Journal of Emergency Nursing

Broadening My Perspective

Diane Gurney — 2010-01-01

Happy New Year. 2010 promises to be an extraordinary year for health care. And ENA stands front and center positioned for a flagship future “transforming care together” (our 2010 theme). Happy Anniversary. This December ENA will mark the 40th Anniversary of the date our co-founders Judith Kelleher and Anita Dorr first joined together to set the purpose for ENA's journey.

Anniversaries and Resolutions

Reneé Semonin-Holleran — 2010-01-01

At the beginning of each year, many of us take stock of what we have done during the past year and what we might do during the year to come. This year is a special one for the Emergency Nurses Association. It is the 40th Anniversary of the dream of two nurses, Anita Dorr and Judith Kelleher, who made a difference.

Thank You for Article on Venous Access in Children

Nina Brooks — 2010-01-01

Once again, Journal of Emergency Nursing has provided readers with an article filled with methods of improved nursing practice, encompassing the idea of holistic care. The October 2009 article “Difficult Venous Access in Children: Taking Control” identified issues that many nurses have in obtaining venous access in children.

Secondary Traumatic Stress and Mindfulness Training

Nancy M. Crumpton — 2010-01-01

This year I celebrate 33 years in nursing, 29 years as an emergency nurse, and my final 9 months of graduate school for nursing administration. The recent article by Dominguez-Gomez and Rutledge regarding the prevalence of secondary traumatic stress (STS) and compassion fatigue (CF) among emergency nurses was one I can empathize with, and I share a sincere interest in resolving these issues as a nurse leader. Emergency nurses give of themselves to the point of having nothing left to resolve their own emotional needs. Emergency departments also are suffering from the loss of experienced nurses to less stressful areas of nursing. Methods to care for wounded nurses must be encouraged and supported by ED leadership. I am suggesting that nurse leaders support mindfulness training as a method to help relieve the stress suffered by ED nurses.

Response From the Authors

Elvira Dominguez-Gomez, Dana N. Rutledge — 2010-01-01

We are thrilled that Ms. Crumpton is inspired by our manuscript and is interested in proposing mindfulness training (MT) as a potential deterrent or treatment for secondary traumatic stress (STS). We believe she has pointed to the need for potentially important research studies: What are the effects of MT on (a) preventing or (b) treating STS in emergency nurses? We appreciate her comments, and hope that someone who is knowledgeable in MT is able to carry out such a study.

Interdisciplinary Perspective Needed

Jessica Castner — 2010-01-01

The article, “Evaluation and Management of Hereditary Hemophilia in the Emergency Department,” by Nguyen and Takenaka appearing in the September 2009 issue of the Journal of Emergency Nursing did not meet the potential of the subject and the manuscript to add to emergency nursing knowledge. While the article succinctly relayed the differential diagnosis and medical care of patients with hemophilia, key nursing decisions and judgments were notably absent from the article. For example, the case presentation overlooked the triage nurse's findings and decisions. Deeper scholarly nursing exploration at the beginning of resuscitation would have been beneficial. The monitoring and trending of assessment by nurses, nursing decisions to interrupt diagnostic testing, provision of family care, and lessons learned from acute changes in a patient's condition or failure to rescue would have been of great assistance to ED nurse knowledge, and yet they are notably ignored by the authors.

Response

David Nguyen — 2010-01-01

We thank Ms. Castner for her reply to our article “Evaluation and Management of Hereditary Hemophilia in the Emergency Department” in the September 2009 edition of the Journal of Emergency Nursing. Our primary interest in publishing this article in a nursing journal was to discuss the pathophysiology and treatment of hereditary hemophilia. Our focus was on overall patient care and decision making, and these decisions are made as a team between the nurses and physicians in our institutions of practice. Although Ms. Castner feels that we did not discuss certain nursing aspects, our article was intended to be a case report and review article for hemophilia and not geared specifically towards one class of health care provider only. The reason why we chose JEN as our journal of publication is due to its wide audience base of emergency health care providers. In addition, we felt that JEN would allow us the ability to review certain fundamentals of hemophilia for this broad audience as it can be an extremely complex illness. Our article also was approved by JEN's rigorous editorial board which includes numerous well respected nurses and other health care providers.

Missed Opportunities: Under-detection of Trauma in Elderly Adults Involved inMotor Vehicle Crashes

Jenelle M. Weber, Rita A. Jablonski, Janice Penrod — 2009-07-27

Introduction: Geriatric trauma, mainly as a result of motor vehicle crashes (MVCs), has been a persistent and serious problem for those older than 65 years of age. Because of physiological changes and pre-existing disease, older adults present a unique clinical challenge to emergency nurses and staff. “Are older adults involved in MVCs appropriately assessed and treated?”Methods: A review of the research literature, including 17 articles from 2003 to 2009, on the topic of geriatric trauma, specifically trauma that resulted from MVCs will be explored.Results: Four different areas were discussed: (1) the under-detection of geriatric trauma, (2) prehospital triage guidelines, (3)the injury severity score, and (4) common resultant injuries encountered by older adults.Discussion: Understanding specific patterns of injury in older adults and the geriatric trauma outcomes data is essential to emergency nursing practice. Following this literature review, the emergency nurse will be more comfortable managing the next geriatric patient arriving in the emergency department.

The Efficacy of an Educational Intervention on Documentation of Pain Management for the Elderly Patient With a Hip Fracture in the Emergency Department

Susan E. Jackson — 2009-02-11

Introduction: Pain is one of the foremost reasons that patients appear in the emergency department. Documentation of pain levels may be difficult to determine because the elderly patient with a hip fracture may have an alteration in the clinical presentation because of hearing deficits, impaired cognitive functioning, or chronic disease processes. The intent of this research project was to explore the results of a staff educational intervention with evaluation of medical record documentation before and after implementation.Methods: An educational intervention for staff included a review of hospital pain policies/protocols, documentation required, and elderly physiologic and psychological systems relating to the treatment of acute pain. Documentation was audited before and after educational intervention.Results: A χ2 test showed that there was no significant difference [χ2 (1, N = 110), 1.48; P = .223] for the documentation for time to treatment (<60 minutes). However, a χ2 analysis [χ2 (1, N = 149), 8.315, P = .004] showed that there was a statistically significant difference as a result of the educational intervention for the documentation of pain levels in a timely manner after analgesic treatment.Discussion: Educational interventions may be used to facilitate documentation of patient’s pain. Barriers to medical recording need to be addressed to improve the proficiency of the registered nurse in the emergency department. Performance measures are entwined with competency levels for health care workers and standards of care delivery. A continuous and ongoing effort to facilitate the best practice for patients is a major initiative without an endpoint.

A Comparison of the Quality of Blood Specimens Drawn in the Field by EMS Versus Specimens Obtained in the Emergency Department

Gina Harrison, Karen Gabel Speroni, Lisa Dugan, Marlon G. Daniel — 2009-02-17

Introduction: Emergency Department (ED) acceptance of blood specimens drawn by Emergency Medical Services (EMS) staff is not a consistent standard of practice across hospitals. The literature does not address acceptance of pre-hospital phlebotomy specimens drawn by EMS staff. The purpose of this study was to compare specimen redraw rates and ED throughput times for specimens drawn by EMS versus ED staff.Methods: Data was collected on 400 patients regarding phlebotomist type, intravenous (IV) site, IV angiocatheter size, number of IV attempts producing blood specimens, redraw reason, undue blood exposure to phlebotomist, diagnosis, and length of stay.Results: In this study of 400 patients (EMS=200; ED=200), the redraw rate was higher for the ED group (11.5%) than the EMS group (9.5%). The primary reason for redraw in the EMS group was insufficient quantity (52.6%; ED=8.7%, p<.05). The primary reason for redraw in the ED group was hemolysis (52.2%; EMS=31.6%). Median ED throughput time was 17 minutes less for the EMS group (163 minutes) than for ED group (180 minutes). There were no incidences of undue blood exposure in either group.Discussion: Based on no statistically significant differences between the two study groups in redraw rates, a decreased ED patient throughput time, and no undue blood exposure incidences, pre-hospital phlebotomy by EMS in the field and subsequent ED acceptance of samples is a standard of practice that can be implemented.

Retrospective Audit of Triage of Acute Traumatic Shoulder Dislocation by Emergency Nurses

Carl Paul McQueen, Kathryn Joanna Gay — 2009-05-20

Introduction: Acute traumatic shoulder dislocation (ATSD) is a relatively common presentation to the emergency department. Research into nurse-led triage shows emergency nurses to be accurate at identifying patients with bony injuries and follow protocols to expedite appropriate care.The aim of this study was to assess the quality of triage decisions made by emergency nursing staff in cases of confirmed ATSD, in an emergency department in the United Kingdom.Methods: A retrospective audit was undertaken on patients with ATSD for 12 months (August 2006-August 2007). The nursing triage sheet and the clinical record forms were used to obtain data detailing the entire patient journey from arrival in the department to discharge.Results: Emergency nurses were less likely to identify ATSD at triage than their physician colleagues during their initial clinical assessment (OR 0.06; 99% CI 0.014-0.272). Failure to identify ATSD at triage affected the efficiency of the remaining patient journey.Discussion: A learning need for nursing staff in the initial assessment and identification of ATSD has been identified. The King's Mill Hospital's integrated care pathway for ATSD has been developed in response to the findings of this study, designed to aid diagnosis at triage and expedite patients through the stages of their ED journey.Conclusion: Significant areas for improvement have been identified in the initial assessment and management of patients with ATSD presenting at triage in the emergency department. The impact of the King's Mill Hospital's integrated care pathway on the quality of triage in ATSD requires further assessment.

Administration of Amiodarone During Resuscitation of Ventricular Arrhythmias

Heather D. Eppert, Kara B. Goddard — 2009-06-26

Amiodarone is an antiarrhythmic drug indicated in the treatment of ventricular arrhythmias. Early studies evaluating amiodarone for the management of ventricular arrhythmias demonstrated the efficacy of amiodarone in patients who were refractory to treatment with multiple antiarrhythmic drugs. More recently, 2 major trials, published in 1999 and 2002, described the efficacy of amiodarone as a primary treatment modality in the treatment of ventricular arrhythmias compared with another antiarrhythmic drug, lidocaine, and placebo. As a result of this literature, the American Heart Association Advanced Cardiac Life Support (ACLS) guidelines recommend amiodarone as the antiarrhythmic of choice in the resuscitation of patients with ventricular arrhythmias.

The Older Adult in the Emergency Department: Aging and Atypical Illness Presentation

Mary-Lynn Peters — 2009-08-17

As the baby-boom generation reaches older adulthood, the numbers of older adults (aged ≥65 years) seeking medical attention will increase. Older adults who present to the emergency department for treatment are typically more complex than younger clients. The older adult tends to have multiple comorbidities and polypharmacy and may have an atypical presentation of symptoms. The treatment of the older adult is further affected by the various physiologic changes of aging, such as impaired renal flow, impaired hepatic flow, and poor homeostatic mechanisms. Cognitive impairment, hearing impairment, and vision impairment may also have an effect on the older adult’s stay in an emergency department.

A Review of the American Heart Association Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome

Andrew Harding, Susan Mangini — 2009-05-29

The American Heart Association (AHA) recently released a scientific statement on the use of prehospital ECGs to improve the quality of care among patients with ST segment elevation myocardial infarction (STEMI). The authors state that fewer than 10% of patients with STEMI receive a prehospital ECG. However, even when an ECG is obtained, there is no systematic transmission coordination with hospital emergency departments. The stated purpose of the AHA scientific statement is to “summarize evidence concerning the benefits of using prehospital emergency medical services (EMS) ECGs, review barriers and challenges to routine use, and recommended approaches to enhance their effectiveness for improving quality of care for patient with acute coronary syndromes (ACS).”

An 82-year-old Man With A 2-Day History of Vomiting and Epigastric Pain

Melodie Cannon — 2009-03-23

An 82-year-old man complained of vomiting and epigastric pain for 2 days but refused to seek care despite family concerns. His medical history included hypertension, dyslipidemia, pulmonary embolism, and cholecystectomy. On the day of admission, a family member found the man semiresponsive, tachypneic, and diaphoretic. Shortly after prehospital care providers arrived, the patient had a pulseless electrical activity arrest. Interventions at the scene included nasal intubation and the administration of intravenous fluids, atropine, epinephrine, and dopamine.

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

Kathleen Carlson — 2009-12-04

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.

Stroke Scales You Can Use

Andrew Harding — 2009-10-09

Stroke is the third leading killer in the United States. Stroke is an emergency and has recently been an initiative for many quality teams, emergency departments, and public health education programs. The mantra “time is muscle” for myocardial infarctions has been adapted to “time is brain” for stroke. The crux of both of these ailments is tissue perfusion.

When Your Pediatric Patient Becomes a Crime Scene

Ruth Clevinger — 2009-12-09

The death of a pediatric patient is always a stressful time in the emergency department. These events are even more difficult when the child's death is the result of suspected criminal activity. Emergency nurses have the ability to change our own responses, as well as the responses of our teammates, during these difficult events. By comparing 2 scenarios, this article will show how (1) improved teamwork, (2) reviewing and updating policies and procedures to reflect current research and practice guidelines, (3) education, and (4) formal, structured debriefing of the event changed the outcome of the team response between 2 pediatric homicides.

Respiratory Emergencies

Michael Seaver — 2009-11-23

January of 2009 marked the start of the Certified Pediatric Emergency Nurse (CPEN) examination. In support of this new certification, three times a year JEN will feature this new 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.

Ectopic Pregnancies and Methotrexate: Are You Prepared to Manage This Hazardous Drug?

Ann Shastay, Susan Paparella — 2009-11-27

It is 8 pm on Saturday evening in the emergency department. A 34-year-old woman presents with severe lower abdominal pain and reports a positive home pregnancy test approximately 2 weeks ago. Her surgical history includes a reversal of a tubal ligation within the last 18 months, and she states that her last menstrual period was 6 weeks ago. The quantitative β–human chorionic gonadotropin level is reported to be less than 2,000 mIU/mL. An ultrasound of the abdomen shows an empty uterine cavity and an ectopic pregnancy (3 cm in size) within the left fallopian tube. No fetal heart activity can be documented. On consultation with obstetrics and gynecology staff physicians, medical treatment with single-dose methotrexate (also available as Abitrexate), 50 mg/m2 intramuscularly, is ordered. As an emergency nurse, are you prepared to administer this medication? Are you familiar with the safety precautions required with this class of hazardous drug? Do you know your hospital's policies for use of this medication?

The Impact of Crisis Intervention Team Programs: Fostering Collaborative Relationships

Michael Ralph — 2009-11-20

Emergency departments, the unintended endpoint of the health care system, have first-hand knowledge of our communities' inpatient psychiatric bed deficiency and of the decay in communities' mental health services availability. When people with mental illnesses are without needed treatment and services and when they are having a psychiatric crisis, law enforcement officers often become the first-line responders. Once these medical patients are in the custody of police officers, jails repeatedly “become de facto psychiatric institutions for individuals who have not been identified as having a mental illness or who have not been engaged in community mental health programs.” The National Alliance for Mental Illness (NAMI), the consumer advocate organization, says of this disturbing dynamic, “the criminalization of people with mental illness is a systems problem and the only way to fix it is to bring all the parts of the broken system together to find a solution.”

Navigating Through the Myriad of Available Journals

Nancy McGowan — 2009-11-23

In reading journals, it is often difficult to differentiate what is considered “scholarly,” what may be viewed as “respected,” and what information should be considered “suspect.” The purpose of this article is to shed light on what process journals have in place to ensure that scholarly articles are written with correct information, by a reputable source. With the myriad of nursing journals available both in print and online, it is important to be able to sift through the information and determine what is considered relevant, worthwhile information.

Injury Prevention in a Winter Wonderland

Megan Hamilton, Cheryl Hewitt — 2009-11-20

Winter sports in snow country can be as exhilarating as they can be dangerous. Mother Nature sends storms and the occasional avalanche to remind people just how dangerous playing in the snow can be. Each sport has its own inherent injury pattern, and understanding the risks while taking precautions with the appropriate gear can prevent injuries and save lives.

Third World Humanitarian Medical Trips—Are They Safe?

Jeff Solheim — 2009-11-13

As the founder and director of a third world humanitarian medical organization, I am asked many questions by prospective team members, with the most frequent question being, “Is a medical trip to the third world safe?” The answer to this question is complex. I would compare the question about the safety of traveling with a medical team to the Third World to a question such as, “How safe is it for me to drive from my home to the hospital to work a shift?”

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

Jeff Solheim, AnnMarie Papa — 2009-11-09

Nursing leadership is a challenging and difficult task, especially in these tough economic times. Leaders struggle with competing challenges ranging from nursing shortages to budget shortfalls and increasing regulatory oversight. Many nurses have risen to the challenge and provide outstanding leadership in the face of these adversities. We would like to highlight one of those nurses in this month's column. Bev Crum was honored in Baltimore with the Nurse Manager Award. We recently had a chance to speak with Bev and gain some insight into her journey through nursing leadership and some of the reasons she was selected for this honorable award.—Jeff and AnnMarie

Effective Leadership: Making the Difference

Jason Wade Grimm — 2008-09-09

The term leadership brings to mind the characteristics and actions of notable figures. Individuals such as Florence Nightingale, John F. Kennedy, Ronald Reagan and other people in history are regarded as leaders because of the qualities they possessed and the decisions they made. They often had a vision of change and achieved it by imparting the need to set a new course and by inspiring their followers to share in their vision. Many times circumstances forced them to act without much regard of the consequences of their actions.

On the Differences Between a Child and a Kitten

Cindy Tait — 2009-11-13

The American Heart Association (AHA) recently sent a memo to all affiliated training centers reminding them that the AHA “does not require or endorse the use of live animals” in their Pediatric Advanced Life Support (PALS) course and have thereby distanced themselves from training centers that opt to use animals for training purposes. It no doubt came as a surprise to many instructors to learn that animals were being used for such purposes, because most centers have neither the funds nor the desire to use animals.

Isopropyl Alcohol Intoxication

Jason D. Clark — 2010-01-01

A 42-year-old man was found unresponsive, lying face down on his front porch. Three empty 8-ounce bottles of rubbing alcohol were found with the victim. His estimated down time was unknown. The man's sister reported to EMS that the patient has been abusing alcohol for many years. The EMS providers noted that the victim had poor respiratory effort, dilated pupils, and significant hypotension. His Glasgow Coma Scale score was 3. He did not respond to the initiation of intravenous crystalloids. Endotracheal intubation was performed and his airway was secured. A helicopter was called to the scene and the patient was rapidly transported to a tertiary care facility with toxicology and hemodialysis services.

Lawn Mower Injuries: A Review

Jean Mullins — 2009-11-13

A 2 1/2-year-old boy was brought to a regional medical center after being backed over by a ride-on lawn mower. He sustained a partial amputation of his distal foot, including several of his toes and metatarsals, as well as a large open wound on the medial side of his heel. Some pieces of his foot were salvaged, wrapped in cool, moist dressings, and transported with him. He was transferred without incident to a level I trauma center for further treatment of his foot. Upon arrival, the orthopedic team assessed the patient and took him to the operating room for irrigation and debridement of his wound.

What is a Triage Nurse?

Anna C. Montejano, Lynn S. Visser — 2009-09-17

Exhausted, hungry, and ready for my 12-hour shift to end, I faced my next patient in the triage area of the emergency department. I began with the words that I repeated all day long to every patient I saw in triage. “Hi, my name is Annalynn, and I am the triage nurse. I will be starting your care. What can we do for you today?” The patient looked at me and said, “What is a triage nurse?”

Earn up to 8 Contact Hours by Reading the Designated Articles and Taking these Post Tests

2010-01-01

Clinical Test Questions

2010-01-01

Research Test Questions

2010-01-01

Professional/Administrative Test Questions

2010-01-01

CE Enrollment Form

2010-01-01

What’s New

2010-01-01

Coming Meetings

2010-01-01

Editorial Board

2010-01-01

Information for readers

2010-01-01

Journal of Emergency Nursing

Broadening My Perspective

Anniversaries and Resolutions

Thank You for Article on Venous Access in Children

Secondary Traumatic Stress and Mindfulness Training

Response From the Authors

Interdisciplinary Perspective Needed

Response

Missed Opportunities: Under-detection of Trauma in Elderly Adults Involved inMotor Vehicle Crashes

The Efficacy of an Educational Intervention on Documentation of Pain Management for the Elderly Patient With a Hip Fracture in the Emergency Department

A Comparison of the Quality of Blood Specimens Drawn in the Field by EMS Versus Specimens Obtained in the Emergency Department

Retrospective Audit of Triage of Acute Traumatic Shoulder Dislocation by Emergency Nurses

Administration of Amiodarone During Resuscitation of Ventricular Arrhythmias

The Older Adult in the Emergency Department: Aging and Atypical Illness Presentation

A Review of the American Heart Association Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome

An 82-year-old Man With A 2-Day History of Vomiting and Epigastric Pain

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

Stroke Scales You Can Use

When Your Pediatric Patient Becomes a Crime Scene

Respiratory Emergencies

Ectopic Pregnancies and Methotrexate: Are You Prepared to Manage This Hazardous Drug?

The Impact of Crisis Intervention Team Programs: Fostering Collaborative Relationships

Navigating Through the Myriad of Available Journals

Injury Prevention in a Winter Wonderland

Third World Humanitarian Medical Trips—Are They Safe?

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

Effective Leadership: Making the Difference

On the Differences Between a Child and a Kitten

Isopropyl Alcohol Intoxication

Lawn Mower Injuries: A Review

What is a Triage Nurse?

Earn up to 8 Contact Hours by Reading the Designated Articles and Taking these Post Tests

Clinical Test Questions

Research Test Questions

Professional/Administrative Test Questions

CE Enrollment Form

What’s New

Coming Meetings

Table of Contents

Editorial Board

Information for readers