SciCombinator

Discover the most talked about and latest scientific content & concepts.

Journal: Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association

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AS HEALTHCARE providers, we rely on the latest technology. It helps us to understand and treat complex health conditions, and to model clinical trials.

Concepts: Health care, Health care provider, Medicine, Health, Epidemiology, Clinical trial, Medical ethics, ClinicalTrials.gov

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Due to major changes in how emergency care is delivered across different communities, one emergency department is no longer like another. Some have separate minor injury provision, some are general departments that cater for all types of patient, while others are designated major trauma centres. These differences in patient profile affect the required numbers and skill mix of nursing establishments so that the nursing workforce in each cannot be predicated on patient numbers alone. This article describes the development by the RCN Emergency Care Association of an evidence-based staffing tool and how it can be used in practice.

Concepts: Hospital, Urgent care, Emergency medicine, Emergency department

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Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.

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Rhabdomyolysis is a rare and complex condition that involves injury of the skeletal muscle fibres, resulting in the release of substances such as creatine kinase and myoglobin. It is associated with acute kidney injury and mortality. This article describes the case of a 40-year-old man who presented to the emergency department after an overdose of tramadol hydrochloride. It uses critical reflection to explore traumatic and non-traumatic causes of rhabdomyolysis and reviews the literature relating to the diagnosis of rhabdomyolysis through laboratory and point-of-care testing. To ensure the timely identification of patients at risk of deterioration, emergency nurses need to be aware of the potential causes and the clinical signs and symptoms of rhabdomyolysis.

1

The first article in this two-part series evaluated healthcare professionals' approaches to the care of women who present to the emergency department (ED) with injuries related to intimate partner violence (IPV). It identified barriers to appropriate care provision, which included a lack of knowledge on the part of healthcare professionals and negative professional attitudes. This second article details the findings of a literature review of three databases that aimed to evaluate strategies to address the lack of knowledge of healthcare professionals and negative attitudes concerning IPV. A total of 11 articles were included in the review. Two main strategies to address ED healthcare professionals' knowledge deficits and negative attitudes about IPV were identified. These were developed into the themes of IPV/domestic violence specialists, and education and training.

1

This article explores secondary traumatic stress (STS) and the emotional challenges that emergency nurses face when dealing with traumatised patients. The few studies on STS have shown a higher occurrence of STS symptoms in emergency nurses but provide limited evidence on how personal experiences may contribute to STS. Risk factors identified include repeated exposure to trauma; morbidity and mortality; personal trauma; chronic stressors; workload and emergency department pressures. STS can lead to reduced job satisfaction, sick leave and burnout. Protective factors include awareness and self-care, emotional intelligence, social support and education about STS. Strategies to minimise STS include balancing personal and professional life and the support of employers to help reduce compassion fatigue and aid staff retention.

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The aim of this study was to examine an emergency department’s (ED) multidisciplinary teams' (MDTs) attitudes towards an advanced nurse practitioner (ANP) service. The ED in question is not the author’s place of work.

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Distal limb fractures are common presentations to emergency departments and minor injury units (MIUs). The authors conducted a study of the usefulness and efficiency of portable ultrasound in detecting the presence of minor fractures in patients presenting to Cirencester Hospital’s MIU. Patients above two years of age about whom there was a high clinical suspicion of a closed fracture of the distal forearm or wrist, or the lower limb, were included in the study. After initial clinical assessments, the patients were referred for X-ray, as is usual for such patients, and also for ultrasound imaging of their injured sites. The ultrasound and radiograph images were subsequently compared for injury and presence of fracture, and this article discusses the results.

Concepts: Hospital, Medical imaging, Radiography, Magnetic resonance imaging, Injury, Medical physics, Medical ultrasonography, Forearm

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Buckle fractures of the distal radius are unique to children and a frequent presentation in the emergency department (ED). In University Hospital Waterford, Ireland, the treatment of buckle fractures followed the traditional method involving a rigid cast and a follow-up hospital appointment. However, the latest literature indicates that buckle fractures are stable and heal without complication, so a minimalist approach to treatment is recommended. Therefore, the advanced nurse practitioners in the ED introduced a change in protocol at the hospital. This involved the use of a soft cast for removal at home, with verbal and written discharge information and no follow-up appointment. An audit was conducted to ensure that this new protocol was safe and effective, and the time and distance saved by patients through avoiding a return hospital visit was estimated. Treatment in a soft cast with verbal and written discharge information revealed a successful outcome for all 88 patients included in the audit. Avoiding return hospital visits resulted in significant travel time and distance savings for patients and families.

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Patient experience and satisfaction are often used to evaluate the quality of care provided in emergency departments (EDs). Several studies have evaluated the experiences of patients and their family members in EDs internationally, but few studies have investigated the experiences of those attending EDs in Iran.