Journal of Emergency Nursing

Your Generation Matters!

Diane Gurney — 2010-07-01

As I write this, I am almost halfway through my presidency year. During that time I have traveled to many states for conferences and meetings, and I have been honored to meet many emergency nurses in person. The effect has been one of joy and wonderment, and I am humbled to wear the title of “president” this year. I have been impressed by your passion, enthusiasm and excitement as I hear you talk about your patients, your practice and your colleagues. Most amazing is that each age/generation does not seem to waver when it comes to their passion for emergency nursing and I see it displayed in various ways. It is our multigenerational diversity.

What Can Nurse Practitioners Do for Emergency Care?

Reneé Semonin-Holleran — 2010-07-01

I am thrilled to announce that I have completed a Masters in Nursing as a Family Nurse Practitioner. I am also hoping that by the time this editorial is published, I will have passed my boards! This is why I am particularly proud that we are publishing in the September 2010 issue of the Journal of Emergency Nursing the “Nurse Practitioner Delphi Study: Competencies for Practice in Emergency Care.” The report is currently available online at www.jenonline.org. These competencies were developed through the work of the ENA Nurse Practitioner Validation Work Team.

Shock: Early Recognition and Management

Thomas T. Levins — 2010-07-01

The clinical article published in the March 2010 issue of the Journal of Emergency Nursing by Wilmont titled “Shock: Early Recognition and Management,” though generally well written, is noted to have omitted some very important points regarding the assessment and treatment of patients with sepsis.

Thoughts on the Word “Seeker”

Lisa Jones Bromfield — 2010-07-01

“Seeker” is a word I used to treasure. To me, seekers are people with open minds looking for deep truths. My mental images, not to mention the images of much literature and movies, often depict seekers on arduous journeys into places of danger and wonder. Seekers are people who know that the answers to life's deepest mysteries do not come quickly or easily but come and change and evolve as we grow and as we learn to respect ourselves and others.

Patient Transportation

Kate Reeves — 2010-07-01

I read with interest the article by Chang et al concerning improving safety of critically ill patient transportation in the emergency department. I recognized the same problems we addressed 25 years ago when I wrote “Design and Use of an ACLS Transport Cart” in the November/December 1985 issue of the Journal. Even after 25 years, some things never change, or change very little, and it appears that this group was “reinventing the wheel” so to speak, especially when discussing the need for a portable blood pressure monitor, ECG, pulse oximeter, oxygen tank, and “medications in a resuscitation bag.” If they were using an advanced cardiac life support transport cart, that stuff would already be in place and ready to go. We used to admit some critical patients directly to the cart, which saved moving them from gurney to gurney.

Reply

Yu-Nu Chang, Li-Hua Lin, Yen-Chun Peng — 2010-07-01

We thank Kate Reeves for her interest in and favorable comments on our article about critically ill patient transportation from the emergency unit. We have read Kate Reeves' report entitled “Design and Usage of an Advanced Cardiac Life Support Transport Cart” and understand the concepts she described. The benefits of the Advanced Cardiac Life Support (ACLS) transport cart for transporting critically ill patients are well known, and in addition to transportation equipment, transportation guidelines have also been well established. However, the incidence of mishaps during and in connection with patient transportation remains high according to the results of one recent study. Staff cannot resolve all problems related to critically ill patient transportation based only on guidelines or using an ACLS transport cart. How to implement and maintain the transportation guidelines as used by staff may be a more important issue after setting up the process. With the goals of patient safety and monitoring of the transportation process, our quality-control work on critically ill patient transport included defining indicators, establishment and implementation of guidelines, and maintenance of the process. The strategies for critically ill patient transportation include training of health care workers, setting up of equipment, and transportation method design. The ACLS cart concept is only a part of the transportation process. We thank Kate Reeves for sharing her experience about designing an ACLS transport cart. In our experience, implementation guidelines, staff training, transport method design, and monitoring of the transport process also play important roles in the transportation of critically ill patients.

Modeling and Analysis of the Emergency Department at University of Kentucky Chandler Hospital Using Simulations

2009-09-16

Introduction: In this article, we present a simulation study conducted in the emergency department at the University of Kentucky Chandler Hospital.Methods: Based on analysis of process and flow data, a simulation model of patient throughput in the emergency department has been developed.Results: What-if analyses have been proposed to identify bottlenecks and investigate the optimal numbers of human and equipment resources (eg, nurses, physicians, and radiology technology). The simulation results suggest that 3 additional nurses are needed to ensure desired clinical outcomes. Diagnostic testing, the computed tomography scan in particular, is found to be a bottleneck. As a result, acquisition of an additional computed tomography scanner is recommended. Hospital management has accepted the recommendations, and implementation is in progress.Discussion: Such a model provides a quantitative tool for continuous improvement and process control in the emergency department and also is applicable to other departments in the hospital.

Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries

Christien van der Linden, Resi Reijnen, Rien de Vos — 2009-12-09

Introduction: Our objectives were to determine the incidence of missed injuries and inappropriately managed cases in patients with minor injuries and illnesses and to evaluate diagnostic accuracy of the emergency nurse practitioners (ENPs) compared with junior doctors/senior house officers (SHOs).Methods: In a descriptive cohort study, 741 patients treated by ENPs were compared with a random sample of 741 patients treated by junior doctors/SHOs. Groups were compared regarding incidence and severity of missed injuries and inappropriately managed cases, waiting times, and length of stay.Results: Within the total group, 29 of the 1,482 patients (1.9%) had a missed injury or were inappropriately managed. No statistically significant difference was found between the ENP and physician groups in terms of missed injuries or inappropriate management, with 9 errors (1.2%) by junior doctors/SHOs and 20 errors (2.7%) by ENPs. The most common reason for missed injuries was misinterpretation of radiographs (13 of 17 missed injuries). There was no significant difference in waiting time for treatment by junior doctors/SHOs versus ENPs (20 minutes vs 19 minutes). The mean length of stay was significantly longer for junior doctors/SHOs (65 minutes for ENPs and 85 minutes for junior doctors/SHOs; P < .001; 95% confidence interval, 72.32-77.41).Discussion: ENPs showed high diagnostic accuracy, with 97.3% of the patients being correctly diagnosed and managed. No significant differences between nurse practitioners and physicians related to missed injuries and inappropriate management were detected.

Barriers to Change Hindering Quality Improvement: The Reality of Emergency Care

Åsa Muntlin, Marianne Carlsson, Lena Gunningberg — 2009-11-09

Purpose: The aim of this study was to investigate physicians' and nurses' perspectives and prerequisites for quality improvement in the emergency department based on results from a previous patient survey.Method: The study used an explorative design with a qualitative approach and was conducted at the main emergency department of a Swedish university hospital. Interviews were conducted with 5 focus groups. In total, the groups comprised 22 respondents.Results: The respondents suggested goals and quality improvements, such as more patient-centered care, reduced waiting times, and better pain management. However, barriers to quality improvement also were identified and represented 3 themes: the patient is looked upon as an object or a problem; the physicians and nurses belong to different organizational cultures; and the hospital's organization hinders the optimal flow of patients and improvements to quality.Discussion: When assigning priority to the topic areas, most of the focus groups ranked “information, respect, and empathy” as most important to improve. Adequate information, proper care, and treatment within a reasonable time in the emergency department were cited as the goals for patient care, but the health care professionals perceived barriers to change in the hospital culture and organization. To ensure quality care and patient safety, these barriers should be addressed by leaders on all levels in the organization, including the hospital board. Health care professionals' perspectives of quality of care are valuable and should be included in quality improvement work.

Central Pontine Myelinolysis

Kerri Hromanik — 2009-12-09

A 66-year-old woman was found convulsing on the floor 2 weeks after beginning therapy with diuretic medication. Her serum sodium level was 95 mmol/L when it was first measured in the emergency department. She underwent intravenous (IV) infusion 500 mL of 3% saline solution. On the second day of her hospital stay, the patient's serum sodium level had increased to 111 mmol/L and she was awake and following commands. Her serum sodium concentration continued to increase to 122 mmol/L by the next day. An additional 800 mL of 3% saline solution was infused to further increase her sodium level. The patient's condition continued to improve; after 4 days of hospitalization, her sodium concentration was 146 mmol/L. She was awake, alert, and oriented, and she no longer required mechanical ventilation.

Subarachnoid Hemorrhage

Mark R. Reinhardt — 2009-12-21

Subarachnoid hemorrhage (SAH) is a condition defined by extraverted blood in the subarachnoid space. Blood activates meningeal nociceptors leading to occipital pain and meningism signs. Approximately 80% of patients with nontraumatic SAH have ruptured saccular aneurysms. If an SAH is left untreated, the patient will have a poor prognosis or will die. Therefore it is imperative that ED staff know how to recognize the early signs and start treatment immediately upon SAH confirmation. For the purpose of this article, SAH will be discussed from an ED perspective to include diagnosis and treatment.

The Future of Emergency Medicine

2010-07-01

Abstract: Physician shortages are being projected for most medical specialties. The specialty of emergency medicine continues to experience a significant workforce shortage in the face of increasing demand for emergency care. The limited supply of emergency physicians, emergency nurses, and other resources is creating an urgent, untenable patient care problem. In July 2009, representatives of the leading emergency medicine organizations met in Dallas, TX, for the Future of Emergency Medicine Summit. This consensus document, agreed to and cowritten by all participating organizations, describes the substantive issues discussed and provides a foundation for the future of the specialty.

A 24-year-old Man With Subjective Fever and Syncope

Jeremy M. Johnson, Tiffany M. Thomas, Cindy M. Wilson, L. Kendall McKenzie — 2009-12-31

A 24-year-old man presented to the emergency department following a syncopal episode that occurred a couple of hours prior to ED presentation. The patient's girlfriend reported that the man fell forward and lost consciousness while sitting at home in front of his computer. She denied witnessing any seizure activity. He remained unconscious for an unknown period. On ED arrival, the patient's vital signs were as follows: blood pressure, 96/56 mm Hg; heart rate, 101 beats per minute; and oral temperature, 37.8°C (100°F). His physical examination was remarkable for pallor and lethargy, but he showed no signs of acute distress. His Glasgow Coma Scale score was 14 (mild confusion).

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

Carrie A. McCoy — 2010-05-07

With the current emphasis on credentialing in nursing, many nurses have committed to taking the CEN examination. The following questions have been developed to assist in the emergency nursing knowledge assessment and in preparation for the CEN examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation. ENA has developed educational materials that can be used as further resources for CEN preparation: Emergency Nursing Core Curriculum and CEN Review Manual. For further information on educational review materials, please contact the ENA Association Services Team at (800) 243-8362.

The Crystal Chalice: Investigating the Source of Fiberoptic Science

Keith Stephens-Borg — 2009-11-27

Devices using the technology of fiberoptics, from the direct visual laryngoscope to the flexible endoscope, all share a common light source; nevertheless, throughout their daily use in clinical areas, to even consider excluding the knowledge of focused illumination would be unimaginable. Endoscopes for medical examinations were widely manufactured in Tuttlingen, Germany, by Karl Storz in the 1940s; however, the more agile digital equipment together with a variety of synthetic materials only appeared within the past 20 years following the birth of fiberoptics—the vanguard in the dawn of robotic surgery.

Patient Care Plans: An Innovative Approach to Superusers in the Emergency Department

Lorene Pugh, Lynne Duffy, Mary Stauss — 2010-03-10

Emergency nurses often are frustrated when caring for patients who have long-standing social, substance abuse, or behavioral issues. Many of these patients are frequent ED consumers and have learned demanding behaviors out of their dissatisfaction with the health care system and their perceived unmet needs. They absorb massive amounts of time and resources and frequently place emergency nurses in situations that pose ethical dilemmas and/or create moral distress.

Do Not Put Medication Safety “On Hold” With Boarded Patients

Susan Paparella — 2010-05-07

It is well documented that overcrowding and the subsequent holding of admitted patients in the emergency department has a significant impact on the efficiency of care, estimated to affect up to 40% of emergency departments across the country. Although, over the years, the focus of this overcrowding and delay in treatment has been less on the activities of the emergency department and more on the system issues that surround the operations of the entire facility, the ENA Board of Directors remains steadfast in its identification of crowding as a priority safety issue. The ENA Board and its associated work team have reaffirmed that “ENA does not support holding or boarding in the emergency department because this practice is not in the best interest of patients.”

Evidentiary Blood Alcohol Draws by Emergency Nurses

Christy Adams — 2010-03-15

Emergency nurses often play a vital role in saving lives. From obtaining critical intravenous access to assisting with ventilation, our actions have a direct impact on the patients for whom we provide care. Our code of conduct as nurses directs us to act as our patients' advocates and provide the best care regardless of the circumstances. In the dynamic setting of the emergency department, however, even experienced nurses may be unclear of their role when the patient for whom they are caring may be suspected of driving under the influence (DUI) of alcohol and/or drugs.

Bedside Shift Report Improves Patient Safety and Nurse Accountability

Stephanie J. Baker — 2010-05-17

Why bedside shift report? The short answer: Patient safety. The truth is, thousands of patients are cared for every day in US emergency departments, resulting in thousands of shift changes and thousands of opportunities for error. According to the Institute of Medicine's report To Err is Human: Building a Safer Health System, between 44,000 and 98,000 people die in US hospitals each year because of preventable health care errors.

Epidemiology and Prevention of Sports-related Eye Injuries

Pam Pieper — 2010-06-10

Approximately 90% of sports-related eye injuries are preventable. Far more sports participants are seen by nurses than by ophthalmologists or optometrists. This makes it particularly valuable for nurses to be aware of the epidemiology of sports-related eye injuries and appropriate, available prevention strategies. Emergency nurses have an opportunity to help prevent life-changing monocular loss of vision by sharing sport-appropriate eye protection information with athletes and parents of child athletes.

Faith and Earthquakes

Helen Sandkuhl — 2010-06-11

On Tuesday, January 12, 2010 at 4:53 pm Central Standard Time, the island nation of Haiti was struck by a 7.0 magnitude earthquake. Although the epicenter of the quake was just outside the Haitian capital of Port-au-Prince, the capital city was devastated by widespread destruction. This was the country's most severe earthquake in 200 years, with a death toll that may reach 200,000.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Jeff Solheim, AnnMarie Papa — 2010-05-31

During the past year, we have received a number of requests for information about orientation programs for new nurses and internship programs. We have compiled the following responses to provide some examples of such programs. Many of the respondents provided us with orientation schedule samples, but because of space limits, we are unable to include them in this article. The authors' contact information is provided.

Does Your Staff Really “Get” Initial Patient Assessment? Assessing Competency in Triage Using Simulated Patient Encounters

Lisa Wolf — 2010-05-31

In an ideal world, sufficient resources and staff would be available to care for every person who arrives at the emergency department, but because that is rarely the case, both formal and informal triage is necessary. In the high-acuity, high-uncertainty environment of the emergency department, where multiple distractions, constant interruptions, innumerable high-priority tasks, and limited staff are the norm, the ability of the nurse to assess critical patient factors is central to maintaining both safety and efficiency. The work of the ED triage nurse perhaps best exemplifies the need for rapid accurate assessments that are likely to facilitate recognition of and attention to patients' needs.

Implementing the IOM Recommendations for Improving Pediatric Emergency Care in Your Emergency Department: Start from Where You Are!

Donna Ojanen Thomas — 2010-05-07

In 2006 the Institute of Medicine (IOM) released a report called “The Future of Emergency Care” in which the challenges faced by hospitals and EMS were outlined. In recognition that the majority of children who seek emergency care are seen in community hospitals that treat both adults and children in the same department, a separate part of the report entitled “Emergency Care for Children: Growing Pains” was devoted to pediatric emergency care. This report included a discussion of the issues and recommendations for improving emergency care of children. A summary of these recommendations is listed in .

Common Practice: Medication Waits at Discharge

Gayla Miles, Nolan Martin — 2010-04-23

Decreasing “door-to-discharge” times in the emergency department is a common goal to enhance patient satisfaction. One common practice that delays a patient’s discharge is the observation of patients for an adverse reaction 20 to 30 minutes after receiving an intravenous (IV) or intramuscular (IM) medication. This statement is commonly heard: “They are on a med wait.” In our experience, very few emergency departments have written policies regarding the time required for medication waits after administration of IV or IM medications. The time to observe each patient varies from nurse to nurse. What is the standard for medication wait times? Is one group more prone to having a reaction than another? What drugs more commonly cause anaphylactic reactions? These questions are of interest to us because we have seen very few policies supporting this practice.

Using the Electronic Medical Record for Trauma Resuscitations: Is it Possible?

Lynn E. Eastes, Janie Johnson, Maureen Harrahill — 2010-04-30

Many trauma centers throughout the United States have implemented the electronic medical record (EMR) for inpatient and outpatient care. However, implementation of an electronic trauma resuscitation flow sheet has lagged behind the EMR. We performed a Medline search for articles published about the use of the EMR during trauma resuscitations and found none. Unpublished anecdotal reports indicate both positive and negative results. For example, a surgeon site surveyor for the American College of Surgeons notes on his Web log (blog) that he strongly discourages the use of the EMR in place of a paper trauma flow sheet. He states that use of the EMR during trauma resuscitations should be avoided for 2 major reasons: First, because the trauma team activation is fast and complex, it could be difficult to get accurate and timely data entry, and second, reports produced by various EMR software vendors have been difficult to use and interpret. This surveyor states that EMRs hamper the process improvement process to the point of placing the trauma center's verification status at risk.

Triage following a Natural Disaster: A Haitian Experience

Gabriela Camacho-McAdoo — 2010-05-17

On January 12, 2010, Haiti was rocked by a 7.0 magnitude earthquake, changing the landscape of this country forever. An emergency response team from Stanford Hospital was sought for immediate deployment to Haiti. The Stanford team arrived 5 days later, and as the bus door opened outside of Hospital de l'Universite d'Etat d'Haiti (HUEH), the smell of decomposing bodies was indescribable, as were the stains on the concrete that marked the passing of a human life. As an emergency nurse, nothing had prepared me for the sight and smell. Vicks Vapo rub applied around our noses and the use of an N-95 mask did not veil the smell.

Earn Up To 8.5 Contact Hours by Reading the Designated Articles and Taking These Post Tests

2010-07-01

Clinical Test Questions

2010-07-01

Professional/Administrative Test Questions

2010-07-01

Research Test Questions

2010-07-01

CE Enrollment Form

2010-07-01

What's New

2010-07-01

Coming Meetings

2010-07-01

Editorial Board

2010-07-01

Information for Readers

2010-07-01

Journal of Emergency Nursing

Your Generation Matters!

What Can Nurse Practitioners Do for Emergency Care?

Shock: Early Recognition and Management

Thoughts on the Word “Seeker”

Patient Transportation

Reply

Modeling and Analysis of the Emergency Department at University of Kentucky Chandler Hospital Using Simulations

Diagnostic Accuracy of Emergency Nurse Practitioners Versus Physicians Related to Minor Illnesses and Injuries

Barriers to Change Hindering Quality Improvement: The Reality of Emergency Care

Central Pontine Myelinolysis

Subarachnoid Hemorrhage

The Future of Emergency Medicine

A 24-year-old Man With Subjective Fever and Syncope

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

The Crystal Chalice: Investigating the Source of Fiberoptic Science

Patient Care Plans: An Innovative Approach to Superusers in the Emergency Department

Do Not Put Medication Safety “On Hold” With Boarded Patients

Evidentiary Blood Alcohol Draws by Emergency Nurses

Bedside Shift Report Improves Patient Safety and Nurse Accountability

Epidemiology and Prevention of Sports-related Eye Injuries

Faith and Earthquakes

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Does Your Staff Really “Get” Initial Patient Assessment? Assessing Competency in Triage Using Simulated Patient Encounters

Implementing the IOM Recommendations for Improving Pediatric Emergency Care in Your Emergency Department: Start from Where You Are!

Common Practice: Medication Waits at Discharge

Using the Electronic Medical Record for Trauma Resuscitations: Is it Possible?

Triage following a Natural Disaster: A Haitian Experience

Earn Up To 8.5 Contact Hours by Reading the Designated Articles and Taking These Post Tests

Clinical Test Questions

Professional/Administrative Test Questions

Research Test Questions

CE Enrollment Form

What's New

Coming Meetings

Table of Contents

Editorial Board

Information for Readers