Journal of Emergency Nursing

ENA, Supporting Emergency Nurses on the Front Lines in 2012

Gail Lenehan — 2012-01-01

In 2011, we faced destruction from both natural and man-made disasters. Tornados, hurricanes, and floods caused the significant loss of lives and property, and a global economic tsunami led to the loss of jobs and, in many cases, homes. We tightened our belts, changed our lifestyles, and, for some of us, put retirement on hold.

New Year, New Challenges, New Opportunities

Reneé S. Holleran — 2012-01-01

During the 2011 ENA General Assembly, two important challenges for the year 2012 were brought to light through two of the many resolutions presented. Resolution GA 11-011 Utilization of Paid Reservations for Emergency Department Services and Utilization of Advertised Wait Times for Emergency Department Services were both introduced and passionately debated throughout the days the General Assembly was in session. Both of these resolutions addressed possible solutions to the ED crowding that continues to be one of the major challenges we face in emergency departments not only across this country, but across many parts of the world.

Advocating for Safety in the Workplace

Melissa Alvarado — 2011-11-07

The clinical article by Andrew Harding published in the May 2011 issue of Journal of Emergency Nursing entitled “Education and Culture: Mitigation for Workplace Violence” points out that “a culture of safety is the antecedent to the education and skill training that can be implemented to mitigate the risks of violence in our emergency departments.” This statement speaks to the fact that ED nurses need to take a stand to advocate for the remaining 12 states that have not yet adopted legislation that provides increased penalties for assault of health care workers.

Interactions Among Benzodiazepine and Buprenorphine/Naloxone

Weiqing Yuan, Barry N. Williams — 2011-11-07

We read with interest the recent article by Heather Martin entitled “The Possible Consequences of Combining Lorazepam and Buprenorphine/Naloxone: A Case Review.” It is an interesting case study and we would like to express our thoughts on the drug interactions among benzodiazepine and buprenorphine/naloxone based on the literature review.

Priority Preparedness Issues

Knox Andress — 2011-12-02

September 2011 is a month to recognize and reflect upon the 10-year anniversaries of the September 11, 2001, and East Coast anthrax attacks and the 6-year anniversary of Hurricane Katrina. These tragedies remind us of the harsh reality of foreign and domestic terrorism within the United States and the destructive capability of natural hazards such as hurricanes. The scarce medical resources available for victims of Hurricane Katrina made the Agency for Healthcare Research and Quality's 2005 “Crisis Standards of Care” concepts a reality as several New Orleans area hospitals sought to provide the best care possible in the worst circumstances. The anniversaries of these catastrophes provide benchmarks for gauging our past preparedness level, current status, and opportunities for the future.

Thank You

Josh Grossman — 2011-11-07

Please accept my thanks—both as a physician and as a diabetic—for your outstanding “Endocrine Emergencies,” published in the May 2011 issue of JEN, volume 37, issue 3, pages 161-162. Truly outstanding!

Prehospital Electrocardiography: A Review of the Literature

Jessica K. Zègre Hemsey, Barbara J. Drew — 2011-12-05

Introduction: The American Heart Association and other scientific guidelines recommend emergency medical services acquire prehospital (PH) electrocardiography (ECG) in all patients with symptoms of acute coronary syndrome. The purpose of this article is to critically review the scientific literature about PH ECG.Methods: Using multiple search terms, we searched the PubMed and Web of Science databases for relevant information. Search limiters were used: human, research (clinical trials, experimental), core journals, and adult. All articles about the clinical effects of PH ECG published between 2001 and 2011 were retained, in addition to a landmark study from 1997.Results: Our search yielded a total of 105 articles when all years of publication were considered. When the same search was limited to articles published between 2001 and 2011 for new and current data, 45 articles were returned. A total of 7 articles about the clinical effects of PH ECG were retained for this review. Articles were conceptualized and organized by clinical effects of PH ECG (timing, reperfusion rate, death, ejection fraction, reinfarction, and stroke). PH ECG has been associated with reduced PH delay time, increased use of reperfusion interventions, earlier diagnosis, and faster time totreatment.Discussion: PH ECG plays a major role in emergency cardiac systems of care and can facilitate early intervention by identifying patients with acute coronary syndrome sooner.

Hemolysis of Coagulation Specimens: A Comparative Study of Intravenous Draw Methods

2010-10-01

Introduction: Hemolysis of blood samples creates significant delays in the treatment and disposition of patients in the emergency department. The purpose of this study was to compare the hemolysis rates of coagulation blood samples obtained during insertion of an intravenous (IV) catheter without (group 1) or with (group 2) extension tubing connected to the IV catheter hub. A secondary purpose of this study was to determine whether the investigators could predict whether a coagulation sample was hemolyzed based on visual observation during the specimen withdrawal process.Methods: A prospective, 2-group randomized comparative design was used to determine which method of blood collection for coagulation specimens provided the lowest hemolysis rate. This study was conducted in an urban level I emergency department averaging 58,000 visits per year. The sample consisted of 121 adult ED patients randomly assigned to 1 of the 2 groups. Data collectors were trained in the 2 methods of coagulation sample collection and followed a strict protocol. The clinical laboratory used a standardized color-coded scale to determine hemolysis.Results: Pearson χ2 analysis was used to test for differences between all nominal variables. The level of significance for all tests was P < .05. There was no significant difference in hemolysis rates between the groups by use of χ2 analysis (P = .84). Nurses were significantly more likely to predict that a sample was hemolyzed when it was not and to think that it was not hemolyzed when in fact it was (P < .001).Discussion: High hemolysis rates occurred equally when coagulation blood samples were drawn via a peripheral IV catheter either at the hub or through extension tubing. Emergency nurse investigators could not accurately predict by visualization whether a coagulation sample was hemolyzed at the time of blood withdrawal. Venipuncture as the preferred method of blood draw is an industry recommendation. This method has been shown in prior experimental studies to reduce hemolysis rates to less than 4%. Therefore, if hemolysis rates are a concern, one should consider obtaining blood whenever possible through a venipuncture rather than through an IV catheter. Replication studies are needed to determine whether the findings of this study can be generalized to the larger population.

Perceptions of Participating Emergency Nurses Regarding an ED Seasonal Influenza Vaccination Program

2010-10-18

Introduction: Numerous professional organizations have recommended that emergency departments provide influenza vaccine to patients. However, no study has reported on the perceptions of participating emergency nurses regarding ED influenza vaccination programs.Methods: We conducted an anonymous Web-based survey to assess the post-participation perceptions of emergency nurses regarding an ED influenza vaccination protocol. The vaccination protocol occurred at an urban, academic emergency department and was designed to be performed by emergency nurses without added staffing resources by using ED Electronic Medical Record technology. Data from the Web-based survey were analyzed using descriptive statistics and χ2 analysis to assess significant associations of where emergency nurses believed the protocol was time inefficient.Results: The ED influenza vaccination protocol was in effect from October 1-25, 2009, with 3091 eligible ED visits and 613 patients receiving ED seasonal influenza vaccination. Fifty-eight of 59 participating emergency nurses (98%) responded to the survey. Significant findings were that 59% of responding emergency nurses found the protocol too time consuming and believed it was inappropriate in the ED setting. Responding emergency nurses reported that protocol efficiency could be improved by adding staff, simplifying screening and vaccination documentation requirements, and improving vaccine supply and stocking procedures in the emergency department.Conclusion: A majority of surveyed emergency nurses who had participated in an ED influenza vaccination program reported that the protocol was too time consuming and inappropriate for the ED setting. Surveyed emergency nurses expressed the opinion that such protocols required added staff, simplified patient consent/vaccination documentation requirements, and improved vaccine supply and stocking processes.

Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department

2011-01-24

Introduction: Efficiency and effectiveness are often used as quality indicators in emergency departments. With an aim to improve patient throughput and departmental efficiency while decreasing left-without-being-seen (LWBS) rates, this two-group, pre-intervention, post-intervention study in a pediatric emergency department evaluated the outcomes of implementing rapid triage on arrival-to-triage time, fast track utilization, and LWBS.Methods: We implemented rapid triage assessment integrating the Emergency Severity Index and fast track guidelines in our pediatric emergency department. Arrival-to-triage times were tracked for 1 month before and after the intervention (N = 13,910 patient visits) by recording the time the patient arrived in the department and time triage assessment was complete. Fast track utilization and LWBS rates were measured for all patients sequentially included in pre-intervention (n = 60,373) and post-intervention (n = 67,939) groups for 10 months.Results: After the intervention, patients experienced a significant decrease in arrival-to-triage times compared with the pre-intervention group (P < .001), with most patients (88.3%) being triaged in less than 10 minutes after the intervention. Following implementation of fast track guidelines, patients were 14% more likely to be triaged to fast track compared with pre-intervention patients (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.11-1.67). Additionally, patients with the lowest acuity were nearly 50% more likely to be triaged to fast track compared with pre-intervention patients (OR = 1.48, 95% CI = 1.35-1.63). Although LWBS rates were insignificant, overall acuity level of this group was lower in the post-intervention group.Discussion: Although LWBS rates did not decrease with the intervention, implementation of a rapid triage system and fast track guidelines reduced arrival-to-triage times and decreased acuity in the LWBS population. Implementing rapid triage and fast track guidelines can affect nurse-sensitive patient outcomes related to safety and care delivery in a pediatric emergency department.

Assessment of Stroke: A Review for ED Nurses

Karen Bergman, Dean Kindler, Lindsy Pfau — 2011-11-14

Stroke affects approximately 795,000 persons in the United States annually, with most of those being first-time strokes and about 185,000 being recurrent strokes. Stroke is the third-leading cause of death in the United States for both men and women. The cost for stroke care in the United States is estimated at $68.9 billion in 2009, which includes health care as well as lost productivity costs. Stroke is the leading cause of long-term disability.

Do Nurses Eat Their Young? Truth and Consequences

Penny Sauer — 2011-11-14

It has been 25 years since Meissner accused nurses of “eating their young.” This provocative image was a call to action for the nursing profession. Since then, many changes have occurred in nursing practice and nurses' work environments. Programs that have influenced practice and the work environment include the American Nurses Credentialing Center Magnet Recognition Program and American Association of Critical Care Nurses Healthy Work Environment initiative and Beacon Awards. Unfortunately, these programs have not eliminated the problem of “insidious cannibalism” between nurse colleagues.

A 35-Year-Old Man with Back Pain and Saddle Anesthesia

Larry Meneghini — 2011-01-24

A 35-year-old man who worked as a laborer presented to the emergency department early one morning. He reported that 2 days prior to arrival he was using a sledge hammer to break concrete when he felt a sharp pain in his lower back. Later that day the patient's chiropractor recommended that the man follow up with his private physician. However, during the night the back discomfort increased and was accompanied by right leg weakness and shooting pains. Progressive lower extremity numbness and urinary incontinence prompted an ED visit.

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

Kathleen Carlson — 2011-11-07

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.

CEN Examination Review Questions Online Only

Cheryl Randolph — 2011-12-02

Time Out for Patient Safety

Anne Meginniss, Frances Damian, Francine Falvo — 2011-07-18

For more than a decade, health care organizations have stepped up their efforts to promote patient safety. Nurses, as patient advocates, understand that critical communication and teamwork are key elements in moving toward a culture of patient safety. The value of sound communication is fundamental to the prevention of sentinel events. Yet, during critical situations, a nurse may not feel empowered to speak up when a patient is at imminent risk of harm. In an effort to improve communication, a standardized communication technique called “time out for patient safety” was developed to provide universally accepted critical language for these situations and empower nurses to assert themselves.

Screening, Brief Intervention, and Referral to Treatment: A Nursing Perspective

Chenit Ong-Flaherty — 2011-11-16

Screening, brief intervention, and referral to treatment (SBIRT) was first initiated by the World Health Organization in the mid 1980s, in recognition that alcohol is an important contributor to ill health, mental health issues, injuries from trauma, and social problems. For example, in 2002, 3.2% of deaths worldwide were attributed to alcohol use. SBIRT has been implemented successfully in primary care and emergency departments throughout the world. In emergency medicine, SBIRT has been mandated by the American College of Surgeons Committee on Trauma for all level I trauma centers in the United States. However, the results of a few studies question the efficacy of SBIRT to reduce alcohol use longer term, at 12 months' follow-up.

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Scott DeBoer, Michael Seaver — 2011-10-07

January 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.

Allergic Reaction or Adverse Drug Effect: Correctly Classifying Vancomycin-Induced Hypersensitivity Reactions

Melissa A. McAuley — 2012-01-01

During the past 5 years, numerous reports have been submitted to the Institute for Safe Medication Practices National Medication Error Reporting Program and to Quantros MEDMARX (an adverse drug event data repository) that described errors and adverse reactions related to vancomycin. Often confusion exists about whether these events are allergic reactions or some other type of adverse event. This confusion often is evidenced by the way the adverse event is recorded and through statements by the health care professionals indicating that the response was “not red man syndrome” or that the “patient had a similar reaction previously, but it was not documented as an allergy.” Typical examples of adverse events with intravenous vancomycin doses are described in the next section.

Developing a Tissue Donation Advocacy Program in a Rural Emergency Department

Aaron M. Sebach, Dorothea McDowell — 2011-04-18

Although major strides have been made with regard to organ and tissue donation, there continues to be a lack of available donors. Currently more than 100,000 persons are awaiting a life-saving transplant, and 1 million others have conditions such as blindness, dermal burns, and malfunctioning heart valves that could be improved with a tissue transplant. Because approximately 40 persons can benefit from just one donor and because many families are comforted knowing that their loved one was able to help others in need, tissue donation efforts are a priority for health care professionals. A limited number of emergency departments across the United States have developed programs in which nurses introduce tissue donation to families after cardiac death occurs. The concept of emergency nurse–initiated tissue donation dialogues with family members is relatively new. As a result, few resources, literature, and programs are available, and thus guidance and support in the development of future programs are needed. This article discusses the development and implementation of a tissue donation advocacy program in a rural emergency department. Planning, training, and recommendations for others wishing to implement a similar program are highlighted. Preliminary outcome information and planned evaluations are included.

Hourly Rounding in the Emergency Department: How to Accelerate Results

Stephanie J. Baker — 2011-12-07

When a woman died in the ED lobby of a Los Angeles hospital several years ago because she could not obtain timely care, it made national news. On that day, Americans around the country wondered how this could happen in the US health care system today. They wondered if it could happen to them.

Experience Talks

Jeff Solheim, AnnMarie Papa — 2011-11-14

We just recently implemented our own scribe program, which is still in its infancy. We decided to develop our own program rather than go with a specialty company to save costs. Although developing our own program has made the process more difficult, we are starting to see positive results and now are finding it to be more efficient and effective. The scribes report to the ED nursing director, and their wages come out of the ED nursing budget.

Serotonin Syndrome—Muscle Rigidity and Confusion in the Older Adult

Joan Somes, Nancy Stephens Donatelli — 2011-11-14

Margaret, an 82-year-old woman, is brought to the emergency department confused and “not acting right.” On arrival, she is confused, restless, diaphoretic, and lacks coordination as she reaches for items (such as the pen). Her blood pressure is 220/110 mm Hg, heart rate irregular at 120 bpm, respiratory rate 24 per minute, and temperature 102.5°F. The paramedics share that the assisted living home staff were very concerned because Margaret is normally “sharp as a tack!”

Have Fun, Be Safe: The Start of an ED Community Outreach Program

Mary M. Pelton — 2011-11-14

Carteret County hugs the Atlantic Ocean along the coast of North Carolina. It is an area rich with tourists, as local and distance travelers come to visit the beaches and explore the waters, especially during the summer months. Many summer visitors to the emergency department in Carteret County are unfamiliar with the local geography and the potential hazards of living near the ocean. Traumas involving water and hazardous marine life rise exponentially from Memorial Day to Labor Day.

Project Helping Hands Unites with Bolivian Leaders

Cindy Tryniszewski — 2012-01-01

In early July of 2011, Project Helping Hands sent a volunteer team of nurses and physicians to Bolivia for a 7-day educational trip. The purpose of this trip was twofold: (1) to provide seminars for Bolivian physicians, nurses, and first responders and (2) to gather information to help develop a 5-year educational program based on the reported needs of health care providers. The educational team was led by Pat Clutter, MEd, RN, and included Dr. Tan Pinney, Dr. Chuck Sheppard, Norma Heuer, RN, and me (Cindy Tryniszewski, MSN, RN).

Sexual Assault Forensic Examiners' Training and Assessment Using Simulation Technology

2011-01-07

Introduction: More than 190,000 sexual assaults involving persons aged 12 years or older occur annually in the United States. For these victims, a forensic examination is the first step in the process to justice. Assessment and treatment of victims, as well as the meticulous collection and documentation of evidence, are vital for a strong case. Providing timely services 24/7 by qualified professionals can be taxing on schedules and budgets. Using in-house resources to cross-train ED personnel, we developed a program that introduced novice forensic examiners to common clinical scenarios encountered in the treatment of victims and provided a framework for the evaluation and management of each case.Methods: Seventeen ED personnel attended statewide sexual assault nurse examination training and participated in four simulation scenarios and debriefings. Pre-tests and post-tests were administered, and a checklist was used to assess competence in performing examinations independently.Results: The majority of participants achieved competence (≥85% on the checklist) with their first case and had statistically significant gains in knowledge between pre-test and post-test (pre-test mean score [±SE] of 69.1 ± 1.7 vs. post-test mean score of 84.4 ± 2.6, P < .001). Course evaluations were favorable, with a mean score of 91.3%.Discussion: Our results validated the use of simulation technology and in-house resources for cross-training in a sexual assault forensic examination program, together with a checklist to assess competence in performing examinations independently. Benefits of having a sexual assault forensic examination program in the emergency department are standardized and timely care for victims, as well as enhanced evidence collection and increased reporting and prosecution of crimes.

ED Fracture Pain Management in Children

Jennifer Gourde, Frances J. Damian — 2011-06-29

Broken bones hurt. Fractures in children are a common reason for ED visits. In 2009, approximately 2600 children visited the emergency department at Children's Hospital Boston for treatment of a fractured extremity. When a bone breaks, pain fibers in the nerve endings that surround the bone become irritated. A broken bone bleeds, and the blood and associated edema cause pain. Additionally, muscles surrounding the injured area sometimes go into spasm in an attempt to hold bone fragments together, causing further pain. Add these elements together, and the ED nurse sees a grimacing child, alongside a distressed parent, stumbling through the doors holding a swollen arm after falling off the monkey bars, a bicycle, or the kitchen counter.

Reversal of Warfarin-induced Coagulopathy: Review of Treatment Options

A. Brad Hall, Brittany C. Carson — 2011-04-07

Warfarin is a mainstay of the treatment of a variety of common conditions requiring anticoagulation, including deep venous thrombosis, pulmonary embolism, and atrial fibrillation. Treatment with warfarin requires careful monitoring and dose adjustments because of a narrow therapeutic index. A small window of optimal anticoagulation exists between the lower level of anticoagulation that could still result in clot formation and a higher level of anticoagulation that increases the risk of hemorrhage.

The Knife and Gun Club Just Adjourned: Managing Penetrating Injuries in the Emergency Department

Kathryn Moore — 2011-12-05

The Lynyrd Skynyrd chorus lyrics make it clear, “It's a Saturday night special/Got a barrel that's blue and cold/Ain't no good for nothin'/But put a man six feet in a hole.” Saturday night has a reputation in bad neighborhoods as a time when folks with knives and guns come out to play, and the result is business in the emergency department. The associated injuries are described as penetrating injuries.

A Pivot Nurse at Triage

Marie Martin — 2011-12-02

Emergency nurses will continue to face challenges and constant change moving through the 21st century. Historically, emergency care has been influenced by many factors outside the control of professionals practicing in the specialty. Unfortunately, many of the systems and processes put into place during the past several decades no longer efficiently serve our practice or our patients. The challenge is to give up decades-old, traditional, outdated, and dysfunctional practices to implement systems that work. Negative consequences of ED crowding include prolonged patient wait times, patient dissatisfaction, increased patient complaints, decreased staff satisfaction, and decreased physician productivity.

Earn Up to 10 Contact Hours by Reading the Designated Articles and Taking These Post Tests

2012-01-01

Clinical Test Questions

2012-01-01

Research Test Questions

2012-01-01

Professional/Administrative Test Questions

2012-01-01

CE Enrollment Form

2012-01-01

Editorial Board

2012-01-01

Information for Readers

2012-01-01

Journal of Emergency Nursing

ENA, Supporting Emergency Nurses on the Front Lines in 2012

New Year, New Challenges, New Opportunities

Advocating for Safety in the Workplace

Interactions Among Benzodiazepine and Buprenorphine/Naloxone

Priority Preparedness Issues

Thank You

Prehospital Electrocardiography: A Review of the Literature

Hemolysis of Coagulation Specimens: A Comparative Study of Intravenous Draw Methods

Perceptions of Participating Emergency Nurses Regarding an ED Seasonal Influenza Vaccination Program

Outcomes of Implementing Rapid Triage in the Pediatric Emergency Department

Assessment of Stroke: A Review for ED Nurses

Do Nurses Eat Their Young? Truth and Consequences

A 35-Year-Old Man with Back Pain and Saddle Anesthesia

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination

CEN Examination Review Questions Online Only

Time Out for Patient Safety

Screening, Brief Intervention, and Referral to Treatment: A Nursing Perspective

Knowledge Assessment and Preparation for the Certified Pediatric Emergency Nurse Examination

Allergic Reaction or Adverse Drug Effect: Correctly Classifying Vancomycin-Induced Hypersensitivity Reactions

Developing a Tissue Donation Advocacy Program in a Rural Emergency Department

Hourly Rounding in the Emergency Department: How to Accelerate Results

Experience Talks

Serotonin Syndrome—Muscle Rigidity and Confusion in the Older Adult

Have Fun, Be Safe: The Start of an ED Community Outreach Program

Project Helping Hands Unites with Bolivian Leaders

Sexual Assault Forensic Examiners' Training and Assessment Using Simulation Technology

ED Fracture Pain Management in Children

Reversal of Warfarin-induced Coagulopathy: Review of Treatment Options

The Knife and Gun Club Just Adjourned: Managing Penetrating Injuries in the Emergency Department

A Pivot Nurse at Triage

Earn Up to 10 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

Table of Contents

Editorial Board

Information for Readers