ED patients presenting in pain.Method: A 2-week retrospective exploratory review was conducted.Results: There were 2142 ED presentations during the 2-week study and 52% of patients had documented evidence of arriving with a painful condition. Of the 1113 patients 60% were documented to be in pain on arrival. Of the group documented to have arrived in pain only 28% self-administered or received an analgesic in the pre-hospital/community setting. Patients provided a variety of reasons for not self-administering a pre-hospital analgesic.Conclusion: Unnecessary suffering may be avoided if the public had a better understanding of pain and the benefits of pain management. Further research is required to better understand the beliefs and attitudes towards pain and pain management by clinicians and the public.

The divided self: Near death experiences of resuscitated patients – A review of literature

Robyn Cant, Simon Cooper, Catherine Chung, Margaret O’Connor — 2011-08-08

Abstract: This paper explores the prevalence of ‘near death experience’ phenomena associated with a resuscitation event and examines the current state of evidence for causation. Patients’ reports of unusual recollections associated with a period of unconsciousness (perceived as approaching death) have fascinated individuals and the medical fraternity. Near death experiences (NDE) are reported in 4–9% of general community members and up to 23% of critical illness patients, although they can occur in healthy individuals who may think they are in peril. One explanation is that paranormal visions that include seeing bright lights, a tunnel and having feelings of peace may be a stage of enlightenment as death approaches. More objective explanations point to neuro-chemical changes in a stressed or dying brain as explanation for nearly all the elements of near death experience. However if this is so, NDE should occur in all patients who are critically ill and near death. In general, patients report positive psychological outcomes after a near death experience. Nurses can support patients during a time of crisis by assisting them and their families to comprehend the experiential event using effective communication and listening skill.

Improving the safety of oxygen therapy in the treatment of acute myocardial infarctions

Maria Metcalfe — 2011-05-18

Abstract: Aim: The article examines the evidence for giving oxygen routinely to patients with suspected myocardial infarction, and addresses the challenges in changing practice.Background: It has been thought that administering oxygen to patients suffering from acute myocardial infarctions may be beneficial, but there is a lack of supporting evidence. Furthermore there is evidence that the use of oxygen in some circumstances may not improve clinical outcome. Despite conflicting evidence, guidelines in the past have recommended supplementary oxygen as part of treatment. Therefore it was necessary to understand and identify best practice.Methods: Evidence was collated using electronic databases. Search terms included ‘acute myocardial infarction’ ‘acute coronary syndrome’ ‘oxygen’ and ‘hypoxia’, ‘hyperoxaemia’.Conclusion: A systematic review of studies did not confirm that the use of routine oxygen in the acute stages of a myocardial infarction reduces myocardial ischemia. In reality, some evidence suggests that oxygen may even increase myocardial ischemia. Therefore it is crucial that emergency care nurses/practitioners across the world use observation skills and monitoring such as pulse oximetry to recognise the clinical need for supplementary oxygen to be given to a patient.

Nail gun may cause heart injury: A young adult’s misadventure

2011-08-03

Abstract: Penetrating cardiac and great vessels trauma is life threatening and a surgical challenge. We relate an unusual case of pulmonary artery injury secondary to an accidental trauma by a nail gun. Surgical repair was late but successful.

Myasthenia gravis: A real emergency

Jared M. Kutzin — 2011-08-01

One afternoon, a 31year-old, obese, African–American female presents to the triage nurse of a moderately sized tertiary care facility, complaining of difficulty breathing and swollen eyes since earlier in the morning. The patient reports diarrhoea for one week and a feeling of general weakness. The patient appears anxious and her vital signs are; blood pressure 148/86mmHg, heart rate of 110beat/min, respiratory rate of 24breaths/min, oxygen saturation of 100% on room air and temperature of 37.2°C (98.9°F). The patient is transported via wheelchair to a treatment room where care is handed off from the triage nurse and a complete history and physical exam was performed. On exam the patient’s eyes are noticeably swollen and tearing, the patient is able to speak in short sentences but is frequently clenching her chest, coughing, and stating “I feel my throat is closing”. Her lung sounds are clear to auscultation bilaterally with good air movement despite her restlessness and anxious appearance. Her oral exam revealed no obvious airway obstruction or tongue oedema. The remainder of her exam was unremarkable. An EKG was obtained, a 20 gauge IV was placed in her right antecubital space, cardiac monitoring was initiated, and oxygen was supplied via nasal cannula. Vital signs upon arrival in the treatment room were not significantly changed from triage vital signs, with a blood pressure of 158/90mmHg, heart rate 120beats/min in a sinus tachycardic rhythm, respiratory rate of 26breaths/min, and oxygen saturation of 98% on 2L oxygen via nasal cannula.

Heather Jarman — 2011-06-15

This is a new topic in the at a glance series that although could be used by any health professional working in emergency medicine it is geared toward students and junior staff members. It focuses on the most common or critical conditions presenting in the emergency setting and is organised in symptom headings rather than under diagnoses.

Carole Rush — 2011-08-22

This book serves as the main reference text for the comprehensive, multidisciplinary course, “Acute Medical Emergencies”, which I am sorry is only taught in the UK at this time. The content is inclusive of the major medical emergencies encountered by health professionals working with critically ill patients: Cardiac, respiratory and neurological emergencies, toxicological emergencies, endocrine emergencies such as complication of diabetes, anaphylaxis, and gastrointestinal bleeding. The authors, reviewers and editorial board for this text represent the major specialities of Emergency Medicine, Anaesthesia, General Medicine, Cardiology, Respirology, Geriatrics and Intensive Care Medicine.

Research Review

Alastair Gray — 2012-03-07

Venkat, A., Hunter, R., Hegde, G., Chan-Tompkins, N., Chuirazzi, D., Szczesiul, J., 2012. Perceptions of participating emergency nurses regarding an ED seasonal influenza vaccination program. Journal of Emergency Nursing 38 (1) 22–29

News and Notices

2012-04-01