Journal of Emergency Nursing RSS feed: Current Issue. The Journal of Emergency Nursing is highly acclaimed by emergency nurses, nurse managers and emergency departments. As the official peer-reviewed journal of the Emergency Nurses Association (ENA), the Journal of Emergency Nursing reaches the greatest number of emergency nurses, emergency/trauma departments and emergency department managers of any journal. The journal is always expanding its coverage of the practice and professional issues, based on current evidence, that challenge emergency nurses every day. It features original research and updates from the field. http://www.jenonline.org/?rss=yesElsevier Inc.en © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. Journal of Emergency Nursing0099-1767383May 2012 © 2012 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.jenonline.org/article/PIIS0099176712001304/abstract?rss=yes A resident enters a child's weight of 44 into the information system as kilograms (Kg), when, in fact, the patient was weighed in pounds (lbs). The inaccuracy causes an overdose that results in the patient becoming fosphenytoin toxic.The Emergency Nurses Association (ENA) “Weighs in” on Pediatric Medication Safety: “Weigh Children in Kilograms Only!”Gail Lenehan10.1016/j.jen.2012.04.010Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0President's Message205206http://www.jenonline.org/article/PIIS009917671200116X/abstract?rss=yes In place of JEN Editor-in-Chief Reneé Holleran's regular editorial, JEN is featuring guest editor J. Jeffery Jordan, MS, RN, MBA, CEN, CNE, EMT-LP, of Macomb, Oklahoma. Mr. Jordan is a past ENA Board member and is currently serving as the Chair of the 2012 Resolutions Committee. He is a member of the Oklahoma State Council and serves on their board as Immediate Past President. Mr. Jordan is an instructor and coordinator of the RN to BSN program at East Central University in Ada, Oklahoma, and a part-time staff RN in the emergency department at Seminole Medical Center, Seminole, Oklahoma.Really, Have We Become that Complacent?J. Jeffery Jordan10.1016/j.jen.2012.03.012Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Guest Editorial207208http://www.jenonline.org/article/PIIS0099176712001195/abstract?rss=yesI read the article "Do Nurses Eat Their Young? Truth and Consequences" with considerable interest. I completely agree that nurses do eat their young. I have observed this over the years, both in a hospital setting and for years as a paramedic. It almost seems like nurses can act similar to a group of lions sitting in the grass and looking for a weak water buffalo. Once they pounce, they will never let up until that nurse quits or a weaker nurse comes along. As our nursing population grows older and closer to retirement, we will need these new, inexperienced nurses to care for us. In the article, the example of such a nurse is a character named Carrie. I found the story very plausible and realistic. I also think it was a reflection of a lack of communication and leadership. What is equally alarming is that other new nurses may join in the bullying, either in an effort to not become targets themselves or in an attempt to fit in. In your example, Carrie's peers never attempted to help or defend her. It was, in my opinion, a clear failure of not providing an experienced nurse as both a mentor and a resource for situations such as these. No orientation, no matter how well intended, intense, or complete, can ever encompass every possibility. Do nurses eat their young? Absolutely, and it may be a while before it becomes completely unacceptable across the entire workplace environment.Do Nurses Eat Their Young?Sean P. McDowell10.1016/j.jen.2012.03.015Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Letters to the Editor209209http://www.jenonline.org/article/PIIS0099176712001201/abstract?rss=yesI would like to commend Penny Sauer for highlighting the problem of lateral violence in her article entitled “Do Nurses Eat Their Young? Truth and Consequences,” published in the January 2012 issue of Journal of Emergency Nursing. As the problem of bullying in schools makes headlines, it is easy to dismiss it as a problem of youth. As Ms. Sauer points out, this problem occurs in our nursing units among nurses who, as caregivers, should care for fellow staff members above all others. This problem was around when I started in the emergency department 24 years ago but is currently receiving more attention. The statistic of a 31% incident rate of bullying in the workplace should motivate us to take action! As nursing professionals, we abhor abuse directed at helpless victims. How many of us have angry feelings toward abusers of children? Yet, we fail to see the connection when abuse occurs with our young, new, inexperienced nurses. Kathleen Bartholomew, RN, MN, spoke at the ENA Leadership Conference in 2011 on nurse-to-nurse violence. According to her research, up to 60% of new RNs leave their first job after 6 months due to abuse from coworkers.Stop Eating Our Young!Brenda Fahlgren10.1016/j.jen.2012.03.016Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Letters to the Editor209210http://www.jenonline.org/article/PIIS0099176712001316/abstract?rss=yesThank you for taking the time to respond to the article “Do Nurses Eat Their Young? Truth and Consequences.” Nurse-on-nurse hostility has been tolerated for too long in the nursing profession. Although it saddens me to hear of nurses’ stories of bullying and hostilities, I think it is vitally important that we talk about our experiences with bullying. These problems are deeply entrenched in the profession and will require more than organizational changes to correct them. Each individual nurse must be dedicated to ending the hostilities, which will mean standing up for those who are bullied and telling bullies that the behavior will not be tolerated. I am glad to know you are champions for change in the nursing profession!ResponsePenny Sauer10.1016/j.jen.2012.04.011Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Letters to the Editor210210http://www.jenonline.org/article/PIIS0099176710005295/abstract?rss=yesIntroduction: The purposes of this study were to investigate the adequacy of pain management for patients with long-bone fractures seen in the emergency department and to determine whether racial disparities exist.Methods: The design was an exploratory, correlational design using patient data abstract ed from electronic medical records of 2 major urban medical centers located in the Southeastern United States. Data collected included demographics, time of initial pain assessment by the registered nurse, time of pain medication administration, severity of pain, fracture location by radiograph, type of pain medication, and route-dosage of pain medication administered. The primary outcome variable, which was the pain management index, was calculated and used as a measure of adequate pain management.Results: The majority of the sample (N = 218) was female (61%) and white (63%), with 28% black and about 10% of the sample consisting of other minorities. Seventy-nine (36%) of the 218 patients received no medication while in the emergency department despite a mean pain score of 6.9 (SD = 2.5) on a 0 to 10 scale representing moderate to severe pain. Patients who received pain medication (n = 126) waited for the medication 1.76 hours (±1.47). Among the patients who received an analgesic (n = 126), younger patients, black patients, and those with higher pain severity were more likely to receive inadequate pain management than were white patients.Discussion: According to the pain management index, the majority of the patients in this study received inadequate pain management while in the emergency department. Future interventions may need to focus on giving ED nurses information about inadequate pain management and disparities in pain management in the ED setting and exploring possible reasons for disparities in order to ultimately improve patient care.Long-Bone Fracture Pain Management in the Emergency DepartmentPtlene Minick, Patricia C. Clark, Jo Ann Dalton, Eva Horne, Debbie Greene, Monica Brown10.1016/j.jen.2010.11.001Journal of Emergency Nursing 38, 3 (2012)2011-03-24Journal of Emergency Nursing2011-03-24383S0099-1767(11)X0009-0Research211217http://www.jenonline.org/article/PIIS0099176710004393/abstract?rss=yesIntroduction: Pain is the most common presenting complaint in emergency departments and the primary reason patients seek medical care and take prescription medications. Improving inadequate pain control is a critical goal in emergency health care. As patients' primary health care advocates, emergency nurses play a vital role in resolving under-treated pain in their patients. The purpose of this qualitative study was to explore the perceptions of ED nurses regarding the processes used when managing adult patients' pain and to increase understanding of how these perceptions affect patients' pain management.Methods: Participants were recruited from the membership of the local emergency nurses association and 6 hospital-based emergency departments in Northeast Florida. Fifteen emergency nurses with tenure ranging from 1 to 35 years were individually interviewed. Interviews were transcribed verbatim and analyzed using content analysis methodology.Results: The central core category that emerged highlighted the ED environment as a barrier to demonstrating caring when managing adult patients' pain. The core category was supported by 3 broad themes, each consisting of 3 subcategories: (a) feeling overwhelmed as a result of constant prioritizing and perceived lack of control and adequate staffing, (b) perceived non-cohesiveness of the health care team, including nurses, administrators, and emergency physicians, and (c) frustration concerning abuse of the emergency department, complexity of pain, and unrealistic patient expectations of the nurses' role.Discussion: Interventions that improve the ED environment and facilitate the process of pain management are warranted. Implications for accomplishing these interventions clearly exist in nursing education, practice, research, and public policy.Emergency Nurses' Perceived Barriers to Demonstrating Caring When Managing Adult Patients' PainCheryl L. Bergman10.1016/j.jen.2010.09.017Journal of Emergency Nursing 38, 3 (2012)2011-01-24Journal of Emergency Nursing2011-01-24383S0099-1767(11)X0009-0Research218225http://www.jenonline.org/article/PIIS0099176710004253/abstract?rss=yesIntroduction: Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating neurologic insult often presenting to the emergency department as a headache. Recognition and prompt treatment are important to good outcomes. The purpose of this analysis was to examine the presentation of aSAH patients to the emergency department and determine whether presentation predicts length of stay or death.Methods: This is a retrospective review of data gathered from 2 existing studies. Data from patients diagnosed with acute aSAH were reviewed for symptoms, clinical presentation, history, demographics, and laboratory results. Statistical analysis was completed by use of χ2 and regression analysis.Results: This sample of 193 adult aSAH patients confirmed headache as well as meningeal signs as the most frequent symptom on presentation to the emergency department, and this was cited as the most common reason for seeking medical treatment. Symptom presentation did not appear to affect length of stay; however, survival analysis showed that patients who presented with a Hunt and Hess grade greater than 3 along with bradycardia were 15.6 times more likely to die within the first month of aSAH.Discussion: Although aSAH presentation remains the same, this analysis did find a correlation between poor clinical grade and bradycardia to be a significant predictor of death at 30 days. Additional study may help to determine whether any intervention could lessen this effect. Although patient diagnosis and referral from the community emergency department to a tertiary center were relatively quick, there was a wide window of time between patient recognition of symptoms and seeking medical treatment.Correlation Between ED Symptoms and Clinical Outcomes in the Patient with Aneurysmal Subarachnoid HemorrhageKristin Adkins, Elizabeth Crago, Chien-Wen J. Kuo, Michael Horowitz, Paula Sherwood10.1016/j.jen.2010.09.003Journal of Emergency Nursing 38, 3 (2012)2011-01-24Journal of Emergency Nursing2011-01-24383S0099-1767(11)X0009-0Research226233http://www.jenonline.org/article/PIIS0099176711000882/abstract?rss=yesOut-of-hospital cardiac arrest is a significant public health problem that affects all communities. Survival rates among these victims remain low despite resuscitative efforts provided by bystanders and emergency personnel. However, there are several factors that positively influence survival after out-of-hospital cardiac arrest: early initiation of cardiopulmonary resuscitation (CPR), good quality of CPR, and early defibrillation. Bystander CPR has been cited as a major factor in increasing chances of survival from out-of-hospital cardiac arrest by 50%. Despite these medical advances, the survival rate for patients having out-of-hospital cardiac arrest remains low. Recent findings in cardiac arrest theory and pathophysiology have led to numerous studies over the past decade. New techniques, such as compression-only CPR (COCPR) and modified prehospital advanced cardiac lifesaving (ACLS) protocols, have been trialed with fascinating results. Other studies have investigated factors associated with low bystander CPR rates. This article will examine the relationship between the new COCPR findings and how incorporating this research in the public sector may positively influence bystander CPR rates.Improving Patient Outcomes with Compression-Only CPR: Will Bystander CPR Rates Improve?Kristin K. Drager10.1016/j.jen.2011.02.008Journal of Emergency Nursing 38, 3 (2012)2011-04-25Journal of Emergency Nursing2011-04-25383S0099-1767(11)X0009-0Clinical234238http://www.jenonline.org/article/PIIS0099176711000808/abstract?rss=yesHigh hemolysis rates continue to adversely affect many emergency departments. Hemolysis of blood samples occurs when the red blood cells break down and can preclude accurate laboratory results. When a blood specimen is hemolyzed, further time and resources are required to obtain a new laboratory specimen from the patient, further delaying patient throughput in many already crowded emergency departments. Causes and determination of hemolysis seem variable, making improvement of hemolysis rates more challenging to address, and our emergency department was no exception to this challenge.Let the Data Speak: Decreasing Hemolysis Rates Through Education, Practice, and DisclosureJayne K. McGrath, Pete Rankin, Melissa Schendel10.1016/j.jen.2011.01.015Journal of Emergency Nursing 38, 3 (2012)2011-04-25Journal of Emergency Nursing2011-04-25383S0099-1767(11)X0009-0Clinical239244http://www.jenonline.org/article/PIIS0099176710006434/abstract?rss=yesAny ED nurse has undoubtedly faced the common occurrence of providing care for a patient who has elevated blood pressure readings. Elevated blood pressure is often an incidental finding in ED patients who come in for other problems, and it is a troublesome finding for nurses. When a patient presents to the emergency department with elevated blood pressure readings and no other blood pressure–associated signs or symptoms, the questions of concern to the nurse are whether the elevated blood is a significant finding, if intervention is required, and whether the patient should be referred for follow-up evaluation of blood pressure. In situations in which the blood pressure is severely elevated, discharge may be delayed as the nurse continues to observe the patient's blood pressure, anticipating that readings will gradually decline to a normal or near normal level, which may or may not occur.Elevated Blood Pressure in ED Patients: Best Evidence on the Importance of Assessment, Recognition, and ReferralSally Robelli, Lauren Lawson10.1016/j.jen.2010.12.017Journal of Emergency Nursing 38, 3 (2012)2011-04-25Journal of Emergency Nursing2011-04-25383S0099-1767(11)X0009-0Clinical245250http://www.jenonline.org/article/PIIS0099176710006161/abstract?rss=yesThe Golden Rule, or the ethic of reciprocity, is perhaps the world's most often cited guide to ethical human behavior. Simply stated, the rule asks that we treat others as we wish to be treated. Religious leaders such as Jesus and Confucius used the rule to summarize their teachings. Many religions and cultures have adopted some interpretation of The Golden Rule, which suggests its universal acceptance. However, to actually live one's life according to The Golden Rule is a unique challenge, especially for nurses who often have to make difficult ethical decisions. The significance of The Golden Rule and how it can be applied within the emergency department will be considered in this article.Ethical Decision Making in the Emergency Department: The Golden RuleLouanne Friend10.1016/j.jen.2010.12.012Journal of Emergency Nursing 38, 3 (2012)2011-02-23Journal of Emergency Nursing2011-02-23383S0099-1767(11)X0009-0Clinical251253http://www.jenonline.org/article/PIIS009917671000615X/abstract?rss=yesIdentified or not, a large percentage of ED visits in the United States are related to substance abuse and other behavioral health issues. Some patients with these problems are seen so frequently in the emergency department that they become well known to many of the staff. Even in emergency departments with mental health professionals on staff or who are available for consultations, the bulk of patient encounters, particularly at night and on weekends, is with nurses. Motivational interviewing (MI) is an evidence-based approach that has been shown to improve the effectiveness and reduce the frustration of ED staff who work with persons who have addictions and exhibit other self-destructive behaviors. The purpose of this article is to help ED nurses better understand persons with addictions and self-destructive behaviors and provide nurses with additional knowledge and skills that are useful when working with these patients and their families.Motivational Interviewing for Emergency NursesSteven L. Baumann10.1016/j.jen.2010.12.011Journal of Emergency Nursing 38, 3 (2012)2011-04-25Journal of Emergency Nursing2011-04-25383S0099-1767(11)X0009-0Clinical254257http://www.jenonline.org/article/PIIS0099176711004697/abstract?rss=yesA 48-year-old woman was brought to the emergency department by her husband and daughter. The patient was unable to verbalize a complaint, but repeatedly stated, “Something is wrong.” Family members had left home that morning. When they returned in the early afternoon the woman was confused about the day of the week and repeatedly asked where her family had been. The patient had no recollection of the morning’s events and did not recognize her own home. Her long-term memory appeared to be unaffected. In the emergency department, the patient denied any physical complaints but continued to ask repetitive questions. She had no history of recent fever, chills, infections, seizures, injury, or unusual stress. The woman’s husband believed the confusion was improving, but the patient still was not at her baseline.A 48-year-old Woman with AmnesiaAdam Herzog, Alendia Hartshorn10.1016/j.jen.2011.08.023Journal of Emergency Nursing 38, 3 (2012)2011-11-14Journal of Emergency Nursing2011-11-14383S0099-1767(11)X0009-0Case Review258259http://www.jenonline.org/article/PIIS0099176712000074/abstract?rss=yesWith 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.Knowledge Assessment and Preparation for the Certified Emergency Nurses ExaminationKathleen Carlson10.1016/j.jen.2012.01.001Journal of Emergency Nursing 38, 3 (2012)2012-03-26Journal of Emergency Nursing2012-03-26383S0099-1767(11)X0009-0CEN Review Questions260261http://www.jenonline.org/article/PIIS0099176712000190/abstract?rss=yesWith 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.Knowledge Assessment and Preparation for the Certified Emergency Nurses ExaminationS. Kay Sedlak10.1016/j.jen.2012.02.004Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0CEN Review Questionse5e6http://www.jenonline.org/article/PIIS0099176711006829/abstract?rss=yesThe emergency nurse faces the dilemma of pain relief in a certain type of patient on a daily basis. This patient is the drug seeker. Emergency departments are required by the Emergency Medical Treatment and Active Labor Act to provide an appropriate medical screening examination to determine whether an emergency medical condition exists. If this condition exists, the hospital must provide the necessary stabilizing treatment. This screening must include a pain assessment. An “emergency medical condition” is defined in the Emergency Medical Treatment and Active Labor Act as a “medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain).” The Joint Commission on Accreditation of Healthcare Organizations considers pain as the fifth vital sign. It requires the management of pain. We, as nurses, want to help our patients. The evidence of pain relief shows us that we are meeting our goals. How, then, do we perform our jobs as nurses and not enable the addictions or habits of our patients?Is it Possible to Gain Pain Relief in the Drug-Seeking Patient?Pamela A. Dougherty10.1016/j.jen.2011.12.011Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Clinical Nurses Forum262263http://www.jenonline.org/article/PIIS0099176711004636/abstract?rss=yesJanuary 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this certification, three times a year JEN features this column supplying questions similar to those in the CPEN examination to assist in preparation for the examination. Questions, rationale for the correct answers, and references are provided here for your self-evaluation.Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse ExaminationScott DeBoer, Michael Seaver10.1016/j.jen.2011.08.017Journal of Emergency Nursing 38, 3 (2012)2011-10-07Journal of Emergency Nursing2011-10-07383S0099-1767(11)X0009-0CPEN Review Questions264266http://www.jenonline.org/article/PIIS0099176712000104/abstract?rss=yesAn unconscious 67-year-old male patient is brought into the emergency department after being found face down on the sidewalk outside of the local mall. During the initial assessment, an unknown medical device is found on the patient's waist. An ED nurse was able to identify it as an insulin pump. After discovering the identity of the patient, it was determined that he has never been seen in the hospital before, and therefore no record of his medical history, medications, and specifically his insulin management are available.Patient-supplied Medication Infusion Devices in the Emergency Department: Are You Ready?Stacy L. Carson10.1016/j.jen.2012.01.004Journal of Emergency Nursing 38, 3 (2012)2012-03-19Journal of Emergency Nursing2012-03-19383S0099-1767(11)X0009-0Danger Zone267269http://www.jenonline.org/article/PIIS0099176711003515/abstract?rss=yesOne of the Emergency Nurses Association's (ENA) top three clinical priorities is crowding in the emergency department (ED). Crowding, which is defined as an excessive number of patients, was brought to the forefront of health care discussion via the 2006 Institute of Medicine report The Future of Emergency Care. Crowding is becoming progressively worse as the current recession creates additional pressure on our already strained health care system. Whether it is state funding cuts that result in closing psychiatric care facilities, individuals losing health care coverage, or individuals not being able to afford the medications that they or their families need, all of these situations result in more people coming to the emergency department for their health care of last resort.Development of Consensus Statement on Definitions for Consistent Emergency Department MetricsSonia Astle, Susan K. Banschbach, William T. Briggs, William T. Durkin, Linda K. Groah, Charlotte Guglielmi, Diane Gurney, Nancy L. Hughes, Nicholas Jouriles, Michael G. Millin, Randy Pilgrim, Jesse M. Pines, Heather E. Russell, Sandra M. Schneider, Suzanne K. Stone-Griffith, Suzette Thorby, Nicholas Tsarouhas10.1016/j.jen.2011.07.003Journal of Emergency Nursing 38, 3 (2012)2011-07-18Journal of Emergency Nursing2011-07-18383S0099-1767(11)X0009-0Emergency Nursing Advocacy270272http://www.jenonline.org/article/PIIS0099176711004922/abstract?rss=yesIntroduction: Opioid abuse and overdose have increased drastically in recent years. Diversion of opioids used to treat pain, either through theft or sharing, is increasing and may contribute to this misuse. Based on these trends, we designed a study to investigate opioid storage and disposal practices of patients who were prescribed these agents in the emergency department.Methods: A prospective cohort pilot study was conducted. All adults (aged ≥18 years) with a chief complaint of either minor musculoskeletal trauma, renal colic, or acute back pain who were discharged home with an opioid prescription were eligible for inclusion; persons with chronic pain were excluded. Patients were asked to participate in two home interviews in which the research assistant viewed the storage location of the opioid prescription. Safe storage was defined as being stored in a locked container or cabinet. Safe disposal was defined as returning the drugs to a designated location or mixing unused pills with an undesirable substance, placing in a sealable container, and then in the trash. Patients self-reported disposal methods. Feasibility of study methods evaluated the ability to conduct home interviews after the ED visit. Descriptive statistics were used to analyze the data.Results: Twenty-five subjects consented to participate; 20 patients completed both home interviews. None of the medications were safely stored. Only 1 patient disposed of the medication, yet did so improperly.Conclusion: This pilot study revealed widespread improper storage and disposal of opioids. The study has major implications for education for ED physicians, nurses, and residents.How Do Emergency Department Patients Store and Dispose of Opioids After Discharge? A Pilot StudyPaula Tanabe, Judith A. Paice, Jennifer Stancati, Michael Fleming10.1016/j.jen.2011.09.023Journal of Emergency Nursing 38, 3 (2012)2011-12-28Journal of Emergency Nursing2011-12-28383S0099-1767(11)X0009-0Evidence-Based Practice273279http://www.jenonline.org/article/PIIS0099176712000189/abstract?rss=yesAs emergency nurses, we are responsible for a myriad of patient populations. Some of the most vulnerable are those with behavioral health issues, substance misuse, and cognitive changes. This month, we chose to highlight 2 successful programs that we hope provide you with some ideas to enhance the care of these patients in your emergency department.—Jeff, Cindy, and AnnMarieExperience TalksJeff Solheim, AnnMarie Papa, Cindy Lefton10.1016/j.jen.2012.02.003Journal of Emergency Nursing 38, 3 (2012)2012-04-11Journal of Emergency Nursing2012-04-11383S0099-1767(11)X0009-0Experience Talks280282http://www.jenonline.org/article/PIIS0099176712001171/abstract?rss=yesEighty-five-year-old Hannah is brought to your emergency department by EMS after she tripped over her cat and fell onto a wooden chair. She complains of pain in the left rib area, and “trouble breathing.” Although no paradoxical chest movement is noted over the left rib cage, it is noted that the left anterior and lateral chest has significant bruising and crepitus on palpation. Hannah has decreased breath sounds on the left, seems to be splinting when she breathes, and is using some accessory muscles. Further examination reveals no head, neck, or upper extremity pain. Her left upper abdomen is tender. She has shortening and rotation of the left leg, her pelvis is stable, and color, motion, and sensation (CMS) of the leg is intact. She has no injury to the right side or back. There was no loss of consciousness. Blood pressure is 102/60, heart rate is 98 beats/min, respiratory rate is 32 breaths/min, oxygen saturation is 88% on 2 liters nasal cannula, and her temperature is 97.8°F.Do Not Intubate/Do Not Resuscitate: Treating the Severely Ill or Injured Geriatric Patient in the Emergency DepartmentJoan Somes, Nancy Stephens Donatelli10.1016/j.jen.2012.03.013Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0Geriatric Update283286http://www.jenonline.org/article/PIIS0099176712000128/abstract?rss=yesHyperthermia is the leading cause of non–crash-related vehicle deaths for children younger than 14 years. Since 1998, a total of 524 children ranging in ages from 5 days to 14 years have died from vehicular hyperthermia in the United States, an average of 38 deaths per year. About half of the deaths were caused by a caregiver forgetting about the children in the car, and 30% were the result of children playing unattended in a vehicle. In addition to those who die, it is estimated that annually, hundreds of children experience varying degrees of heat illness from being left in cars.Hyperthermia and Children Left in CarsThelma Kuska10.1016/j.jen.2012.01.006Journal of Emergency Nursing 38, 3 (2012)2012-03-26Journal of Emergency Nursing2012-03-26383S0099-1767(11)X0009-0Injury Prevention287288http://www.jenonline.org/article/PIIS009917671200102X/abstract?rss=yesIn October 2011, I had the honor and pleasure of leading a delegation of emergency nurses to Cuba, “The Pearl of the Antilles” (). The purpose of our trip was to advance professional research and gain insight into the role of the nurse in the Cuban health care system. What an experience! We flew from Miami to Havana, Cuba, and landed on the morning of Sunday, October 23, 2011. It felt like we had stepped back into the 1950s. Our first day was an opportunity for us to become acclimated with our surroundings, settle in, and meet our guides. We had a traditional Cuban welcome dinner with our hosts at a restaurant in Old Havana's Cathedral Square and discussed our program of adventure for the next few days.The Pearl of the Antilles Becomes a Pearl of Shared WisdomAnnMarie Papa10.1016/j.jen.2012.02.013Journal of Emergency Nursing 38, 3 (2012)2012-04-16Journal of Emergency Nursing2012-04-16383S0099-1767(11)X0009-0International Nursing289292http://www.jenonline.org/article/PIIS0099176711006854/abstract?rss=yesAbstract: Non-emergent use of the emergency department has grown over the past decade. Lack of resources, access to care, medical insurance, and knowledge can all contribute to the inappropriate use of the emergency department. In return, the increase in the number of patients will then add to the wait time for those who need emergent treatment. The role of the emergency nurse can be enhanced by providing discharge teaching to patients and families about the proper use of the emergency department or where to seek treatment if needed. This education has the potential to significantly reduce the number of repeat visits, as well as misuse of the emergency department. The purpose of this article is to discuss the importance of discharge teaching for the patient and family in the ED setting.Patient and Family Education in the Emergency Department: How Nurses Can HelpAlisha Gozdzialski, Melanie Schlutow, Laura Pittiglio10.1016/j.jen.2011.12.014Journal of Emergency Nursing 38, 3 (2012)2012-03-30Journal of Emergency Nursing2012-03-30383S0099-1767(11)X0009-0Nurse Educator293295http://www.jenonline.org/article/PIIS0099176711003503/abstract?rss=yesEditors’ note: At first glance, one might think that this particular article is better suited for another section of JEN. However, in the 2009 Joint Policy Statement – Guidelines for Care of Children in the Emergency Department, the American Academy of Pediatrics stated that the guideline outlines resources necessary “to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents.”1 The guideline goes on to state that a newborn delivery kit Is one of the specialized trays or kits all EDs should have. Implicit in this recommendation is that EDs have plans in place to help with that first important pediatric milestone—transition to extrauterine life. This article outlines just such a plan.REFERENCE 1. American Academy of Pediatrics Committee on Pediatric Emergency Medicine, American College of Emergency Physicians Pediatric Committee, Emergency Nurses Association Pediatric Committee. Joint policy statement: Guidelines for care of children in the emergency department. Pediatrics. 2009;124(4):1233-43.“Did You Just Say . . . the Baby's Coming!!??”: A Nurse's Guide to Prepare for a Safe Precipitous Delivery in the Emergency DepartmentConnie Blake10.1016/j.jen.2011.07.002Journal of Emergency Nursing 38, 3 (2012)2011-09-09Journal of Emergency Nursing2011-09-09383S0099-1767(11)X0009-0Pediatric Update296300http://www.jenonline.org/article/PIIS0099176711000791/abstract?rss=yesA 46-year-old woman presents to triage because she has had trouble speaking and swallowing since she awoke that morning. She is alert and oriented, but her speech is a slightly garbled. Her vital signs are as follows: heart rate, 86 beats per minute; respirations, 16 per minute; blood pressure, 136/86 mm Hg; temperature, 37.2°C (98.9°F); and oxygen saturation, 96% on room air. Her medical history is negative except for hepatitis C and frequent urinary tract infections. Her social history is positive for smoking one pack per day, as well as abuse of prescription narcotic medications and, more recently, heroin. She tells you the last time she shot up was 3 days ago.Wound Botulism Resulting from Heroin Abuse: Can You Recognize It?Laura Abavare, Charles Abavare10.1016/j.jen.2011.01.014Journal of Emergency Nursing 38, 3 (2012)2011-04-25Journal of Emergency Nursing2011-04-25383S0099-1767(11)X0009-0Pharm/Tox Corner301303http://www.jenonline.org/article/PIIS0099176712000177/abstract?rss=yesCalifornia Shock Trauma Air Rescue (CALSTAR) was dispatched to the scene of a “shotgun blast to the face” at 12:15 pm. At 12:22 pm, the CALSTAR helicopter lifted off from quarters en route to the scene and was flying overhead in radio contact with ground Emergency Medical Services crews at 12:25 pm. Because the scene was not yet secured by law enforcement, an alternate landing zone (LZ) was designated at a nearby city softball park. The rendezvous LZ was secured by the fire department, and the CALSTAR helicopter landed at the alternate site at 12:32 pm. The flight medical crew, consisting of 2 flight nurses, left the helicopter to await the arrival of the patient by ground ambulance. The ground ambulance arrived at the LZ at 12:40 pm, and patient contact was established by the medical crew.Shotgun Blast to the Face with Unexpected ConsequencesRich Ikerd, Matthew B. Murphy, Aaron E. Bair10.1016/j.jen.2012.02.002Journal of Emergency Nursing 38, 3 (2012)2012-04-16Journal of Emergency Nursing2012-04-16383S0099-1767(11)X0009-0Trauma Notebook304305http://www.jenonline.org/article/PIIS0099176711005435/abstract?rss=yesIntroduction: Numerous factors affect patient flow in the emergency department. One important factor that has a negative impact on flow is ED patients waiting for an inpatient bed. It currently takes approximately 5 hours from triage to a request for an inpatient bed in our emergency department. Knowledge of patients requiring admission early in their ED evaluation could speed up the process of securing a bed. The objective of this study was to determine if an ED triage nurse (TRN) can determine at triage if a patient will be admitted to an inpatient unit. A secondary objective was to measure the confidence of the TRN prediction.Methods: A prospective, non-consecutive study was conducted during an 18-day period in 2010 in a community hospital emergency department treating 76,000 patients. Experienced TRNs were trained in the evaluation tool. Immediately after the initial TRN evaluation, a determination was made in writing by the TRN regarding the likelihood of hospital admission and level of confidence in this decision. Patients who did not enter the emergency department through triage (ambulance) or were younger than 18 years were excluded.Results: A total of 3514 patients approached triage. Of these patients, 1866 were eligible for the study and 1164 (62%) were enrolled. We excluded 25 subjects because of missing data, resulting in 1139 subjects. Missed subjects had the same baseline characteristics. A total of 287 (25.2%) hospital admissions occurred. TRN predicted 217 admissions, with a sensitivity of 75.6% (95% confidence interval [CI] 71.3-79.5) and a specificity of 84.5% (95% CI 83.1-85.8). The TRN reported being extremely confident in the prediction 50.1% of the time. In these cases, the TRN demonstrated an admission sensitivity of 81.6% (95% CI 76.5-85.8) and specificity of 93.1% (95% CI 91.8-94.3).Conclusions: The TRN demonstrated a high sensitivity and specificity in admission prediction at triage and could potentially save many hours in requesting an inpatient bed. This increased efficiency could result in a more rapid ED throughput and decreased ED boarding.Triage Nurse Prediction of Hospital AdmissionBlythe Stover-Baker, Barbara Stahlman, Marc Pollack10.1016/j.jen.2011.10.003Journal of Emergency Nursing 38, 3 (2012)2012-03-30Journal of Emergency Nursing2012-03-30383S0099-1767(11)X0009-0Triage Decisions306310http://www.jenonline.org/article/PIIS0099176712001262/abstract?rss=yesEarn Up to 9 Contact Hours by Reading the Designated Articles and Taking These Post Tests10.1016/j.jen.2012.04.006Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0CE Tests311311http://www.jenonline.org/article/PIIS0099176712001274/abstract?rss=yesClinical Test Questions10.1016/j.jen.2012.04.007Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0CE Tests312314http://www.jenonline.org/article/PIIS0099176712001286/abstract?rss=yesResearch Test Questions10.1016/j.jen.2012.04.008Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0CE Tests315315http://www.jenonline.org/article/PIIS0099176712001298/abstract?rss=yesCE Enrollment Form10.1016/j.jen.2012.04.009Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0CE Tests316316http://www.jenonline.org/article/PIIS0099176712001432/abstract?rss=yesTable of Contents10.1016/S0099-1767(12)00143-2Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0FrontmatterA2A2http://www.jenonline.org/article/PIIS0099176712001444/abstract?rss=yesEditorial Board10.1016/S0099-1767(12)00144-4Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0FrontmatterA9A10http://www.jenonline.org/article/PIIS0099176712001456/abstract?rss=yesInformation for Readers10.1016/S0099-1767(12)00145-6Journal of Emergency Nursing 38, 3 (2012)2012-05-01Journal of Emergency Nursing2012-05-01383S0099-1767(11)X0009-0FrontmatterA12A12