Int Emerg Nurs. 2022 May 15;63:101168. doi: 10.1016/j.ienj.2022.101168. Online ahead of print.

ABSTRACT

INTRODUCTION: Due to philosophical tensions between end-of-life care and emergency care, nurses in the emergency department face challenges in the provision of end-of-life care. The purpose of this integrative review was to synthesise evidence of the end-of-life care practices of emergency care nurses and the factors that influence these practices.

METHODS: For this integrative review, CINAHL, Embase, and MEDLINE databases were systematically searched in April 2020. In total, 30 studies written in English and published between 2010 and 2020 investigating the experiences of nurses caring for a patient that died in the emergency department were included. A constant comparative method was used to analyse and synthesise data.

RESULTS: End-of-life care practices prominent in the literature included modifying the environment for privacy, the provision of information to families and the management of symptoms. The culture of emergency care, the nurse's personal characteristics, the trajectory of death and available resources are factors that appear to determine whether ED nurses immerse themselves in end-of-life care or display distancing behaviours.

CONCLUSION: There is limited evidence articulating the frequency to which specific practices are undertaken and the magnitude to which various factors influence end-oflife care provision. The generation of such knowledge may facilitate the development of initiatives that can optimise end-of-life care in the emergency department.

PMID:35584560 | DOI:10.1016/j.ienj.2022.101168

NeuroRehabilitation. 2022 Apr 29. doi: 10.3233/NRE-210310. Online ahead of print.

ABSTRACT

BACKGROUND: The optimization and standardization of emergency nursing and monitoring procedures are of great significance for thrombolytic treatment of acute cerebral infarction.

OBJECTIVE: Studies on the emergency nursing and monitoring procedure on cognitive impairment and neurological function in patients with acute cerebral infarction are still limited.

METHODS: The study was a randomized controlled trial and 134 patients with acute cerebral infarction were recruited. They were randomly arranged into the control group (n = 67) receiving normal nursing procedure and the intervention group (n = 67) receiving emergency nursing and monitoring procedure after pre-intervention assessment. The cognitive impairment, neurological function and levels of inflammatory biomarkers and neuron-specific enolase of the participants were evaluated and analyzed.

RESULTS: Emergency nursing and monitoring procedure improved Mini-mental State Examination and Montreal Cognitive Assessment scores of patients with cerebral infraction compared with the control group. It also improved the scores of National Institutes of Health Stroke Scale, activities of daily living scale, Fugl-Meyer scale in the participants. Emergency nursing and monitoring procedure led to significantly decreased neuron-specific enolase and inflammatory cytokines in the serum of the participants.

CONCLUSION: Emergency nursing and monitoring procedure are beneficial for cognitive impairment and neurological function recovery in patients with acute cerebral infarction.

PMID:35527573 | DOI:10.3233/NRE-210310

Ann Palliat Med. 2022 Apr;11(4):1518-1525. doi: 10.21037/apm-21-2995.

ABSTRACT

BACKGROUND AND OBJECTIVE: We conducted a literature review on the epidemiology and emergency nursing care of oral and craniomaxillofacial trauma in order to facilitate rescue and care planning. Traumatic accidents alter oral and craniomaxillofacial anatomy and physiology, resulting in craniomaxillofacial scars and deformities, temporomandibular disorders, and oromandibular dysfunction. Such trauma affects speech, chewing, and eating; results in long hospitalization and burdensome healthcare expenses; and in severe cases may lead to potentially life-threatening complications such as respiratory obstruction and brain injury.

METHODS: EMBASE, MEDLINE, and PubMed were investigated for relevant systematic reviews. By conducting a literature review of reports on oral and craniomaxillofacial trauma to summarize the epidemiological characteristics and emergency care of oral and craniomaxillofacial trauma.

KEY CONTENT AND FINDINGS: Numerous studies, both domestic and foreign, have investigated the epidemiological characteristics of oral and craniomaxillofacial trauma and have reported different incidences of this trauma, with significant inter- and intraregional variation. The studies show that most patients with maxillofacial trauma are young adults, and males consistently outnumber females. Maxillofacial trauma can be physical or chemical, though most are physical injuries, the road traffic accident (RTA) is the leading cause of oral and maxillofacial trauma. Oral and maxillofacial trauma can be simple soft tissue trauma, simple bone trauma, or soft tissue plus bone trauma, the brain injury is the most common concomitant injury of patients with maxillofacial trauma. Different studies have reached different conclusions about the temporal distribution of maxillofacial trauma. Several important emergency care models in the management of oral and craniomaxillofacial trauma have resulted in improved outcomes. These include accurate assessment, effective airway maintenance, careful management. The more common use of virtual surgical planning, surgical navigation, computer-aided surgery and 3D printing will no doubt continue to improve accuracy and efficiency in the management of these patients.

CONCLUSIONS: By conducting a literature review of domestic and foreign reports on oral and craniomaxillofacial trauma to summarize the epidemiological characteristics and emergency care of oral and craniomaxillofacial trauma, we aimed to provide a reference for the rescue and care planning for patients with oral and craniomaxillofacial trauma.

PMID:35523757 | DOI:10.21037/apm-21-2995

HIV AIDS (Auckl). 2022 Apr 19;14:195-206. doi: 10.2147/HIV.S346182. eCollection 2022.

ABSTRACT

BACKGROUND: Opportunistic infections are the major causes for morbidity and mortality due to HIV infections. Despite advances in HIV diagnosis and management, the incidence of opportunistic infections remains high. This study aimed to assess the incidence and predictors of opportunistic infections among persons living with HIV/AIDS in Ethiopia.

METHODS: A retrospective follow-up study was conducted on 354 samples of adults living with HIV on antiretroviral therapy at Dessie Comprehensive Specialized Hospital. Simple random sampling technique was used to select study participants. The data collection format was taken from national antiretroviral intake and follow-up forms. Epi-data Version 4.6.1 and STATA Version 16 software were used for data entry and data analysis respectively. The Cox-proportional hazards regression model was fitted. Kaplan-Meier survival curve was used to estimate opportunistic infections-free survival time. Both bi-variable and multivariable Cox-proportional hazard regression analysis were done to identify predictors of opportunistic infections.

RESULTS: Of the total 354 peoples living with HIV, 114 (32.2%) developed OI, with an incidence rate of 13.5 per 100 person-year (95% CI: 10.8-15.6). Advanced World Health Organization clinical disease stage (IV) (AHR: 2.1 (95% CI: 1.16, 3.8)), being bedridden (AHR: 1.66 (95% CI: 1.04, 2.65)), poor adherence (AHR: 1.7 (95% CI: 1.1-2.63), and low CD4 count (AHR: 1.92 95% CI: 1.14-3.22) were significant predictors of OIs.

CONCLUSION: Opportunistic infection among HIV/AIDS continues to be a significant public health concern in Ethiopian health care setting. Our results indicate that the incidence of OI is high. Besides, Stage IV HIV status, being bedridden, low CD4 count and poor adherence independently predicts an increased incidence/decreased survival time of OIs among PLWHIV. Early care-seeking and initiation of HAART and continuous follow-up of patients to take their drug timely are essential to curb the incidence of opportunistic infections and improve overall health. Further research on this area is highly recommended.

PMID:35469324 | PMC:PMC9034843 | DOI:10.2147/HIV.S346182

J Healthc Eng. 2022 Mar 31;2022:3387394. doi: 10.1155/2022/3387394. eCollection 2022.

ABSTRACT

Most members of the general public find it difficult to identify poisonous wild mushrooms, resulting in family food poisoning. Toxic mushroom poisoning can produce nausea, vomiting, abdominal pain, and other severe symptoms 30 minutes or more after ingestion that can even lead to death. Using a "four-in-one" optimized emergency nursing procedure to treat mushroom poisoning can reduce the rescue time and improve the survival rate of patients. This study aimed to analyze the influence of a "four-in-one" optimized emergency nursing procedure to treat patients with toadstool poisoning. A prospective randomized study was conducted. Sixteen cases of toadstool poisoning, corresponding to 78 patients admitted to our hospital from January 2017 to July 2020, were selected and divided into a study group and a control group of 39 cases each using a random number table. The control group was provided with routine emergency care, and the study group was given a "four-in-one" treatment that optimized the emergency care process; both groups were subjected to basic treatment + blood purification and other treatment measures, and the treatment time in the rescue room and the first blood purification time of the two groups were compared. Differences in routine blood tests, liver and kidney function indices, hospitalization time, coma time, treatment outcome, and nursing satisfaction before and after treatment were found. The treatment time and the first blood purification time of the study group were lower than those of the control group, and the difference was statistically significant (P < 0.05); ALT, AST, TBIL, TBA, and ALB were measured upon admission for the study and the control groups. The measured values of PT, APTT, CK, CK-MB, and BUN were compared for the two groups, but the difference in the values between the two groups was not statistically significant (P > 0.05); after 7 days of treatment, the ALT, TBA, and APTT indicators of the study group were lower than those of the control group, and the difference was statistically significant (P < 0.05); the measured values of ALT, AST, TBIL, TBA, ALB, PT, APTT, CK, CK-MB, BUN, and Scr after 7 days of treatment were significantly lower than those before treatment for both groups (P < 0.05). The length of stay for the study group was lower than that for the control group, and the difference was statistically significant (P < 0.05); the treatment efficiency was 87.18% for the study group, compared with 82.05% for the control group, but the difference was not statistically significant (P > 0.05). The study group rated nursing care as follows: very satisfactory, 79.49%; relatively satisfactory, 15.38%; and acceptable, 5.13%; the control group rated nursing care as follows: very satisfactory, 51.28%; relatively satisfactory, 30.77%; and acceptable, 12.82%; the results were statistically significant (P < 0.05). Using a "four-in-one" optimized emergency care process to treat patients with mushroom poisoning can significantly reduce the rescue room treatment time and the first blood purification time and improve nursing satisfaction, but has a limited effect on improving the treatment efficiency.

PMID:35399847 | PMC:PMC8989573 | DOI:10.1155/2022/3387394

BMC Health Serv Res. 2022 Apr 8;22(1):463. doi: 10.1186/s12913-022-07904-8.

ABSTRACT

BACKGROUND: During the cluster randomised TRIAGE-trial, a nurse advised 13% of low-risk patients presenting at an emergency department in Belgium to visit the adjacent general practitioner cooperative. Patients had the right to refuse this advice. This exploratory study examines the characteristics of refusers by uncovering the determinants of non-compliance and its impact on costs, as charged on the patient's invoice.

METHODS: Bivariate analyses with logistic regressions and T-tests were used to test the differences in patient characteristics, patient status, timing characteristics, and costs between refusers and non-refusers. A chi-square automatic interaction detection analysis was used to find the predictors of non-compliance.

RESULTS: 23.50% of the patients refused the advice to visit the general practitioner cooperative. This proportion was mainly influenced by the nurse on duty (non-compliance rates per nurse ranging from 2.9% to 52.8%) and the patients' socio-economic status (receiving increased reimbursement versus not OR 1.37, 95%CI: 0.96 to 1.95). Additionally, non-compliance was associated (at the 0.10 significance level) with being male, not living nearby and certain reasons for encounter. Fewer patients refused when the nurse perceived crowding level as quiet relative to normal, and more patients refused during the evening. The mean cost was significantly higher for patients who refused, which was a result of more extensive examination and higher out-of-pocket expenses at the ED.

CONCLUSIONS: The nurse providing the advice to visit the general practitioner cooperative has a central role in the likelihood of patients' refusal. Interventions to reduce non-compliance should aim at improving nurse-patient communication. Special attention may be required when managing patients with a lower socio-economic status. The overall mean cost was higher for refusers, illustrating the importance of compliance.

TRIAL REGISTRATION: The trial was registered on registration number NCT03793972 on 04/01/2019.

PMID:35395840 | PMC:PMC8994354 | DOI:10.1186/s12913-022-07904-8

J Emerg Nurs. 2022 May;48(3):266-277. doi: 10.1016/j.jen.2022.01.005. Epub 2022 Feb 13.

ABSTRACT

INTRODUCTION: Effective communication is essential to good health care, and hearing loss disrupts patient-provider communication. For the more than 2 million veterans with severe hearing loss, communication is particularly challenging in noisy health care environments such as emergency departments. The purpose of this qualitative study was to describe patient and provider perspectives of feasibility and potential benefit of providing a hearing assistance device, a personal amplifier, during visits to an emergency department in an urban setting affiliated with the Department of Veterans Affairs.

METHODS: This qualitative descriptive study was conducted in parallel with a randomized controlled study. We completed a semistructured interview with 11 veterans and 10 health care providers to elicit their previous experiences with patient-provider communication in the ED setting and their perspectives on hearing screening and using the personal amplifier in the emergency department. Interview data were analyzed using content analysis and Atlas.ti V8.4 software (Scientific Software Development GmbH, Berlin, Germany).

RESULTS: The veteran sample (n = 11) had a mean age of 80.3 years (SD = 10.2). The provider sample included 7 nurses and 3 physicians. In the ED setting, hearing loss disrupts patient-provider communication. Screening for hearing loss in the emergency department was feasible except in urgent/emergent cases. The use of the personal amplifier made communication more effective and less effortful for both veterans and providers.

DISCUSSION: Providing the personal amplifier improved the ED experience for veterans and offers a promising intervention that could improve health care quality and safety for ED patient populations.

PMID:35172928 | DOI:10.1016/j.jen.2022.01.005

J Multidiscip Healthc. 2022 Jan 26;15:161-173. doi: 10.2147/JMDH.S340596. eCollection 2022.

ABSTRACT

BACKGROUND: This study sought to determine whether uric acid levels have a relationship with and can potentially be used as a prognosis for coronary heart disease (CHD) biomarkers using a scoping review.

METHODS: This study was conducted following Arksey and O'Malley's scoping review framework. It was reported as obeying the Preferred Reporting Item for Systematic Review and Meta-analysis for Scoping Review (PRISMA-ScR). The subject was extensively searched for in PubMed, CINAHL, and ScienceDirect. The inclusion criteria in the study were that the sources were journal articles written in English and were available in full text. The age of the subject in the item is the elderly population to capture the relationship between uric acid levels and the prognosis of CHD. The publication time limit was 2010 to 2020. The study was analyzed using thematic analysis.

RESULTS: We identified 592 studies in our initial search, and 21 studies with a cohort design were included in this study's analysis. The majority of the evidence suggests an independent correlation with a poor prognosis of CHD in the elderly population. The prognosis of gout includes the prognosis of clinical outcome, severity, and mortality, all of which influence the prognosis value, which becomes a marker.

CONCLUSION: Uric acid levels have been identified as a potential biomarker for poor CHD prognosis. Nurses and other healthcare workers should learn how to control poor CHD prognosis.

PMID:35115780 | PMC:PMC8801359 | DOI:10.2147/JMDH.S340596

Adv Emerg Nurs J. 2022 Jan-Mar 01;44(1):54-62. doi: 10.1097/TME.0000000000000391.

ABSTRACT

Burnout is a significant problem in emergency nursing, and it is associated with higher turnover rates than other disciplines of health care. Emergency nurses are highly susceptible to burnout due to continual exposure to traumatic events, varying work schedules, violence directed at staff, and, in recent times, due to the stressors of the COVID-19 pandemic. This literature review will (1) expose the causes of emergency department (ED) nurse burnout and (2) discuss strategies to build resilience in ED nurses. A systematic review of studies published in academic journals discussing burnout and resilience, specifically related to ED nurses, published in English between 2015 and 2019. The databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Source, Health Source: Nursing/Academic Edition, APA PsycArticles, Military and Government Collection, Gender Studies Database, SocINDEX, and PsycINFO were searched. Sixteen studies were included in this review. Work schedules and shift work, violence toward staff, and lack of management support were factors linked to burnout. Self-discipline, optimism, and goal-oriented behaviors evolved as characteristics of resilient ED nurses. Burnout rates among ED nurses are steep. Shift work, traumatic events, violence, and management support are determinants of burnout. Specialized actions can combat burnout and increase resilience. Nursing management can provide specific education to nurses to assist in this effort.

PMID:35089283 | DOI:10.1097/TME.0000000000000391

Crit Care Res Pract. 2022 Jan 18;2022:6448504. doi: 10.1155/2022/6448504. eCollection 2022.

ABSTRACT

BACKGROUND: Early vasopressor utilization has been associated with improved outcomes of patients with spinal shock; however, there are difficulties in weaning off vasopressors, in which patients after recovery from spinal shock develop a state of persistent vasodilation, which may take a few days to resolve and delays the discharge in the intensive care unit (ICU). Therefore, we tested the hypothesis using two oral vasopressors (midodrine and minirin) to facilitate weaning off intravenous vasopressors, reducing the ICU length of stay, and compare them for more efficacy.

METHODS: A randomized controlled trial was conducted in the trauma ICU at the Assiut University Hospital in Egypt in patients with spinal shock who required intravenous vasopressor for ≥24 h. A convenience sample was classified into three groups, in which 30 patients were included for each group. The midodrine group received midodrine 10 mg per oral every 8 h with gradual weaning off intravenous (IV) vasopressor (noradrenaline) after receiving 4 doses, the minirin group received minirin 60 μg per oral every 8 h with gradual weaning off IV vasopressor after receiving 4 doses, whereas the control group received IV vasopressor (noradrenaline) with gradual weaning according to the routine hospital care without adding oral vasopressors. The primary outcome was shortening the duration of IV vasopressor requirements. The secondary outcome was reducing the ICU length of stay.

RESULTS: Our results showed that the duration of IV vasopressor requirements in the midodrine (3.3 ± 1.32) and minirin groups (4.8 ± 1.83) was significantly lower than in the control group (6.93 ± 2.32). Additionally, the ICU length of stay (days) in the midodrine (5.13 ± 1.83) and minirin groups (5.5 ± 1.91) was significantly lower than in the control group (9.03 ± 3.74).

CONCLUSION: Midodrine and minirin accelerated liberation from intravenous noradrenaline and effective in reducing the ICU length of stay in patients with spinal shock.

PMID:35087688 | PMC:PMC8789437 | DOI:10.1155/2022/6448504

Comput Math Methods Med. 2021 Dec 14;2021:1077358. doi: 10.1155/2021/1077358. eCollection 2021.

ABSTRACT

In order to improve the comprehensive nursing effect of the hospital emergency treatment, this paper analyzes the process of the hospital emergency treatment. In addition, this paper combines the possible risks to analyze the risk factors of the comprehensive nursing in the hospital emergency treatment and builds an intelligent analysis model based on the actual situation of the hospital emergency treatment. At the same time, this paper conducts a systematic survey of emergency services and gives the composition and structure of the system. In addition, this paper divides the business required by the system into modules, including registration module, doctor workstation, nurse workstation, query statistics module, decision-making module, and maintenance module. Finally, this paper suggests that in the process of the clinical triage, more ideas for improving the existing evaluation model should be proposed, and experience should be transformed into advantages, so as to improve emergency triage skills; establish an objective, quantitative, and scientific concept of emergency classification and triage; and fully realize scientific triage and precise triage.

PMID:34950220 | PMC:PMC8691987 | DOI:10.1155/2021/1077358

Contrast Media Mol Imaging. 2021 Nov 24;2021:6423398. doi: 10.1155/2021/6423398. eCollection 2021.

ABSTRACT

The research achievements of artificial intelligence technology in the development of chronic obstructive pulmonary disease were explored, and the advantages and problems encountered in the development of intelligent nursing were analyzed. This paper presents the application of artificial intelligence in the emergency care of patients with chronic obstructive pulmonary disease. The method included 447 COPD patients in a randomized controlled trial to observe the improvement of quality of life at 4 and 12 months after artificial intelligence medical intervention. A prospective randomized controlled trial included 101 patients with COPD who underwent a 9-month web-based knowledge exercise on the prevention of acute exacerbation of COPD through artificial intelligence medicine and were randomly divided into two groups: the experimental group and the control group. The results show that, in the experimental group and the control group, after 4 months, the quality of life does not change; after 12 months, compared with controls, the quality of life and emotional and psychological conditions have improved obviously. 29 patients who participated in the experiment and were randomly divided into the experimental group and the control group showed satisfactory results. COPD hospitalized rate and length of hospital stay were decreased in the experimental group than in the control group. For single-factor analysis, artificial intelligence medical intervention has not achieved significant significance, and the experimental results have preliminarily confirmed the effectiveness of artificial intelligence medical treatment.

PMID:34908913 | PMC:PMC8635944 | DOI:10.1155/2021/6423398

Prehosp Disaster Med. 2022 Feb;37(1):65-70. doi: 10.1017/S1049023X21001217. Epub 2021 Dec 6.

ABSTRACT

OBJECTIVES: Successful placement of a peripheral intravenous catheter (PIVC) on the first attempt is an important outcome for difficult vascular access (DVA) patients. This study compared standard technique, ultrasonography (USG), and near-infrared light (NIR) in terms of success in the first attempt in patients with DVA.

METHODS: This was a prospective, randomized controlled study. The study was conducted in a tertiary care hospital. Emergency department patients who describe DVA history, have no visible or palpable veins, and were assessed by the nurse to have a difficult PIVC were included to study. The PIVC procedure was performed on patients by standard, USG, or NIR device techniques. For all approaches, the success of the first attempt was the primary aim. Total procedure time, the total number of attempts, and the need for rescue intervention were secondary aims.

RESULTS: This study evaluated 270 patients. The first attempt success rates for USG, standard, and NIR methods were 78.9%, 62.2%, and 58.9%, respectively. The rate of first attempt success was higher in patients who underwent USG (USG versus standard, P = .014; USG versus NIR, P = .004; standard versus NIR, P = .648). The total median (IQR) procedure time for USG, standard, and NIR methods was 107 (69-228), 72 (47-134), and 82 (61-163) seconds, respectively. The total procedure time was longer in patients undergoing USG (standard versus USG, P <.001; NIR versus USG, P = .035; standard versus NIR, P = .055). The total median (IQR) number of attempts of USG, standard, and NIR methods were 1 (1-1), 1 (1-2), and 1 (1-2), respectively. A difference was found among the groups regarding the total number of attempts (USG versus NIR, P = .015; USG versus standard P = .108; standard versus NIR, P = .307). No difference was found among groups in terms of the need for rescue methods.

CONCLUSION: It was found that USG increases the success of the first attempt compared with the standard method and NIR in patients with DVA.

PMID:34865664 | DOI:10.1017/S1049023X21001217

Nurs Open. 2022 Mar;9(2):1060-1065. doi: 10.1002/nop2.1144. Epub 2021 Nov 30.

ABSTRACT

AIM: To assess the effect of abdominal massage pre-gavage feeding on tolerated feeding for low birth weight (LBW) infants.

METHODS: An experimental research design at a government hospital at Egypt. Purposive sample composed of LBW infants was randomly divided into study and control groups each with 60 LBW infants.

RESULTS: A total of 55% of the participants in the study group grew sleepy, whereas only 15% of the studied participants in the control group grew sleepy. The abdominal circumference after feeding in the study group was 23.18 ± 2.99 cm, whereas that in the control group was 24.79 ± 2.99 cm. The gastric residual volume in the study group was 0.8 ± 0.10 ml, whereas that in the control group was 3.86 ± 1.03 ml.

CONCLUSION: Finally, abdominal massage had a positive impact on the postfeeding state of alertness and feeding tolerance.

PMID:34850605 | PMC:PMC8859033 | DOI:10.1002/nop2.1144

J Healthc Eng. 2021 Oct 6;2021:1034972. doi: 10.1155/2021/1034972. eCollection 2021.

ABSTRACT

In order to help pathologists quickly locate the lesion area, improve the diagnostic efficiency, and reduce missed diagnosis, a convolutional neural network algorithm for the optimization of emergency nursing rescue efficiency of critical patients was proposed. Specifically, three convolution layers and convolution kernels of different sizes are used to extract the features of patients' posture behavior, and the classifier of patients' posture behavior recognition system is used to learn the feature information by capturing the nonlinear relationship between the features to achieve accurate classification. By testing the accuracy of patient posture behavior feature extraction, the recognition rate of a certain action, and the average recognition rate of all actions in the patient body behavior recognition system, it is proved that the convolution neural network algorithm can greatly improve the efficiency of emergency nursing. The algorithm is applied to the patient posture behavior detection system, so as to realize the identification and monitoring of patients and improve the level of intelligent medical care. Finally, the open source framework platform is used to test the patient behavior detection system. The experimental results show that the larger the test data set is, the higher the accuracy of patient posture behavior feature extraction is, and the average recognition rate of patient posture behavior category is 97.6%, thus verifying the effectiveness and correctness of the system, to prove that the convolutional neural network algorithm has a very large improvement of emergency nursing rescue efficiency.

PMID:34659675 | PMC:PMC8514904 | DOI:10.1155/2021/1034972

J Clin Nurs. 2021 Oct 4. doi: 10.1111/jocn.16073. Online ahead of print.

ABSTRACT

OBJECTIVE: Non-traumatic headache is a frequent reason for visits to the emergency department (ED). We evaluated the performance of the Manchester Triage System (MTS) in prioritising patients presenting to the ED with non-traumatic headache.

METHODS: In this single-centre observational retrospective study, we compared the association of MTS priority classification codes with a final diagnosis of a severe neurological condition requiring timely management (ischaemic or haemorrhagic stroke, subarachnoid haemorrhage, cerebral sinus venous thrombosis, central nervous system infection or brain tumour). The study was conducted and reported according to the STROBE statement. The overall prioritisation accuracy of MTS was estimated by the area under the receiver operating characteristic (ROC) curve. The correctness of triage prediction was estimated based on the "very urgent" MTS grouping. An undertriage was defined as a patient with an urgent and severe neurological who received a low priority/urgency MTS code (green/yellow).

RESULTS: Over 30 months, 3002 triage evaluations of non-traumatic headache occurred (1.7% of ED visits). Of these, 2.3% (68/3002) were eventually diagnosed with an urgent and severe neurological condition. The MTS had an acceptable prioritisation accuracy, with an area under the ROC curve of 0.734 (95% CI 0.668-0.799). The sensitivity of the MTS for urgent codes (yellow, orange and red) was 79.4% (95% CI 74.5-84.3), with a specificity of 54.1% (95% CI 52.9-55.3). The triage prediction was incorrect in only 6.3% (190/3002) of patients with headache.

CONCLUSION: The MTS is a safe and accurate tool for prioritising patients with non-traumatic headache in the ED. However, MTS may need further specific tools for evaluating the more complicated symptoms and for correctly identifying patients with urgent and severe underlying pathologies.

RELEVANCE TO CLINICAL PRACTICE: The triage nurse using MTS may need additional tools to improve the assessment of patients with headache, although MTS provides a good safety profile.

PMID:34608700 | DOI:10.1111/jocn.16073

Iran J Public Health. 2021 Jun;50(6):1097-1107. doi: 10.18502/ijph.v50i6.6409.

ABSTRACT

BACKGROUND: The efficacy of graded emergency nursing on acute pancreatitis (AP) patients was evaluated by the Meta-analysis system.

METHODS: The databases of CNKI, WanFang, VIP, PubMed, the Cochrane Library and Web of Science were searched by computer in January 2021. The references were screened according to the inclusion and exclusion criteria. The data were extracted and the quality of those references was evaluated. Meta-analysis was made by RevMan 5.4 software, publication bias was detected by funnel chart, and sensitivity analysis was carried out.

RESULTS: Thirteen papers were included, including 11 waiting time indexes, 7 disease judgment accuracy indexes, 13 rescue success rate indexes and 5 patient satisfaction rate indexes. Meta-analysis showed that compared with conventional emergency nursing methods, graded emergency nursing methods had shorter waiting time (MD=-11.97, 95%CI (-15.74, -8.21), P<0.00001), higher accuracy in judging illness (OR=6.6, 95%CI (3.13, 13,93), P<0.00001) and rescue success rate (OR=7.12, 95%CI (4.16, 12.20), P<0.00001), and patients' satisfaction was higher (OR=8.79, 95%CI (3.59, 21.56), P<0.00001).

CONCLUSION: Graded emergency nursing can optimize the allocation of emergency resources, effectively shorten the waiting time of AP patients. It also improves the accuracy of disease judgment, the success rate of rescue and the satisfaction of patients. It is an efficient emergency nursing method and is worthy of clinical application.

PMID:34540731 | PMC:PMC8410971 | DOI:10.18502/ijph.v50i6.6409

Adv Emerg Nurs J. 2021 Jul-Sep 01;43(3):217-224. doi: 10.1097/TME.0000000000000363.

ABSTRACT

Acute pain is a common presenting complaint in the emergency department (ED) and is most often treated with opioid or nonopioid analgesia. However, studies have shown that receiving analgesia alone does not always influence patient satisfaction with pain management in the ED. Pain anxiety and catastrophizing have been shown to affect pain intensity and patients' response to analgesia. The objective of this study was to determine whether a brief therapeutic conversation would improve patient satisfaction with pain management compared with standard care for adult patients presenting to the ED with moderate to severe acute pain. Adult (18 years or older) patients presenting to the ED with moderate to severe acute pain were randomized to either the standard care group or the intervention group. Patients in the intervention group participated in a brief therapeutic conversation with an ED nurse to discuss their perceived cause of pain, level of anxiety, and expectations of their pain management. Prior to discharge, all patients were asked to complete a self-reported, 9-item questionnaire to assess their level of satisfaction with their overall ED experience. A total of 166 patients (83 in each group) were enrolled. Patient satisfaction with ED pain management and the proportion of patients who received analgesia in the ED were similar in both the control (n = 57; 68.7%) and intervention (n = 58; 69.9%) groups (Δ 1.2%; 95% CI [12.6, 15]). Qualitative findings demonstrate that patients place high importance on acknowledgment from ED staff and worry about the unknown cause of pain. This study suggests that patient satisfaction with pain management in the ED is multifactorial and complex. Further research should investigate additional methods of integrating nurse-led interventions into the care of patients in acute pain.

PMID:34397500 | DOI:10.1097/TME.0000000000000363

J Emerg Nurs. 2021 Sep;47(5):742-751.e1. doi: 10.1016/j.jen.2021.05.007. Epub 2021 Jul 21.

ABSTRACT

BACKGROUND: National Heart Lung and Blood Institute guidelines for the treatment of vaso-occlusive crisis among people with sickle cell disease in the emergency department recommend assigning an emergency severity index of 2 at triage. However, patients with sickle cell disease often do not receive guideline-concordant care at triage. To address this gap, a decision support tool was developed, in the form of a text banner on the triage page in the electronic health record system, visible to triage nurses.

METHODS: A prospective quality improvement initiative was designed where the emergency severity index clinical decision support tool was deployed to a stratified random sample of emergency department triage nurses to receive the banner (n = 24) or not to receive the banner (n = 27), reminding them to assign the patient to emergency severity index category 2. The acceptability of the emergency severity index clinical decision support tool was evaluated with the Ottawa Acceptability of Decision Rules Instrument. Descriptive and bivariate (chi-square test) statistics were used to characterize the study's primary outcome, proportion of visits assigned an emergency severity index of 2 or higher. A generalized linear mixed model with clustering at the level of the triage nurse was performed to test the association between the banner intervention and triage practices.

RESULTS: A total of 384 ED visits were included for analysis. Before study initiation, the percentage of sickle cell disease patients' visits with the proper emergency severity index assignment at triage was 37.04%. After initiation, the proportion of sickle cell disease patients' visits with an emergency severity index of 2 or higher triaged by nurses in the intervention group was markedly higher in the intervention group than in the control group (64.95% vs 35.05%; χ² = 8.79, P ≤ .003). Accounting for clustering by nurse, the odds ratio for proper triage emergency severity index assignment was 3.22 (95% confidence interval 1.17-8.85; P ≤ .02) for the intervention versus control. Surveyed triage nurses reported the emergency severity index clinical decision support tool to be moderately acceptable (nurses' mean Ottawa Acceptability of Decision Rules Instrument scores ranged from 4.13 to 4.90 on the 6-point scale; n = 11). There were no differences in ED experience outcomes including time to first analgesic or length of stay between the control and intervention groups.

CONCLUSION: Substantial improvements in triage guideline concordance were achieved and sustained without direct nursing education.

PMID:34301422 | DOI:10.1016/j.jen.2021.05.007

Front Public Health. 2021 Jun 25;9:707264. doi: 10.3389/fpubh.2021.707264. eCollection 2021.

ABSTRACT

Background: Military personnel are widely exposed to risk factors for heat-related illnesses. Knowledge, attitudes, and practices (KAP) are three of the most important means by which to prevent such illnesses, but there has been a lack of investigations into and correlation analyses of KAP. This study aimed to explore the heat-related KAP of military personnel in China. Methods: We conducted a cross-sectional study (June 1-25, 2019). A total of 646 military personnel were recruited from two Chinese Navy troops in the tropical zone and one troop in the temperate zone. We collected data on demographic characteristics and KAP scores using questionnaires. Univariate analysis and Scheffe's method were used for data analyses. Results: The mean KAP scores were 10.37 (range = 3-13, standard deviation = 1.63) for knowledge (K-score), 7.76 (range = 0-16, SD = 2.65) for attitudes (A-score), and 3.80 (range = 1-6, SD = 1.12) for practices (P-score). There were noticeable differences in mean K-score according to age, military rank, and educational level (P < 0.05). Participants from the tropical zone had higher A-scores (P < 0.05) and higher P-scores (P < 0.001) than those from the temperate zone. Additionally, participants with relevant experience also had higher A-scores (P < 0.05) than those without such experience. Conclusions: Military personnel's awareness of preventive and first-aid measures against heat-related illnesses need to be strengthened. It will be very important to develop educational programmes and enrich systematic educational resources to raise this awareness.

PMID:34249854 | PMC:PMC8267788 | DOI:10.3389/fpubh.2021.707264

Int Emerg Nurs. 2021 Jul;57:101015. doi: 10.1016/j.ienj.2021.101015. Epub 2021 Jun 21.

ABSTRACT

BACKGROUND: Assessment and reassessment of self reported pain intensity scores form the basis of acute pain care in the emergency deprtment (ED), however are frequently undocumented. The effects of not documenting pain assessments on time to first analgesic medication (TTA) and ED length of stay (EDLOS) are unknown.

METHODS: This is a retrospective cross-sectional study to investigate the association between documented evidence of pain intensity scores, TTA and EDLOS in the ED. It also examined the factors associated with the documentation of pain intensity scores. Univariate and multivariable modelling was used on a random sample of presentations.

RESULTS: There were no statistically significant associations between the documented evidence of pain intensity scores and TTA or EDLOS. Modelling suggests that patients were less likely to have documented evidence of pain intensity scores if they were male, were streamed to the fast-track treatment area, had a lower burden of co-morbidities, or when the general departmental workload was increased.

CONCLUSIONS: The documentation of pain intensity scores was not associated with TTA or EDLOS. Some demographic, illness and workload factors are associated with the lack of pain intensity score documentation, however, the effect on patients outcomes needs further investigation.

PMID:34166989 | DOI:10.1016/j.ienj.2021.101015

Medicine (Baltimore). 2021 May 28;100(21):e24763. doi: 10.1097/MD.0000000000024763.

ABSTRACT

BACKGROUND: We carried out a randomized trial of an emergency department (ED)-based nursing intervention to evaluate the impact of an ED nursing intervention on ED revisits, patient perceptions of continuity of care, illness perceptions, self-care capacities and psychological symptoms.

METHOD: We conducted a randomized controlled trial to compare the ED-based intervention with usual care. The protocol was reviewed and approved by the Research Ethics Board of the Huzhou Central Hospital & Affiliated Central Hospital Huzhou University (K901923-021), each participant signed a written consent before participating, and SPIRIT guidelines were followed throughout. To be eligible, patients ready for discharge from the ED had to be at risk for ED return based on 2 criteria: at least one ED visit during the year prior to the initial visit, and current treatment with at least 6 medications. Exclusion criteria included cognitive problems (e.g., dementia) that would preclude provision of informed consent either noted in the medical chart or identified based on the clinical judgment of the project nurse. To avoid multiple interveners for the same patient, we also excluded patients already receiving other regular follow-up (e.g., at a specialized clinic in the hospital or from external resources). The major outcomes were assessed with the Heart Continuity of Care Questionnaire, the Illness Perception Questionnaire-Revised, the Therapeutic Self-Care Tool, the Hospital Anxiety and Depression Scale, and the Self-Reported Medication-Taking Scale.

RESULTS: Two hundred patients who met the inclusion criteria were included in our study, Table 1 showed the effects of nursing intervention on measures of clinical outcomes.

DISCUSSION: The ED is a major entry point into the health care system of many countries. Unnecessary ED revisits may result in overcrowding, increased waiting time, and failure to provide appropriate emergency care. The ED-based interventions literature focuses primarily on service use and ways to reduce ED revisits, with very little focus on impacting secondary outcomes. Because of their potential link with health service utilization, secondary outcomes such as perceived continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence might influence ED revisits. Future research was needed to better understand the complex relationship between ED utilization and a variety of intermediary factors in order to develop interventions that will optimize ED utilization.

PMID:34032691 | PMC:PMC8154481 | DOI:10.1097/MD.0000000000024763

Am J Transl Res. 2021 Apr 15;13(4):3658-3665. eCollection 2021.

ABSTRACT

OBJECTIVE: The purpose of this study is to analyze the influencing factors of postoperative pain in patients presenting with emergency orthopedic trauma, and to determine the effect of high-quality nursing on pain.

METHODS: In this prospective study, 78 emergency orthopedic trauma patients were randomized into the research group for high-quality nursing and the control group for routine emergency nursing. The two groups were compared with respect to pain degree, pain resolution time, related clinical indexes, pre- and post-treatment joint range of motion (ROM) and psychological state, as well as nursing satisfaction and complications. Univariate analysis and Logistic regression were carried out to analyze the influencing factors of pain following fractures.

RESULTS: Compared with before operation (at baseline), the visual analogue scale (VAS) scores decreased gradually from 1 to 7 days postoperatively in both groups, and were lower in the research group than in the control group in the same time period (all P<0.05). Logistic regression analysis revealed that male, anxiety and/or depression as well as general family support were the major factors affecting postoperative pain in patients with traumatic fractures (P<0.05). Patients in the research group showed significantly less pain resolution time and evidently shorter time of hospitalization and fracture healing than the control group (all P<0.01). Compared with the baseline, ROM scores increased significantly in both groups after intervention, and were higher in the research group than in the control group; Hamilton anxiety (HAMA) and Hamilton depression (HAMD) scores reduced remarkably in the two series, and were even lower in the research group (all P<0.05). In comparison with the control group, the nursing satisfaction was higher and the incidence of complications was lower in the research group (both P<0.05).

CONCLUSIONS: Gender, psychological state and family supportive attitudes have certain effects on postoperative pain degree of emergency orthopedic trauma patients. High-quality nursing can relieve postoperative pain degree and adverse psychological state of patients, with fewer complications, higher satisfaction and shorter hospitalization time.

PMID:34017548 | PMC:PMC8129256

J Emerg Nurs. 2021 Jul;47(4):669-674. doi: 10.1016/j.jen.2021.03.009. Epub 2021 Apr 27.

ABSTRACT

OBJECTIVE: The Emergency Severity Index (ESI) is a highly reliable and valid triage scale that is widely used in emergency departments in not only English language regions but also other countries. The Japan Triage and Acuity Scale (JTAS) is frequently used for emergency patients, and the ESI has not been evaluated against the JTAS in Japan. This study aimed to examine the decision accuracy of the ESI for simulated clinical scenarios among nursing specialists in Japan compared with the JTAS.

METHOD: A parallel group randomized trial was conducted. In total, 23 JTAS-trained triage nurses from 10 Japanese emergency departments were randomly assigned to the ESI or the JTAS group. Nurses independently assigned triage categories to 80 emergency cases for the assessment of interrater agreement.

RESULTS: Interrater agreement between the expert and triage nurses was κ = 0.82 (excellent) in the ESI group and κ = 0.74 (substantial) in the JTAS group. In addition, interrater agreement by acuity was level 2 = 0.42 (moderate) in the ESI group and level 2 = 0.31 (fair) in the JTAS group. Interrater agreement for triage decisions was classified in a higher category in the ESI group than in the JTAS Scale group at level 2. Triage decisions based on the ESI in Japan maintained the same level of interrater agreement and sensitivity as those in other countries.

CONCLUSION: These findings suggest that the ESI can be introduced in Japan, despite its different emergency medical background compared with other countries.

PMID:33931236 | DOI:10.1016/j.jen.2021.03.009

J Emerg Nurs. 2021 Jul;47(4):590-598.e3. doi: 10.1016/j.jen.2020.12.015. Epub 2021 Feb 26.

ABSTRACT

INTRODUCTION: The aim of the study was to identify emergency nurses' knowledge, attitudes, and practices related to blood sample hemolysis prevention and explore associations between these factors and demographic characteristics. The current state is unknown. Understanding baseline knowledge, attitudes, and practices addresses a gap in the literature.

METHOD: An exploratory, descriptive design with cross-sectional survey methodology employing a study-specific instrument was used.

RESULTS: Request for participation email was sent to a random sample of 5000 Emergency Nurses Association members, and 427 usable surveys were returned (response rate = 8.5%). Mean years in nursing was 13.85 (standard deviation = 10.78), and 226 (52.9%) were certified emergency nurses. Only 85 participants (19.9%) answered all 3 knowledge questions correctly. Answering the 3 knowledge questions correctly was significantly associated with being a certified emergency nurse (χ² = 7.15, P < .01). Participant responses to attitude items about the sequelae of blood sample hemolysis were skewed toward agreement, and most attitude items were associated with whom participants reported as being primarily responsible for phlebotomy. Emergency nurses remain primarily responsible for phlebotomy as well as addressing hemolyzed samples, but few reported that blood sample hemolysis was addressed at a departmental level.

DISCUSSION: Findings suggest that emergency nurses lack some knowledge related to blood sample hemolysis prevention best practices. Attitudes toward phlebotomy practices may be 1 reason practice has not changed. Every effort should be made to prevent hemolyzed blood samples to decrease delays and costs in emergency care.

PMID:33642055 | DOI:10.1016/j.jen.2020.12.015

J Diabetes Res. 2021 Feb 4;2021:5304124. doi: 10.1155/2021/5304124. eCollection 2021.

ABSTRACT

BACKGROUND: Currently, diabetic peripheral neuropathy (DPN) is one of the most severe complications of diabetes mellitus (DM). Despite the seriousness of this problem, limited evidence is available on the prevalence of diabetic peripheral neuropathy among patients with diabetes mellitus in Ethiopia. In Ethiopia, there were no updated studies that estimate the national prevalence of DPN. Hence, this systematic review and meta-analysis provided a national prevalence of diabetic peripheral neuropathy among patients with diabetes mellitus in Ethiopia.

METHODS: This study was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2020 and accepted with the registration number CRD42020173831. Different database searching engines were searched online to retrieve related articles, including PubMed, Scopus, Google Scholar, African Journals Online, World Health Organization (WHO) Afro Library, and Cochrane Review. The reviewers used the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline in the reviewing process. In this systematic review and meta-analysis, all published and unpublished articles were analyzed. The reviewers used the random effects model to estimate the pooled prevalence of diabetic peripheral neuropathy among diabetes mellitus patients. The reviewers conducted the statistical analysis using the R version 3.5.3 and RStudio version 1.2.5033 software for Windows. The reviewers evaluated the heterogeneity across the included studies by the inconsistency index (I ²). The reviewers examined the publication bias by the funnel plot.

RESULTS: The search of the databases produced 245 papers. After checking the inclusion and exclusion criteria, 38 articles with 14029 total patients with diabetes mellitus were found suitable for the review. Except for three (retrospective cohort study), all studies were cross-sectional. The overall pooled prevalence of diabetic peripheral neuropathy was 22% (95% CI 18% to 26%). The subgroup analysis of diabetic peripheral neuropathy among patients with diabetes in the different regions was 23% (95% CI 17% to 29%) in Addis Ababa, 27% (95% CI 16% to 38%) in Oromia, 16% (95% CI 14% to 18%) in South nation and nationalities, and 15% (95% CI 6% to 24%) in Amhara.

CONCLUSIONS: More than one-fifth of patients with diabetes have diabetic peripheral neuropathy. According to this study, the prevalence of diabetic peripheral neuropathy in Ethiopia is considerably high. This evidence suggests that attention should be given to patients with diabetes in monitoring patients' blood glucose.

PMID:33628833 | PMC:PMC7880716 | DOI:10.1155/2021/5304124

JBI Evid Synth. 2021 Feb 9. doi: 10.11124/JBIES-20-00289. Online ahead of print.

ABSTRACT

OBJECTIVES: The objectives of this review will be to identify the characteristics (eg, type, duration, and provider) of family-oriented interventions in long-term care residential settings. The authors will also identify which outcomes are reported in the literature when implementing family-oriented interventions.

INTRODUCTION: An array of family-oriented interventions in long-term care residential settings exist. Given the heterogeneity of current literature, mapping characteristics and intended outcomes of family-oriented interventions is an essential step to inform how best to support families of patients in long-term care residential settings.

INCLUSION CRITERIA: This review will consider studies describing family-oriented interventions for families of elderly patients in long-term care residential settings with no exclusion based on country, gender, or comorbidities. Interventions that address any family-related issue, such as quality of life, psychological burden, and family involvement in patient care, are eligible for inclusion. Studies will be excluded if the patients are cared for at their own homes or institutionalized care is provided on a temporary basis. Quantitative, qualitative, and mixed-method study designs will be considered for inclusion.

METHODS: A scoping review will be conducted using the JBI methodological approach. Seven databases will be systematically searched: Medline, CINAHL, Scopus, Evidence-Based Medicine Reviews including Cochrane library, PsycINFO, OpenGrey, and the Grey Literature Report. Citations will be screened against the inclusion criteria by two reviewers independently. Relevant data will be extracted from the included studies, and will be synthesized, summarized, and reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Findings will be published in a peer-reviewed journal.

PMID:33577233 | DOI:10.11124/JBIES-20-00289

J Emerg Nurs. 2021 Mar;47(2):313-320. doi: 10.1016/j.jen.2020.11.005. Epub 2021 Feb 3.

ABSTRACT

INTRODUCTION: Electrocardiogram interpretation is an essential skill for emergency and critical care nurses and physicians. There remains a gap in standardized curricula and evaluation strategies used to achieve and assess competence in electrocardiogram interpretation. The purpose of this study was to develop an importance ranking of the 120 American Heart Association electrocardiogram diagnostic labels with interdisciplinary perspectives to inform curriculum development.

METHODS: Data for this mixed methods study were collected through focus groups and individual semi-structured interviews. A card sort was used to assign relative importance scores to all 120 American Heart Association electrocardiogram diagnostic labels. Thematic analysis was used for qualitative data on participants' rationale for the rankings.

RESULTS: The 18 participants included 6 emergency and critical care registered nurses, 5 cardiologists, and 7 emergency medicine physicians. The 5 diagnoses chosen as the most important by all disciplines were ventricular tachycardia, ventricular fibrillation, atrial fibrillation, complete heart block, and normal electrocardiogram. The "top 20" diagnoses by each discipline were also reported. Qualitative thematic content analysis revealed that participants from all 3 disciplines identified skill in electrocardiogram interpretation as clinically imperative and acknowledged the importance of recognizing normal, life threatening, and time-sensitive electrocardiogram rhythms. Additional qualitative themes, identified by individual disciplines, were reported.

DISCUSSION: This mixed-methods approach provided valuable interdisciplinary perspectives concerning electrocardiogram curriculum case selection and prioritization. Study findings can provide a foundation for emergency and critical care educators to create local ECG educational programs. Further work is recommended to validate the list amongst a larger population of emergency and critical care frontline nurses and physicians.

PMID:33546884 | DOI:10.1016/j.jen.2020.11.005

Worldviews Evid Based Nurs. 2021 Feb;18(1):23-32. doi: 10.1111/wvn.12485. Epub 2021 Jan 25.

ABSTRACT

BACKGROUND: Emergency care clinicians are expected to use the latest research evidence in practice. However, emergency nurses do not always consistently implement evidence-based practice (EBP). An educational intervention on EBP was implemented to promote emergency nurses' use of EBP, and the effectiveness of it was evaluated.

AIMS: This study aimed to evaluate the effectiveness of an EBP educational intervention on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The study also examined learners' satisfaction with the EBP educational intervention.

METHODS: A randomized controlled trial with parallel groups with evaluations before the education, immediately after it, and 6 and 12 months after the education was conducted at four emergency departments in two university hospitals. The experimental group (N = 40) received EBP education while the control group (N = 40) completed self-directed EBP education. The primary outcomes were emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior, while the secondary outcome was satisfaction with the EBP education.

RESULTS: Thirty-five participants of an experimental and 29 participants of a control group completed the study. There were no statistically significant (p < .05) improvements and differences between groups in EBP attitude, self-efficacy, or behavior immediately after the EBP education. At the 6-month measurement point, the experimental group showed significantly better EBP attitudes, behavior, knowledge, and self-efficacy than the control group. At the 12-month measurement point, the improvements began to decrease. The groups also differed significantly in terms of participant satisfaction with how the teacher encouraged learners to ask clinical questions.

LINKING EVIDENCE TO ACTION: The EBP educational intervention implemented in this study had a positive effect on emergency nurses' EBP attitudes, knowledge, self-efficacy, skills, and behavior. The effects of the education appeared the best 6 months after the education. After this point, the results began to decrease and approached baseline levels. EBP educational interventions designed for emergency nurses should apply various teaching strategies to improve their EBP attitude, knowledge, self-efficacy, skills, behavior, and satisfaction with the education.

PMID:33492782 | DOI:10.1111/wvn.12485

J Nurs Scholarsh. 2021 Mar;53(2):189-197. doi: 10.1111/jnu.12613. Epub 2021 Jan 21.

ABSTRACT

PURPOSE: Contextualization of psychological first aid (PFA) in different cultural, political, and socioeconomic contexts and in different population groups is essential. This review analyzes the efforts that have been made to contextualize PFA in different parts of the world for different disasters and emergencies.

DESIGN: Integrative literature review.

METHODS: The major databases that were searched for related literature published until August 2019 included JBI, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), BIOSIS, ISI Web of Knowledge, Scopus, EBSCOhost, and PsycINFO. A total of 17 studies published in peer-reviewed journals were included. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, and the 6W3H tool was applied to synthesize the results.

FINDINGS: PFA has been adapted to various disasters and populations in different countries and regions. The organizations that administer PFA range from community level to national level. Professional or "outside helpers" who enter disaster-affected locations include psychologists, fire fighters, social workers, and nurses. "Inside helpers," who live and work in the disaster-affected areas, include HR staff, teachers, and peer emergency personnel. Only a few studies have reported the exact number of first responders who administered PFA. Some studies revised PFA as group based, and a few reported the classification of groups of victims. Notably, all adaptations adhered to the basic principles of PFA, and the time at which PFA was administered ranged from a few days to months after an incident. PFA was conducted on site in all studies. The selection of the location depended on the type of disaster and local situation with due consideration of safety. Only a few studies specified the rationale for revising the PFA. None of these 17 studies reported the cost, cost-benefit, or cost-effectiveness of PFA.

CONCLUSIONS: Population-focused, context-specific, and group-based PFA is emerging worldwide. Nurses are actively playing a role in providing PFA. Research gaps exist in differentiating between the roles played by "outside" and "inside" responders, considering vulnerable age groups other than children, incorporating the major PFA concepts such as resilience, and evaluating the cost-effectiveness of PFA.

CLINICAL RELEVANCE: It is imperative that nurses and other emergency staff consider the intersection of age, gender, cultural, political, social economic, and spiritual contexts when developing a context appropriate PFA.

PMID:33476476 | DOI:10.1111/jnu.12613

J Clin Nurs. 2021 Apr;30(7-8):995-1002. doi: 10.1111/jocn.15645. Epub 2021 Jan 25.

ABSTRACT

AIMS AND OBJECTIVES: To investigate the effect of reverse Trendelenburg position versus semi-recumbent position on respiratory parameters of obese critically ill patients.

BACKGROUND: Reverse Trendelenburg position is recommended for obese patients; however, the effect among critically ill patients, especially those on mechanical ventilation, has limited study.

DESIGN: Randomised, controlled pretest, repeated post-test trial with two parallel groups.

METHODS: The study started from 13 January 2020-12 March 2020. Adult critically ill patients with a body mass index ≥30 were randomly assigned by computer-generated randomisation to either reverse Trendelenburg position group (intervention) or semi-recumbent position group (active comparator control). Outcome measures were ventilation parameters (dynamic compliance, partial pressure of arterial carbon dioxide and minute volume) and oxygenation parameters (hypoxaemic index and partial pressure of arterial oxygen). Measures were assessed immediately before positioning and after positioning in 10 minutes, 20 minutes and 30 minutes. CONSORT checklist was used to report the current study.

SETTINGS: Four general intensive care units.

RESULTS: One hundred and ten patients (55 patients in each group) completed the study. The reverse Trendelenburg position group had a higher improvement than the semi-recumbent position group as estimated by mean differences in their dynamic compliance, minute volume, partial pressure of carbon dioxide, partial pressure of oxygen and hypoxaemic index.

CONCLUSION: Reverse Trendelenburg position improves obese patients' respiratory parameters more than semi-recumbent position.

RELEVANCE TO CLINICAL PRACTICE: This study directs nurses to use the reverse Trendelenburg position, which is an important position for enhancing the parameters of ventilation and oxygenation of obese mechanically ventilated patients.

PMID:33432600 | DOI:10.1111/jocn.15645

J Clin Hypertens (Greenwich). 2021 Mar;23(3):672-679. doi: 10.1111/jch.14168. Epub 2021 Jan 7.

ABSTRACT

Hypertensive urgency (HT urgency) is an alarming sign of uncontrolled hypertension. It is aggravated by nonadherence to medication, as well as psychosocial stress. Mindfulness is beneficial for reducing stress, while deep and slow breathing is effective for lowering blood pressure (BP). In our study, we aimed to assess BP and heart rate effects in HT urgency patients practicing pursed-lip breathing and number counting (PLB with NC)-a practice that promotes mindfulness with deep/slow breathing patterns. In a randomized controlled trial, 110 patients were equally allocated to intervention and control groups. The intervention group was trained and encouraged to do PLB with NC during their emergency room admission, while the control group received conventional medical care. The mean systolic BP (SBP), diastolic BP (DBP), and HR of the intervention group in the 3rd hour were significantly lower than the baseline values at -28.2 mm Hg (95%CI;-23.5 to -32.4), -17.1 mm Hg (95%CI;-14.2 to -20.0), and -4.9 beats per minute (bpm) (95%CI;-4.0 to -5.8), respectively. In the control group, both the mean SBP and DBP were also significantly lower in the 3rd hour. However, HR reduction was inconclusive. When the two groups were compared, a greater degree of reduction was found in the intervention group for SBP (9.80 mm Hg, 95%CI; 4.10 to 15.50), DBP (7.69 mm Hg, 95%CI; 3.61 to 11.77), and HR (3.85 bpm, 95%CI; 1.99 to 5.72). In conclusion, PLB with NC was effective for lowering BP and HR. It might be used as a complementary treatment for HT urgency patients.

PMID:33410589 | PMC:PMC8029503 | DOI:10.1111/jch.14168

J Clin Hypertens (Greenwich). 2021 Mar;23(3):680-686. doi: 10.1111/jch.14103. Epub 2020 Nov 15.

ABSTRACT

Hypertension (HT) is a prominent cardiovascular risk factor. Although there are various pharmacological treatment choices for this condition, many patients fail to adhere to them, making non-pharmacological options attractive alternatives. Foot reflexology has been proven to decrease blood pressure (BP), but data are limited in patients with stage-2 HT. We conducted a randomized clinical trial to examine the effectiveness of foot reflexology in reducing BP and heart rate (HR). Stage-2 HT patients were enrolled and randomized into the intervention and the control groups (n = 47, each), the former of which underwent foot reflexology during a follow-up visit. Office BP and HR were measured before and at 15 and 30 min after the procedure in the intervention group and after resting in the control group. In the intervention group, systolic BP (SBP), diastolic BP (DBP), and HR at 15 min were significantly lower than at baseline: -3.29 mm Hg (95%CI; -5.64 to -0.93), -1.71 mm Hg (95%CI; -3.11 to -0.32), and -1.71 beats per min (bpm; 95%CI; -2.88 to -0.54), respectively. Similar trends were also observed at 30 min. However, when compared with the control group, only the reduction in HR was significant (-4.96 bpm; 95%CI, -9.63 to -0.28). We conclude that foot reflexology was effective in reducing HR in stage-2 HT patients and partially effective in reducing BP.

PMID:33190420 | PMC:PMC8029572 | DOI:10.1111/jch.14103

Curr Diabetes Rev. 2021;17(6):e102620187197. doi: 10.2174/1573399816666201026161009.

ABSTRACT

BACKGROUND: Recognizing and promoting the factors that affect the self-management behaviors of diabetes lead to a reduction in the number of patients and an improvement in the quality of care. The ecological approach focuses on the nature of people's interactions with their physical and socio-cultural environments.

OBJECTIVE: The purpose of this study was to identify the predictors of self-management behaviors with a comprehensive approach in these patients.

METHODS: The keywords were investigated in the relevant national and international databases, including PubMed, Google Scholar, Science Direct, Scopus, and Scientific Information Database, Magiran, and Iran Medex, to obtain the articles published from 2009 to 2019. The search and article selection strategy was developed based on the Prisma checklist and was carried out in three steps.

RESULTS: Most studies have shown that personal factors had the highest prediction power for the self-management of diabetes. The interpersonal factors, society and policy-making factors, and group and organization factors were then the most frequently reported predictors of self-management behaviors in diabetic patients.

CONCLUSION: Self-management of diabetes is necessary for controlling it because 95% of care is done by the patient. When designing self-management interventions, factors are based on the individual level that is to increase self-management behaviors.

PMID:33106146 | DOI:10.2174/1573399816666201026161009

Australas Emerg Care. 2021 Mar;24(1):55-60. doi: 10.1016/j.auec.2020.09.003. Epub 2020 Oct 5.

ABSTRACT

BACKGROUND: Emergency departments (EDs) are often first to feel the intra-hospital effects of disasters. Compromised care standards during disasters eventuate from increased demands on health resources; the facilities, supplies, equipment and manpower imperative for a functioning healthcare facility. Emergency departments must understand the effect of disasters on their health resources. This paper examines the impact on resources within the ED as a result of a disaster and provides a review against the United Nations Office for Disaster Risk Reduction's Sendai Framework for Disaster Risk Reduction 2015-2030 priorities.

METHOD: An integrative literature review design was utilised. Articles were extracted from databases and search engines. The Preferred Reporting Items of Systematic reviews and Meta-Analysis Guidelines for systematic literature reviews were used.

RESULTS: Seven papers met inclusion criteria. Disaster consumable stocking was used to mitigate disaster risk and improve resilience. Logistical challenges were exacerbated by poor building design. Ineffective human resource management, communications failure, insufficient ED space, diminished equipment and supplies and unreliable emergency power sources were described.

CONCLUSIONS: Disaster planning and preparedness strategies can address health resource deficits, increasing ED resilience. Further retrospective case studies are required to greater understand the effects of disasters on ED health resources.

PMID:33032978 | DOI:10.1016/j.auec.2020.09.003

J Emerg Nurs. 2021 Mar;47(2):305-312. doi: 10.1016/j.jen.2020.07.001. Epub 2020 Sep 19.

ABSTRACT

INTRODUCTION: Nurses are often first responders to in-hospital cardiac arrests. However, many nurses do not perform defibrillation even when required. Nurses' attitudes toward defibrillator use are influenced by social and psychological context. This descriptive, cross-sectional study explored factors affecting attitudes toward defibrillator use among nurses in South Korea.

METHODS: A total of 280 nurses with a minimum of 6 months' clinical experience were included. The data were acquired through a self-administered questionnaire. Regression analysis was used to determine factors significantly associated with attitudes toward defibrillator use.

RESULTS: Only 13.6% of the participating nurses had experience with defibrillator use in a cardiopulmonary resuscitation situation, whereas 94.6% of the nurses had received training on defibrillator use. Attitudes toward defibrillator use accounted for 37% of variance in measures of self-confidence, image, and job fit.

DISCUSSION: To improve clinical nurses' attitudes toward defibrillator use, improving their self-confidence, image, and job fit through ongoing assessment and retraining on defibrillation is required. In addition, relevant institutional support and systematic guidelines should be provided.

PMID:32962845 | DOI:10.1016/j.jen.2020.07.001

Inj Prev. 2020 Oct;26(Supp 1):i125-i153. doi: 10.1136/injuryprev-2019-043531. Epub 2020 Aug 24.

ABSTRACT

BACKGROUND: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.

METHODS: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced.

RESULTS: GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes.

CONCLUSIONS: GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

PMID:32839249 | PMC:PMC7571362 | DOI:10.1136/injuryprev-2019-043531

Int Emerg Nurs. 2020 Sep;52:100911. doi: 10.1016/j.ienj.2020.100911. Epub 2020 Aug 19.

ABSTRACT

INTRODUCTION: Nurses' job satisfaction has a direct impact on the quality of their performance, especially in the emergency department, which is a showcase of care in hospitals, since, nurses' moral performance is greatly affected by moral intelligence, Adherence to ethics by nurses, underlies the social capital of the organization.

METHODS: The present study was a cross-sectional, descriptive-correlational study. 99 nurses working in the emergency department of medical educational centers in Semnan, Iran, were selected by simple random sampling. Data were collected by questionnaires: demographic information, job satisfaction, moral intelligence and social capital of nurses. Data were analyzed using descriptive statistics and analytical statistics in SPSS software. All P-values <0.05 were considered statistically significant.

RESULTS: The mean and standard deviation of job satisfaction, moral intelligence, and social capital scores were 51.24 ± 12.03, 148.48 ± 19.05, and 43.45 ± 7.28, respectively. Job satisfaction did not have a significant relationship with moral intelligence and its domains, but it had a significant relationship with social capital and its domains (P = 0.002).

CONCLUSION: Due to the significant relationship between job satisfaction and social capital, Nurses' satisfaction and attitude toward the job can be improved by creating a context for progress and self-actualization.

PMID:32827936 | DOI:10.1016/j.ienj.2020.100911

Int Emerg Nurs. 2020 Jul;51:100889. doi: 10.1016/j.ienj.2020.100889. Epub 2020 Jul 1.

ABSTRACT

INTRODUCTION: Patients who visit emergency departments need to undergo a precise assessment to determine their priority and accurate triage category to ensure they receive the right treatment.

AIM: To identify the effect of triage training on the skills and accuracy of triage decisions for adult trauma patients.

METHOD: A randomized controlled trial design was conducted in ten emergency department of public hospitals. A total of 143 registered nurses and medical officer assistants who performed triage roles were recruited for the control group (n = 74) and the intervention group (n = 69). The skill and accuracy of triage decisions were measured two weeks and four weeks after the intervention group were exposed to the intervention.

RESULTS: There was a significant effect on the skill of triage decision-making between the control and the intervention group p < 0.001, η²_partial = 0.31. Concerning the accuracy of triage decisions, the effect was significantly different between the control group and the intervention group p < 0.001, η²_partial = 0.66 across time.

CONCLUSION: The triage training improved the skills of the participants and the accuracy of triage decision-making across time.

PMID:32622225 | DOI:10.1016/j.ienj.2020.100889

Emerg Med J. 2021 Sep;38(9):694-700. doi: 10.1136/emermed-2019-208910. Epub 2020 Jun 19.

ABSTRACT

INTRODUCTION: Exit block is the most significant cause of poor patient flow and crowding in the emergency department (ED). One proposed strategy to reduce exit block is early admission predictions by triage nurses to allow proactive bed management. We report a systematic review and meta-analysis of the accuracy of nurse prediction of admission at triage.

METHODOLOGY: We searched MEDLINE, Cochrane, Embase, CINAHL and grey literature, up to and including February 2019. Our criteria were as follows: prospective studies analysing the accuracy of triage nurse intuition-after gathering standard triage information-for predicting disposition for adult ED patients. We analysed the results of this test-nurse prediction of disposition-in a diagnostic test analysis review style, assessing methodology with the Quality Assessment of Diagnostic Accuracy Studies 2 checklist. We generated sensitivity, specificity and likelihood ratios (LRs). We used LRs and pretest probability of admission (baseline admission rate) to find positive and negative post-test probabilities.

RESULTS: We reviewed 10 articles. Of these, seven had meta-analysable data (12 282 participants). The studies varied in participant selection and admission rate, but the majority were of moderate quality and exclusion of each in sensitivity analyses made little difference. Sensitivity was 72% and specificity was 83%. Pretest probability of admission was 29%. Positive and negative post-test probabilities of admission were 63% and 12%, respectively.

CONCLUSION: Triage nurse prediction of disposition is not accurate enough to expedite admission for ED patients on a one-to-one basis. Future research should explore the benefit, and best method, of predicting total demand.

PMID:32561525 | DOI:10.1136/emermed-2019-208910

BMC Nurs. 2020 Jun 15;19:51. doi: 10.1186/s12912-020-00446-6. eCollection 2020.

ABSTRACT

BACKGROUND: Pressure ulcer is largely avoidable, but its prevalence rate increased more than 80% in a 13 years study. Nurses have a great position to advance best practices towards the prevention of pressure ulcers. Therefore they should be knowledgeable of the signs and symptoms of pressure ulcers, and preventive strategies to reduce its incidence, but there is limited evidence on nurses' knowledge and its associated factors to prevent pressure ulcers in Ethiopia.

METHODS: A hospital-based cross-sectional study was conducted from March 25 - April 23/ 2018. A total of 356 nurses were selected by stratification with a simple random sampling technique. Pretested structured questionnaire with closed and open-ended questions was used to collect data. Frequency distribution and percentage were computed to describe each variable. Bivariate and multivariable logistic regression with a 95% confidence interval was also carried out to see the effect of each independent variable on the dependent variable and declared statistically significant association with P < 0.05.

RESULT: The mean knowledge score of nurses was 25.22 out of 41 item questions. Fifty-two point 5 % of nurses score above the mean. Males [AOR = 0.44, 95% CI (0.26-0.73)], working a maximum of eight hours [AOR = 3.57, 95% CI (1.48-8.61), not having training [(AOR = 2.31, 95% CI (1.14-4.61)], Low salary [AOR = 3.47, 95% CI (1.03-11.67)] were significantly associated with inadequate knowledge.

CONCLUSION: Generally a nurse's knowledge of pressure ulcers was inadequate. Being female, working less than or equal to eight hours, not having the training and low working salary are contributors to a low level of knowledge for pressure ulcers.

PMID:32549784 | PMC:PMC7296692 | DOI:10.1186/s12912-020-00446-6

J Emerg Nurs. 2020 Jul;46(4):548.e1-548.e11. doi: 10.1016/j.jen.2020.03.013. Epub 2020 Jun 10.

ABSTRACT

INTRODUCTION: One of the main risk factors for poor health is a high level of job stress. Time management skills can greatly reduce job stress. The current study aimed to evaluate the effectiveness of a one-time management training workshop on job stress among nurses working in emergency departments.

METHODS: This randomized experimental study was carried out with 80 nurses working in emergency departments affiliated with a university of medical sciences. The intervention was an 8-hour workshop on time management. Pre- and posttest data were collected by demographic questionnaire and an occupational stress inventory before and 1 month after intervention. Data were analyzed using descriptive, chi-square, t test, Fisher exact, and analysis of covariance statistics.

RESULTS: The mean of job stress in the intervention group increased after the intervention (186.22, SD = 22.97) from baseline (182.52, SD = 34.39) compared with the mean of job stress in the control group (204.42, SD = 22.42) and (204.35, SD = 22.45). The control group had a significantly higher job stress score before the intervention (t = -3.37, P = 0.001). There was no statistically significant difference between the intervention and control group in job stress scores after intervention (t = -3.56, P = 0.77).

DISCUSSION: The time management skills training program did not reduce the moderate-high levels of job stress of nurses in emergency departments. Addressing other sources of job stress, besides time management, is needed.

PMID:32534724 | DOI:10.1016/j.jen.2020.03.013

Am J Emerg Med. 2020 Dec;38(12):2740-2741. doi: 10.1016/j.ajem.2020.04.058. Epub 2020 Apr 22.

NO ABSTRACT

PMID:32513454 | DOI:10.1016/j.ajem.2020.04.058

Epidemiol Health. 2020;42:e2020030. doi: 10.4178/epih.e2020030. Epub 2020 May 13.

ABSTRACT

OBJECTIVES: Medication errors (MEs) made by nurses are the most common errors in emergency departments (EDs). Identifying the factors responsible for MEs is crucial in designing optimal strategies for reducing such occurrences. The present study aimed to review the literature describing the prevalence and factors affecting MEs among emergency ward nurses in Iran.

METHODS: We searched electronic databases, including the Scientific Information Database, PubMed, Cochrane Library, Web of Science, Scopus, and Google Scholar, for scientific studies conducted among emergency ward nurses in Iran. The studies were restricted to full-text, peer-reviewed studies published from inception to December 2019, in the Persian and English languages, that evaluated MEs among emergency ward nurses in Iran.

RESULTS: Eight studies met the inclusion criteria. Most of the nurses (58.9%) had committed MEs only once. The overall mean rate of MEs was 46.2%, and errors made during drug administration accounted for 41.7% of MEs. The most common type of administration error was drug omission (17.8%), followed by administering drugs at the wrong time (17.5%) and at an incorrect dosage (10.6%). The lack of an adequate nursing workforce during shifts and improper nurse-patient ratios were the most critical factors affecting the occurrence of MEs by nurses.

CONCLUSIONS: Despite the increased attention on patient safety in Iran, MEs by nurses remain a significant concern in EDs. Therefore, nurse managers and policy-makers must take adequate measures to reduce the incidence of MEs and their potential negative consequences.

PMID:32512668 | PMC:PMC7644927 | DOI:10.4178/epih.e2020030

J Emerg Nurs. 2020 Jul;46(4):488-496. doi: 10.1016/j.jen.2020.03.012. Epub 2020 May 29.

ABSTRACT

INTRODUCTION: Respiratory rate is the first sign of patient decline. Monitoring and recording respiratory rate are essential nursing competencies. However, health care system emergency nurses' ability to differentiate normal from abnormal respiratory rates was unknown. We conducted a health care improvement project to assess emergency nurses' accuracy in "spot" and "formal" assessments, understand assessment practices, and determine competency and training needs.

METHODS: In an anonymous cross-sectional survey, 78 emergency nurses from 1 health care system viewed 3 "spot" and 3 "formal" mock patient videos and answered questions in REDCap (Vanderbilt University, Nashville, TN). Accuracy (abnormal/normal), systematic error (bias), and random error (imprecision) were assessed. Descriptive statistics, bivariate analyses, and qualitative content analysis of open-ended questions were reported.

RESULTS: Most emergency nurses identified respiration as abnormal in spot and formal assessment videos. Accuracy was lowest for the video displaying 6 breaths per minute. Emergency nurses were more likely to identify abnormal breathing in all formal assessment videos (n = 59, 75.7%) than in all spot assessment videos (n = 41, 52.6%) (McNemar χ² = 10.32, P = 0.001). Most emergency nurses reported a willingness to use formal assessments and thought that respiratory rate was a good indicator of a patient's condition. The barriers to accurate assessment included time limitations, prior training focusing on assessments lasting less than 30 seconds, and monitor and staff errors.

DISCUSSION: Respiratory rate assessment may be best assessed formally, particularly for bradypnea, where formal checks may outperform spot checks. The results present areas for improving respiratory rate assessment training and clinical practice.

PMID:32482501 | DOI:10.1016/j.jen.2020.03.012

J Emerg Nurs. 2020 May;46(3):318-337. doi: 10.1016/j.jen.2020.02.007.

ABSTRACT

INTRODUCTION: A high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury.

METHODS: A systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool.

RESULTS: Nineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard.

DISCUSSION: Patients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.

PMID:32389205 | DOI:10.1016/j.jen.2020.02.007

Simul Healthc. 2020 Dec;15(6):382-387. doi: 10.1097/SIH.0000000000000451.

ABSTRACT

INTRODUCTION: Virtual simulation (VS) is an adaptable medium for teaching critical disaster management skills such as efficient hospital evacuation. We aimed to compare VS and prerecorded narrated multimedia lecture-based training of pediatric nurses for evacuation of a sick newborn in the neonatal intensive care unit and pediatric emergency department (ED) using live evacuation simulations.

METHODS: Thirty neonatal intensive care unit and 30 ED nurses enrolled with 30 randomized to multimedia lecture and 30 randomized to VS, with equal block distribution of nurses from each unit. Pretraining/posttraining surveys were administered, and live evacuation simulations were scored for time to evacuation, items collected, and communication.

RESULTS: Overall, disaster preparation and communication improved within the VS group as compared with the multimedia lecture group. Virtual simulation rated more immersive (P < 0.001), better at safety threat identification (P < 0.05), and better at evacuation preparation compared with multimedia lecture (P < 0.01). Virtual simulation participants felt more prepared in disaster response (P < 0.001) and patient evacuation (P < 0.001). Both groups packed equal essential items, but VS participants packed more equipment (mean, 19 vs. 15, P < 0.01) with no significant evacuation time difference between the VS group (145 ± 58 seconds) and multimedia lecture group (152 ± 59 seconds, P = not significant). Virtual simulation participants had better communication ratings with the charge nurse (P < 0.05) and family (P < 0.001).

CONCLUSIONS: Virtual simulation was well received by nurses compared with multimedia lecture and may be an effective adjunct for training nurses on infant patient evacuation during a disaster.

PMID:32371747 | DOI:10.1097/SIH.0000000000000451

J Emerg Nurs. 2020 Sep;46(5):611-622. doi: 10.1016/j.jen.2020.03.005. Epub 2020 Apr 29.

ABSTRACT

INTRODUCTION: Disasters of any kind can affect public health severely. A shortage of health care specialists, such as physicians and nurses, during a disaster is a challenge for health care systems. The use of technology is 1 emerging strategy for addressing the continually increasing demand for care. Moreover, nurses may use technology in their roles. Therefore, the purpose of this study was to identify the application of telehealth, and more specifically telenursing care, in incidents and disasters.

METHODS: This systematic review study was conducted on the basis of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English language international databases (PubMed, Scopus, Embase, Web of Science, and Google Scholar) were searched through November 2018. The quality of the studies was assessed using the International Narrative Systematic Assessment tool.

RESULTS: Of the 5,759 titles identified in this search, 17 studies met the inclusion criteria. The important findings of this study were grouped into 3 main categories: clinical teams, disaster and communication types, and key outcomes of the telehealth programs used in disasters and incidents. We did not find any articles in the field of telenursing care during incidents.

DISCUSSION: Providing health care during a disaster is essential, and technology is of vital importance for such care. Because of the shortage of specialized nurses in disaster areas, the presence of such a group in the telehealth program will provide a new window for care. Thus, telenursing offers a means of improving health care response.

PMID:32360295 | DOI:10.1016/j.jen.2020.03.005

Health Qual Life Outcomes. 2020 Apr 29;18(1):116. doi: 10.1186/s12955-020-01374-4.

ABSTRACT

BACKGROUND: Studies have shown that poor sleep could result in many unpleasant consequences and is prevalent in nurses. Considering the fact of high stress, overwhelming workload and many night shifts in the emergency department in China, this study aimed to evaluate the current status of emergency nurses' sleep quality in public hospitals in Shandong, China and explored its influencing factors.

METHODS: A self-administered questionnaire incorporating the Job Content Questionnaire and Pittsburgh Sleep Quality Index (PSQI) was conducted among 4856 emergency nurses in five randomly selected city emergency command systems in Shandong, China. The association of potential influencing factors, including occupational, psychosocial and individual factors, with poor sleep (PSQI> 5) was quantified by multivariate logistic regression analysis.

RESULTS: The average PSQI score of 4730 emergency nurses in public hospitals was 8.2 ± 3.9, including 3114 (65.8%) subjects with PSQI > 5 and 2905 (61.4%) > 8; these figures were found highest for 337 emergency nurses in 14 tertiary hospitals with 11.8 ± 4.3, 257 (76.3%) and 232 (68.8%), followed by 1044 emergency nurses in 43 secondary hospitals with 9.5 ± 3.9, 725 (69.4%) and 675 (64.7%) and 3349 emergency nurses in 167 primary hospitals with 7.4 ± 3.5, 2132 (63.7%) and 1998 (59.7%). The following factors were associated with poor sleep: hospital level (tertiary vs. primary, secondary vs. primary), female sex, less of exercise, long work hours per week, many patients in the charge of at night, high monthly night shift frequency (4-6 vs. never, ≥7 vs. never) and high occupational stress.

CONCLUSIONS: The sleep quality of emergency nurses in public hospitals in China was poor, especially in tertiary hospitals. Many factors as listed above, especially occupational stress, night shift taking and workload at night, should be considered when improving emergency nurses' sleep quality.

PMID:32349759 | PMC:PMC7191763 | DOI:10.1186/s12955-020-01374-4

Emerg Nurse. 2019 Nov 5;27(6):19-25. doi: 10.7748/en.2019.e1950.

ABSTRACT

This integrative review is the first of a two-part series about intimate partner violence (IPV). Part 2 will explore strategies to address barriers to the care of women who experience IPV in the emergency department (ED). IPV has become a major concern globally and specifically in Australia. Healthcare professionals in the ED are often the first point of contact for women experiencing IPV and therefore the provision of a comprehensive healthcare response to these vulnerable patients remains a priority. The review evaluated healthcare professionals' approaches to the care of women who present to the ED with injuries related to IPV. A systematic search of studies was undertaken using four databases. After the selection process, a total of 24 articles was identified. Six themes emerged: IPV care protocols, physical care provision, psychosocial care provision, provision of safety, role of referrals and barriers to appropriate care provision. There is a lack of evidence supporting healthcare approaches in the ED to address IPV. ED healthcare professionals experience numerous barriers that hinder their ability to provide patient-centred care, which suggests that patients presenting with IPV-related concerns may not be receiving adequate or appropriate healthcare in ED settings.

PMID:32339451 | DOI:10.7748/en.2019.e1950