International Emergency Nursing - Articles in Press

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

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 impact of interprofessional collaboration on nurses’ satisfaction and comfort with intranasal fentanyl - Corrected Proof

Susanne Moadebi, Fiona Kwan, Sherry Stackhouse, Lisa Reddekopp — 2012-04-09

Abstract: Background: Healthcare providers’ beliefs and comfort with analgesics can impact medication decisions. Interprofessional educational interventions (IPE) improve medication delivery processes ultimately resulting in better patient care. The purpose of this study was to determine the impact on nurses’ satisfaction and comfort with administering intranasal fentanyl for pediatric pain management in the Emergency Department (ED) before and following IPE.Methods: A protocol for administering intranasal fentanyl for children age 1–15years with acute pain was introduced to the ED Nursing staff by an educational session conducted by a clinical pharmacist. Nurses’ level of satisfaction and comfort was surveyed prior to and following IPE. Compliance with patient monitoring was determined by chart review.Results: Eighty percentage of the nurses were very satisfied with the analgesic effect of intranasal fentanyl but barriers for its use included personal comfort, nurse monitoring time and age appropriateness. Most nurses felt comfortable administering intranasal fentanyl but showed increased comfort with intravenous morphine (83% versus 98%, p<0.05). Benefits cited by nurses included having a pharmacist available in the ED to assist in the delivery of intranasal fentanyl.Conclusion: The use of IPE facilitated knowledge sharing to improve nurses’ comfort with administering analgesic medication and the quality of patient care services.

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

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.

Using a theory to understand triage decision making - Corrected Proof

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.

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

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.

Management of anaphylaxis in the ED: A clinical audit - Corrected Proof

Emma J.R. Caton, Maria Flynn — 2012-03-02

Abstract: Anaphylaxis is one of the potentially life threatening conditions which present to the ED however there is no universal understanding or definitive diagnostic test to aid ED practitioners in its management. Evidence suggests this leads to confusion for ED staff and may compromise patient care.This paper reviews the existing evidence around the effective diagnosis, emergency treatment and long term management of anaphylaxis. It then describes a clinical audit which was carried out in the ED of a large UK University hospital.A retrospective audit design sampled all patients presenting with anaphylaxis in one calendar year, 146 cases were eligible for inclusion. The audit results were consistent with the existing understanding and showed widespread inconsistencies in the diagnosis and treatment of this patient group.The implications the findings may have for the wider ED nursing community are discussed and we conclude that further research and service development is needed to ensure the best possible care for patients with anaphylaxis.

Emergency nurses: Procedures performed and competence in practice - Corrected Proof

2012-02-27

Abstract: Introduction: Emergency nurses play an important role in identifying and managing critical illness. Thus, nurses’ competence in performing a range of functions is important. This study aimed to identify the procedures performed and associated competencies of emergency nurses.Methods: A quantitative descriptive design was used and 403 questionnaires distributed to nurses working across 11 emergency departments in Ireland. Data were collected using a researcher developed questionnaire, measuring 119 nursing procedures and corresponding competency levels. A response rate of 53% (n=214) was achieved.Results: Results show that activities relating to diagnostic function were conducted most often, followed by activities relating to organisation and work role competencies. Within the helping role, planning patient care was indicated as a key activity. Identifying patient care priorities was conducted most often in the domain of effective management of rapidly changing situations. Activities performed least often were those associated with administering and monitoring therapeutic interventions. Nurses judged themselves to be most competent in diagnostic function. There was a statistically significant positive relationship between nurses level of perceived competence and frequency of practice (p<0.01).Conclusion: Emergency nurses in Ireland engage in a wide range of activities, many of which are described in other countries as advanced practice. Recognition needs to be given and education prioritised in deficit areas.

Corrected Proof

Annie Jenkin — 2012-02-02

As the title suggests, the content is directed towards an important group of patients who as ED nurses we see many of in our day to day practice. Although there are no specific chapters for nursing older adults in the emergency or urgent care environment, there is a comprehensive range of subject areas that could add to a reader’s breadth of knowledge of this special patient group. The authors engage the reader with well explained concepts and useful cues which could be used to prompt and or further develop managed care in ED. For example when was the last time we engaged with the older adult and considered how their physical injury could impede or influence their regular sporting activity? Application of information gained during initial patient assessment enhances the knowledge known of the patient or indeed could add to the decision making regarding onward admission or discharge.

What makes emergency department patients reduce their alcohol consumption? – A computer-based intervention study in Sweden - Corrected Proof

Anna Trinks, Karin Festin, Preben Bendtsen, Per Nilsen — 2012-01-13

Abstract: Objectives: This study investigates the effectiveness of a computerized emergency department intervention for alcohol consumption and identifies explanation factors associated with reduced alcohol consumption from risk to non-risk drinking.Methods: Patients aged 18–69years registered at the ED triage answered alcohol-related questions on a touch-screen computer. Follow-up data were collected by means of a postal questionnaire that was mailed to the patients 6months after their ED visit.Results: There were four independent explanations for reduced alcohol consumption: being motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider. 339 patients could be followed up and of these were 97 categorized as risk drinkers at baseline and 45 became non-risk drinker 6month later.Conclusions: Being motivated to reduce alcohol consumption at baseline, influenced by just visiting the emergency department, considering the alcohol-related feedback information and impact from a health care provider were predictors for change from risk to non-risk drinking 6months later.

An evaluation of the reasons why patients attend a hospital Emergency Department - Corrected Proof

Lucy Land, Neil Meredith — 2012-01-09

Abstract: This survey evaluates the attendance patterns of people who responded to a two part questionnaire (before and after treatment) regarding the reasons they had presented at a hospital Emergency Department co located with an Urgent Care Centre. A total 485 people responded before treatment and 163 people responded after completing treatment. People have deep rooted convictions that the ‘hospital’ is the best place to be seen for the treatment of their accident or perceived emergency, together with a considerable loyalty and emotional attachment to it. Few people knew that Urgent Care facilities existed within the Emergency Department and fewer what they were for. Some were frustrated at the apparent speed of access to care by those with apparently trivial problems, not understanding that they were accessing a different service. On the whole people who attended were happy with the advice and treatment they received.

Being cold when injured in a cold environment – Patients’ experiences - Corrected Proof

Jonas Aléx, Peter Lundgren, Otto Henriksson, Britt-Inger Saveman — 2012-01-03

Abstract: Background: Patients in prehospital care, irrespective of diseases or trauma might experience thermal discomfort because of a cold environment and are at risk for decreasing body temperature which can increase both morbidity and mortality.Objective: To explore patients’ experiences of being cold when injured in a cold environment.Method: Twenty persons who had been injured in a cold environment in northern Sweden were interviewed. Active heat supply was given to 13 of them and seven had passive heat supply. The participants were asked to narrate their individual experience of cold and the pre- and post-injury event, until arrival at the emergency department. The interviews were transcribed verbatim, then analyzed with qualitative content analysis.Results: Patients described that they suffered more from the cold than because of the pain from the injury. Patients who received active heat supply experienced it in a positive way. Two categories were formulated: Enduring suffering and Relief of suffering.Conclusion: Thermal discomfort became the largest problem independent of the severity of the injuries. We recommend the use of active heat supply to reduce the negative experiences of thermal discomfort when a person is injured in a cold environment.

Sudden death liminality: Dehumanisation and disengagement - Corrected Proof

Tricia Scott — 2012-01-03

Abstract: Purpose of the research: The purpose of this paper is to understand, the uniquely held beliefs and values of emergency personnel involved in sudden death work and specifically, the process of disengagement in the space between life and death.Method: Ethnographic design enabled the researcher, an experienced emergency nurse, to engage with sudden death encounters in three emergency departments in the North of England. Nine focus groups were simultaneously conducted comprising emergency nurses; emergency paramedics and, police traffic officers.Analysis: Computerised qualitative data analysis software was used to generate sudden death themes and thick description explained the process of disengagement.Findings: Themes generated related to ‘role’ resignation, uncertainty, obstruction and routinisation; ‘legitimacy’ concerning age, mode of death and personal analogy; ‘emotionality’, concerning coping, exhaustion, annoyance and humour and, ‘spiritual relevances’ concerning relationship and embodiment. The final theme of ‘liminality, dehumanisation and disengagement’ is selected in this paper and discusses qualitative categories emerging from e.g. preparation of the body, washing the body, wrapping the body, handing over property and valuables, which are presented using direct quotations from the emergency personnel.Discussion: Insight was gained into the expressed perceptions of the emergency personnel in dealing with the intricate, intimate and sometimes emotional moments in sudden death work and the process of disengagement from the deceased. The discussion contributes to the emerging sociology of sudden death.

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

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.

Corrected Proof

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.

Adherence to treatment guidelines for patients with chest pain varies in a nurse-led prehospital ambulance system - Corrected Proof

Fredrik Byrsell, Mattias Regnell, Anders Johansson — 2011-12-07

Abstract: Introduction: Studies have shown that adherence to prehospital treatment guidelines, for patients with non-traumatic chest pain is incomplete and that there is a gender difference in treatment provided.Purpose: The aim of this study was to examine adherence to guidelines in a nurse-led ambulance system in southern Sweden.Method: Retrospective cohort study, including 862 medical records was reviewed. Data relevant to treatment guidelines was obtained e.g. the provision of oxygen, acetylsalicylic acid, glycerin trinitrate, electrocardiogram recorded, pain assessment, patient gender and time of day. Results were presented using descriptive statistics and adherence to present guidelines was described as poor (⩽20%), fair (21–40%), moderate (41–60%), good (61–80%) and very good (81–100%).Results: The medical records included 401 women and 461 men. Twenty-three percent of the patients received ⩾10L/min of oxygen (men vs. women, P<0.81). Sixty-nine percent received treatment with sublingual glyceryl trinitrate, whereas 58% received acetylsalicylic acid (men vs. women, P<0.004). In 95% a twelve lead electrocardiogram was recorded. Pain assessment was performed in 40% before treatment (men vs. women, P<0.011). A significant difference between men and women was found in Time of onset (P<0.013).Conclusions: We conclude that adherence to treatment guidelines varies greatly among the variables studied, ranging from fair (⩾10L/min of oxygen) to very good (obtaining electrocardiogram). There were differences in treatment provided between women and men.

Corrected Proof

Julie Flaherty — 2011-11-28

This is an exceptional, first class, book communicating an exciting and practical guide to paediatric emergency medicine. It is relevant to emergency physicians and nurses who care for children and young people, who require intervention and clinical management either in a general all age Accident and Emergency or a dedicated children’s A&E. The book is made up of 29 sections totalling 171 short chapters. Nonetheless, the chapters are comprehensive and include practically all types of clinical presentation by children attending emergency departments. The chapters are extremely well structured with easy to understand diagrams and illustrations. Toward the end of each chapter is a supporting conclusion with ‘pearls and pitfalls’ as an aide memoir summarising a quick reference of forget-me-nots for clinical management.

Corrected Proof

Samantha J. Brace — 2011-11-21

This book is part of a highly successful series of colour illustrated texts that cover most aspects of modern medicine. This title is a highly visual introduction to the basic principles and practice of emergency medicine. Each topic is covered in a single two-page section to make reference and study organised, easy and effective. Many full-colour line diagrams, clinical photographs, and radiological images demonstrate essential concepts at a glance.

Are emergency care nurses prepared for chemical, biological, radiological, nuclear or explosive incidents? - Corrected Proof

Christina J. Mitchell, W. George Kernohan, Ray Higginson — 2011-11-10

Abstract: Two main areas exist within emergency care where chemical, biological, radiological, nuclear and explosive preparedness can be focused: departmental preparedness and staff preparedness. This study focused upon the latter.Aim: To identify areas where nurses require training in order to improve preparedness for a CBRNe incident.Methods: A competency questionnaire was developed from the literature and completed by 50 nursing staff across three Emergency Departments within one NHS Trust in Northern Ireland. Descriptive analysis was used for the quantitative data along with content analysis for the qualitative questions.Results: Six key areas were identified for training; waste management (including clinical waste, contaminated clothing, contaminated water and the management of the contaminated deceased), Triage, Chain of command, PODs, awareness of the range of Personal Protective Equipment and its appropriate use and the decontamination of people and equipment.Conclusion: There is a need for a standardised ‘blueprint’ of role-specific competency criteria for a CBRNe incident for all emergency healthcare staff. The assessment tool used in this study can help to assess levels of preparedness amongst nursing staff and, if adapted accordingly, help gauge preparedness of other key healthcare professionals.

Clinical handover of patients arriving by ambulance to a hospital emergency department: A qualitative study - Corrected Proof

Nerolie Bost, Julia Crilly, Elizabeth Patterson, Wendy Chaboyer — 2011-11-10

Abstract: Aim: The aims of this study were to (1) explore the clinical handover processes between ambulance and ED personnel of patients arriving by ambulance at one hospital and (2) identify factors that impact on the information transfer to ascertain strategies for improvement.Methods: A focused ethnographic approach was used that included participant observation, conversational interviews and examination of handover tools. Participants included ambulance paramedics, nurses and medical practitioners from an ambulance service and regional hospital located in South East Queensland, Australia. Grounded theory methods of constant comparative data analyses were used to generate categories of findings.Findings: Two types of clinical handover were identified: (1) for non-critical patients and (2) for critical patients. Quality of handover appears to be dependent on the personnel’s expectations, prior experience, workload and working relationships. Lack of active listening and access to written information were identified issues.Conclusion: Clinical handover between two organisations with different cultures and backgrounds may be improved through shared training programmes involving the use of guidelines, tools such as a whiteboard and a structured communication model such as MIST. Future participatory research to evaluate new handover strategies is recommended.

Assessing health professionals’ perceptions of family presence during resuscitation: A replication study - Corrected Proof

Rose Chapman, Rochelle Watkins, Angela Bushby, Shane Combs — 2011-11-10

Abstract: Background: Family witnessed resuscitation is the practice of enabling patients’ family members to be present during resuscitation. Research is inconsistent as to the effectiveness or usefulness of this initiative.Aim: To evaluate the performance of two scales that assess perceptions of family witnessed resuscitation among a sample of health professionals, in an Australian non-teaching hospital, and explore differences in perceptions according to sociodemographic characteristics and previous experience.Design: Descriptive, replication study, using a cross-sectional survey.Method: An anonymous survey was distributed to 221 emergency department clinicians. Sociodemographic characteristics and perceptions of family witnessed resuscitation using the Family Presence Risk–Benefit and Family Presence Self-confidence Scales were assessed. Exploratory factor analysis was used to evaluate the performance of the scales.Results: One hundred and fourteen doctors and nurses returned the survey (response rate of 51.6%). Both Scales were found to have a single factor structure and a high level of internal consistency. Approximately two-thirds of participants considered that family presence was a right of patients and families, and almost a quarter of respondents had invited family presence during resuscitation on more than five occasions. We found no significant differences in scale scores between doctors and nurses.Conclusion: Our findings confirm the validity of the Family Presence Risk–Benefit and Family Presence Self–Confidence Scales in the Australian context, and highlight the need to support clinicians in the provision of family witnessed resuscitation to all families.

Audit of standards of practice in suspected hip fracture - Corrected Proof

Rebecca Taylor, Stuart Nairn — 2011-10-26

Abstract: Background: Hip-fracture is a common orthopaedic injury presenting to the Emergency Department, particularly within the elderly population. Standards of practice dictating the care of these patients include the early administration of analgesia and an accurate clinical assessment. Once a hip-fracture has been confirmed with diagnostic-imaging, the patient should be transferred to an orthopaedic ward as soon as possible. These standards have been identified from a range of national policies and evidence-based literature.Aim: To identify standards of best-practice for the care of patients with a suspected hip-fracture in the Emergency Department and to audit compliance with these standards.Method: A retrospective-audit of 185 Emergency Department Information System records for adult patients admitted with a suspected hip-fracture was conducted using a purpose-designed data-extraction spread-sheet based on discrete standards of audit.Findings: It was found that the Emergency Department performed well on some audit standards, such as the medical assessment of patients. However, some problems of assessment were identified in relation to pressure-care, the timely transfer of patients to a suitable ward and the delivery of pain-relief.Conclusions and recommendations: There were examples of good practice in this audit, but also areas that require improvement. We recommend that a care bundle be implemented to focus on improvements in pain-relief, pressure-care and fast-tracking.

Corrected Proof

Bob McMaster — 2011-10-24

Patients with severe illness and significant physical and social pathologies that were once perceived as life shortening are now living longer and in some cases, surviving into old age. As a consequence it is likely that patients with conditions that were once a rarity will be seen more frequently in the emergency department (ED) with either complications of their condition or co-morbidities. The need for specialist input with such patients is imperative, but there is also a requirement for ED staff to be familiar with the nature, presentation and progression of these conditions and current treatment strategies in order to meet the immediate needs of patients.

Differentiating frailty in older people using the Swedish ambulance service: A retrospective audit - Corrected Proof

2011-10-20

Abstract: The elderly population in Sweden is increasing. This will lead to an increased need for healthcare resources and put extra demands on healthcare professionals. Consequently, ambulance personnel will be faced with the challenge of meeting extra demands from increasing numbers of older people with complex and atypical clinical presentations. Therefore we highlight that great problems exist for ambulance personnel to understand and meet these patients’ care needs. Using a caring science approach, we apply the patient’s perspective, and the aim of this study is to identify and illuminate the conditions that affect elderly people assessed with the assessment category “general affected health condition”. Thus, we have analyzed the characteristics belonging to this specific condition. The method is a retrospective audit, involving a qualitative content analysis of a total of 88 emergency service records. The conclusion is that by using caring science, the concept of frailty which is based on a comprehensive understanding of human life can clarify the state of “general affected health condition”, as either illness or ill-health. This offers a new assessment category and outlines care and treatment that strengthen and support the health and wellbeing of the individual elderly person. Furthermore, the concept of frailty ought to be included in “The International Statistical Classification of Diseases and Related Health Problems” (ICD-10).

The evidence for implementing alcohol screening and intervention in the emergency department – Time to act - Corrected Proof

Marcus Forsythe, Geraldine A. Lee — 2011-10-20

Abstract: The harmful effects of alcohol and its contribution to Emergency Department (ED) presentations are evident on a daily basis and undoubtedly add a significant burden on the health care system. Despite alcohol’s prevalence in ED presentations, formal screening for alcohol use is not routinely applied in EDs. This paper reviews the evidence supporting the use of screening and the use of brief interventions in the ED. It aims to provide some insights into what may constitute best practice for health workers in relation to identifying and treating patients with problematic alcohol use. Although the burden of alcohol-related presentations is evident and the prevalence of problem acknowledged by health care professionals, the implementation of formal screening and brief interventions is at best inconsistent and sparse. Contemporary screening tools and interventions are critiqued within the ED setting and their advantages and disadvantages discussed. In conclusion, while there is a lack of homogeneity regarding the efficacy of screening tools and brief interventions in the ED setting, there are some promising indications that effectiveness may be enhanced by targeting the interventions at specific patient populations. It may also be possible to start considering innovative information technology applications to screen and intervene.

Blast injury: A case study - Corrected Proof

Steven Housden — 2011-10-05

Blast injuries can occur in the civilian setting, but are typically seen in both military and civilian casualties on operations (). However, there is now a greater potential to witness the effects of explosions in the UK due to terrorism and the increased use of Improvised Explosive Devices (IEDs). The use of IEDs are synonymous with Iraq and Afghanistan (), however, IEDs have been utilised by terrorists with devastating results in Bali (2002, 2005), Madrid (2004), and in the UK and Northern Ireland when the Irish Republican Army (IRA) were active, including the Omagh bombing in 1998. The more recent bombings in London (July 2005), showed how civilian authorities have had to manage extensive blast injuries (). Explosions can cause considerable injuries through several mechanisms; by the blast wave, blast wind, fragmentation, blunt force trauma, thermal and chemical burns, yet having carried out an extensive search there is little literature in UK nursing journals pertaining to blast injuries. As emergency nurses are in a key position to treat casualties presenting with these injuries, it is essential to understand the phenomenon that is blast, and the wound patterns it can cause.

An ethnography: Understanding emergency nursing practice belief systems - Corrected Proof

Margaret Fry — 2011-10-04

Abstract: Background: Further insight is needed to better understand how beliefs impact on contemporary Australian Emergency Department (ED) triage nursing practice. Specifically, how do cultural notions drive beliefs that give shape to nursing practice?Methods: Ethnography was the methodological framework used to explore triage practice. A purposeful sample of 10 Triage Nurses across four EDs was selected. Two hundred hours of nonparticipant observation were collected.Results: Beliefs were identified that gave meaning to triage nursing behaviour and action. Belief 1: Respecting space and privacy; Belief 2: Taking control and responsibility; Belief 3: Patients should not arrive with expectations; Belief 4: Do not ask for a bed; Belief 5: Expect a level playing field; Belief 6: No benefit from having a referral letter; Belief 7: Do not waste time. When a belief was engaged Triage Nurses implemented a range of practices, which were culturally oriented and at times at odds with patient expectations and care.Conclusion: The ethnographic study made visible an ED culture of timeliness, appropriateness and efficiency which perpetuated beliefs that framed notions of service worthiness and appropriateness. Making explicit beliefs can assist clinicians to be more considered, sensitive and culturally competent to meet the growing demand for emergency care.

The South African Triage Scale (adult version) provides reliable acuity ratings - Corrected Proof

Michèle Twomey, Lee A. Wallis, Mary Lou Thompson, Jonathan E. Myers — 2011-09-19

Abstract: Objective: To estimate the inter- and intra-rater reliability of triage ratings on Emergency Centre patients by South African nurses and doctors using the South African Triage Scale (SATS).Methods: A cross-sectional reliability study was performed. Five emergency physicians and ten enrolled nursing assistants independently assigned triage categories to 100 written vignettes unaware of the ratings given by others. Four different quantitative reliability measures were calculated and compared. Graphical displays portrayed rating distributions for vignettes with mean ratings at different acuity categories.Results: The estimated quadratically weighted kappa for the group of emergency physicians was 0.76 (95% CI: 0.67–0.84) and for the group of nurses 0.66 (95% CI: 0.58–0.74). These values were close to the estimated intra-class correlation coefficients. For intra-rater reliability, the average exact agreement was 84%. The graphical displays showed that the least variability was evident in the vignettes that had a mean rating of ‘emergency’, ‘very urgent’ or ‘routine’.Conclusion: This study indicates good inter- and intra-rater reliability among nurses and doctors using the SATS. It suggests that the SATS is reliably applied, and supports the feasibility of further implementation of the SATS in similar settings.

Violence in the emergency department: An ethnographic study (part II) - Corrected Proof

Jacqui Bee Chuo Lau, Judy Magarey, Richard Wiechula — 2011-09-07

Abstract: Violence in the emergency department (ED) is a significant and complex problem worldwide. This is a part II of a 2-part series on an ethnographic study. The study which aimed at exploring the cultural aspects of violence was carried out at a major metropolitan ED for 3months. This paper presents the findings and discussions of the study. One hundred and three violent incident questionnaires were completed. A total of 242.5h of observation and 34 (33%) interviews with nurses were conducted. From the data analysis, three critical cultural themes (i.e. ‘problems and solutions’, ‘requests and demands’ and ‘them and us’) were identified. The study indicated that the cultural meanings of violence were complex and highly subjective. Factors such as environment, conflicting messages regarding waiting time, and the nurse–patient/relative behaviours and the resulting reciprocal relationships were critical. Nurses’ efforts to establish rapport with patients was crucial and needed to occur early. There was usually a ‘turning point’ that provided an opportunity for the nurse to avoid violence. While violence is a complex issue with many paradoxes, the study indicates that effective interpersonal empathetic communication has a significant role in reducing violence in the ED.

The profile and follow-up of patients who attend the Emergency Department following a fall - Corrected Proof

2011-08-24

Abstract: Falls in the older population are associated with increased morbidity and mortality especially in the absence of risk reduction measures. The study aims were to compare the characteristics of older people who present to the Emergency Department (ED) following a fall with the general older ED population and examine referral patterns following ED discharge.Face-to-face interviews were carried out with 306 people aged 65years or older. Data was collected on demographic, socio-economic, health and social support factors. Descriptive and inferential statistics (Pearson chi-square test or independent t-test) were used to compare the falls and non-falls group.Falls occurred in 17% (53/306) of the study population and 43% sustained an injury requiring medical intervention. Patients in the falls group were significantly more likely to be female (68%), older (79years (SD 6.6)) and living alone (59%). The physical and mental health profile of the falls and non-falls group was similar with 30–40% of people in both groups experiencing moderate to severe physical health impairment. A third of the falls group was discharged from the ED without evidence of referrals.Conclusion: The older population that present to the ED following a fall requires comprehensive risk factor assessment especially physical function and referrals that include falls prevention. Implications for staff: ED staff need to examine current practice within their ED in relation to falls assessment, management and referral pathways.

Trapped between doing and being: First providers´ experience of “front line” work - Corrected Proof

Carina Elmqvist, Bengt Fridlund, Margaretha Ekebergh — 2011-08-24

Abstract: A common focus in research studies within the Emergency Department (ED) is physician patient relations, experiences of the triage model and nurses´ experiences of caring. Little has, however, been written about different first providers´ experiences of working on the “front line” at the ED. The aim of this study was to describe and understand experiences of being the first provider on the “front line” at the ED, as expressed by nurse assistants, registered nurses and physicians. A reflective lifeworld research approach was used in four different caring situations. The data consisted of eight open-ended interviews with first providers. The analysis showed that being the first provider on the “front line” at the ED entails a continuous movement between providing and responding through performing “life-saving” actions and at the same time create a good relationship with the patient and the next of kin. Five constituents further described the variations of the phenomenon. The readiness to save lives creates a perceived stress of time pressure and the first providers adopt different strategies to cope with the work. Instead of leaving the first providers to find their own way to cope with the complex situation, there are needs for a redesigning of the internal work process within ED organizations.