International Emergency Nursing - Articles in Press

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.

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

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.

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.

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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.

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

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.

Pre-hospital pain management patterns and triage nurse documentation - Corrected Proof

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.

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

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 - Corrected Proof

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.

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

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.

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

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.

Corrected Proof

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.

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

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.

Improving the safety of oxygen therapy in the treatment of acute myocardial infarctions - Corrected Proof

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.