Journal of Emergency Nursing - Articles in Press

Factors Influencing Patient Assignment to Level 2 and Level 3 Within the 5-Level ESI Triage System - Corrected Proof

2010-09-01

Introduction: Prospectively assessing factors that influence triage nurse assignment of patients to the higher risk level 2 compared to the lower risk level 3 has not previously been explored within the 5-level Emergency Severity Index (ESI) triage system. Considering the large amount of information available about the patient, less experienced triage nurses often struggle in deciding what patient information is truly relevant when assessing if a high-risk situation exists. The primary aim of this study was to identify specific factors used by triage nurses to differentiate level 2 patients from level 3 patients.Methods: A convenience sample of triage nurses was recruited from 2 ED sites. If at the completion of the nurse-patient triage interaction the nurse assigned the patient to either level 2 or level 3, the triage nurse then completed a questionnaire related to factors that influenced patient assignment.Results: Overall, 18 triage nurses participated in the study with a total of 334 nurse-patient triage interactions collected. Patient age, vital signs, and need for a timely intervention were found to be significant factors that influenced patient assignment to level 2 while expected number of resources influenced patient assignment to level 3.Discussion: Utilizing experienced triage nurses on average, this study identified specific, objective factors that, combined with factors already delineated in the ESI Version 4 Implementation Manual, have useful implications for less experienced triage nurses by providing a more comprehensive and relevant foundation for data gathering and decision making.

Pediatric Rash and Joint Pain: A Case Review - Corrected Proof

Mindi Dixson — 2010-08-30

A 2-year-old male child presented to the emergency department with a 2-day history of a non-pruritic red rash to the lower extremities and acute onset of left lower extremity pain. The child's mother stated that he had been eating, drinking, and playing normally until dinner, when he began complaining of pain in his left ankle. She then noticed that he would not bear weight on his left leg. She denied any other symptoms including fever, cough, runny nose, throat pain, ear pain, nausea, vomiting, diarrhea, or abdominal pain. The mother did report a history of a “cold” about 6 days ago but stated that the child had been asymptomatic since that time.

Alphabet Soup: Confusion Between DTaP and Tdap - Corrected Proof

Susan Paparella — 2010-08-23

Tetanus is a potentially fatal infection caused by the gram-positive bacteria Clostridium tetani, which is found in soil and animal and human feces. When this anaerobic organism enters the skin during a traumatic injury to the skin, often a puncture wound, the bacteria will incubate in an oxygen-depleted environment and produce a neurotoxin that can eventually invade striated muscle. Left untreated, toxicity characterized by prolonged contraction of the skeletal muscle will develop in patients exposed to tetanus. Spasms from tetanus exposure commonly develop in a descending manner, typically starting in the face and the jaw (thus the term “lockjaw”), which often is followed by difficulty swallowing, and eventually the spasms progress to other muscle groups in the body. Mortality rates from tetanus have declined since the early 1900s as a result of better hygiene and wound management. The highest mortality rates for tetanus have been associated with unvaccinated individuals and persons older than 60 years. According to the 2005 statistics from the Centers for Disease Control and Prevention, 27 cases of tetanus were reported in the United States, two of which were fatal.

Use Intravenous Smart Pumps for Patient Safety - Corrected Proof

Andrew D. Harding — 2010-08-23

The smart technology intravenous (IV) medication administration pump (ie, the smart pump) is currently the best modality available to deliver IV medications or fluids. However, the use of smart pumps does not guarantee that a medication error will not occur. Human intervention in pump design, programming, establishment of the IV therapy library (the “smart technology” feature), and the actual interface with the pump when administering IV therapy are required. These human interventions strengthen the ability of the smart pump to provide more process-oriented IV therapy administrations.

The HEAD FIRST Helmet Safety Program for Kids - Corrected Proof

Rose Utley, Doug Downs — 2010-08-12

According to the Bicycle Helmet Safety Institute, there are an estimated 85 million bicycle riders in the United States. Bicycling accidents result in more than half a million visits to the emergency department for treatment of injuries each year. Of those patients, approximately 67,000 sustain head injuries, and more than 700 die. For children, the rate of injury is especially significant, with bicycles accounting for more injuries than any other mode of transportation except cars. Among persons with bicycle injuries, head injuries account for more than 60% of the total deaths.

Competency and Educational Requirements: Perspective of the Rural Emergency Nurse - Corrected Proof

Terri Bolin, Deborah Peck, Cindy Moore, Peggy Ward-Smith — 2010-08-11

Abstract: Introduction: Continuing education has been associated with maintaining clinical competency for nurses. Despite this information, the availability, time, and financial support to attend continuing educational programs challenge the ability to develop, provide, or attend such programs. Before the development of methods to provide continuing educational programs to nurses working in rurally located emergency departments, a survey was developed to capture the perspective of these nurses.Methods: An investigator-developed survey was administered to emergency nurses working within an emergency department located in a rural Midwestern state. Consent was implied upon return of the survey, and response to the survey was voluntary, in accordance with our institutional review board's policy.Results: Data were obtained from 33 nurses, representing 3 different rurally located ED settings. The perceptions of the participants of this study are that maintaining clinical competency is important and that ongoing continuing education should be mandatory.Discussion: These data indicate that emergency nurses in rural areas are willing to participate in ongoing education and that maintaining clinical competency is valued. Using evidence-based data to develop continuing educational programs increases the potential for the programs to be appropriate and valued and more likely to be attended by these nurses.

Sudden Confusion and Agitation: Causes to Investigate! Delirium, Dementia, Depression - Corrected Proof

Joan Somes, Nancy Stephens Donatelli, Jennifer Barrett — 2010-08-09

You are called to triage to assist as Frank, a frail, older-looking gentleman, is banging on the desk with his cane and yelling, “They're taking my things!” No one is sure what the “things” are, but most people are fearful to get too close or to grab him for fear of being hurt or hurting him. Eventually, you manage to calm him enough to place him in a wheelchair, where you attempt a conversation. It is not going well. His answers are disjointed and not making a lot of sense.

Detecting and Treating Sepsis in the Emergency Department - Corrected Proof

Amy Michelle Vanzant, Marilee Schmelzer — 2010-08-09

Sepsis is a common life-threatening condition that occurs when a once localized bacterial or fungal infection becomes systemic and produces an unregulated inflammatory immune response. Unless promptly treated, sepsis progresses to septic shock, which is a state of severe intravascular volume depletion and cellular hypoxia, usually leading to multiple organ failure and death. Early recognition and treatment of sepsis in the emergency department have been shown to significantly improve survival rates. However, it is difficult to predict when a local infection will progress to sepsis, as well as to recognize sepsis in its early stages when symptoms are vague and often attributed to other problems. This article addresses these issues and discusses possible solutions.

Alcohol Withdrawal Syndrome in Trauma Patients: A Review - Corrected Proof

Lynn E. Eastes — 2010-08-06

Alcohol withdrawal syndrome (AWS) is an all-too-common problem in trauma patients, with between 30% to 50% having ingested some type of intoxicant prior to injury. The positive correlation between alcohol use and trauma is well established in the literature. The spectrum of AWS, however, is not well understood among all trauma care providers. AWS symptoms are similar in some cases to symptoms of sepsis, progression of the brain injury, and a constellation of other diagnoses causing delirium. The purpose of this article is to review the pathophysiology of AWS, identify the common symptoms of AWS that trauma providers will encounter, discuss which trauma patients are at highest risk for AWS, and examine the trauma nurses role in reducing the risk of AWS.

Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination - Corrected Proof

Kathleen Carlson — 2010-08-05

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.

A 30-Year-Old Woman With Acute Leg Pain - Corrected Proof

Mike Spiro — 2010-08-05

A 30-year-old woman presented to the emergency department complaining of subjective fever and pain in her right hip and thigh. She denied any traumatic or medical history except for intravenous drug abuse but stated that her last heroin injection was 6 months ago. The patient's blood pressure and heart rate were unremarkable; her oral temperature was 38.1°C (100.6°F). The right hip and lateral thigh were tender to palpation. No trauma or erythema was evident, but the patient was unable to lift her leg off the stretcher. Blood chemistries were within normal limits, the white blood cell count was 8,400/mm3 (reference range, 5,000-10,000/mm3), and blood cultures showed no growth after 3 days. A hip radiograph was negative for fracture or dislocation. After 975 mg of oral acetaminophen and 30 mg of intramuscular ketorolac (Toradol), the patient was able to ambulate to the bathroom without assistance. She was given a cane and discharged home with prescriptions for ibuprofen and acetaminophen/oxycodone (Percocet).

Health Care Providers' Evaluation of Family Presence During Resuscitation - Corrected Proof

Kathleen S. Oman, Christine R. Duran — 2010-08-05

Introduction: The benefits of family presence (FP) during resuscitation are well documented in the literature, and it is becoming an accepted practice in many hospitals. There is sufficient evidence about health care provider (HCP) and family attitudes and beliefs about FP and little about the actual outcomes after family witnessed resuscitation. The purpose of this study was to evaluate FP at resuscitations.Methods: A descriptive design was used to collect data at an academic medical center in the western U.S. There were 106 resuscitations during the study period. Family presence was documented on 31 (29%) records. One hundred and seventy-four health care provider names were listed on the resuscitation records, and 40 names (23%) were illegible or incomplete. The convenience sample of 134 HCPs was invited to complete an electronic survey and 65 (49%) responded.Results: Respondents indicated that family members were able to emotionally tolerate the situation (59%), did not interfere with the care being provided to the patient (88%). In addition, team communication was not negatively affected (88%). A family facilitator was present 70% of the time, and it was usually a registered nurse (41%). Twenty-one narrative comments were summarized to reflect the following themes: 1) family presence is beneficial; 2) family presence is emotional; 3) a family facilitator is necessary.Discussion: These study findings demonstrate that having families present during resuscitations does not negatively impact patient care, is perceived to benefit family members and that a dedicated family facilitator is an integral part of the process.

Urgent Care of Neck Breathers - Corrected Proof

Itzhak Brook — 2010-08-05

As an infectious diseases specialist for over 40 years, I also had extensive experience in emergency care. After being diagnosed with throat cancer 4 years ago, I had undergone laryngectomy, thus becoming a neck breather. I no longer breathe through my nose or mouth but through a stoma in my neck. Unfortunately, neck breathers are at a higher risk of receiving inadequate therapy when seeking urgent medical care. experienced this myself when I needed such care because of shortness of breath at one of the local emergency departments.

Emergency Nursing AdvocacyUpdate on Health Reform: ENA's Health Care Reform Platform - Corrected Proof

Christine K. Murphy — 2010-08-05

Beginning in 2008, in preparation for the impending debate on health care reform, ENA weighed in by identifying key elements of reform essential to the future security of health care in the United States. Some of these components had been delineated in various ENA position statements, such as the 2006 document Access to Health Care. Based on these well-established positions, ENA developed a Health Care Reform Platform (HCR Platform) to serve as the baseline for ENA to examine and address the various congressional health reform proposals. The HCR Platform consists of 10 planks that ENA held must be addressed in order to resolve the systemic health care crisis in the country:

A 69-Year-Old Man With Gastrointestinal Exsanguination - Corrected Proof

Lindsey Mills, Melissa Stevens, Brian J. Tollefson, Melissa Watkins — 2010-08-05

A 69-year-old man with suspected gastrointestinal bleeding was airlifted to our emergency department from an outlying facility. He had a history of hypertension and lung and esophageal cancer (which was in remission) and a distant history of occasional alcohol use. The man had an esophageal stent placed 2 weeks prior to presentation. He arrived at the transferring facility with a systolic blood pressure in the 70s (mm Hg). He was given 3 units of packed red blood cells and 2 L of normal saline solution. Upon arrival at our emergency department, the man's blood pressure had improved to 100/56 mm Hg. He was alert and oriented and complained of moderate, cramping pain in the mid-abdominal region. His stool tested positive for blood, but no gross bleeding was observed.

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

Jeff Solheim, Ann Marie Papa — 2010-07-23

Subcutaneous hydration (hypodermoclysis) was implemented in the fall of 2009 within our adult emergency departments. Although reluctant at first, staff have embraced this new concept as a quick and easy route for rehydration.

Short-term Pharmaceutical Management of the Violent/Aggressive Patient in the Emergency Department - Corrected Proof

Steven Foley — 2010-07-12

Patient violence occurs in many clinical settings, and staff must be prepared to efficiently cope with unpredictable, violent patients. Frequently patients present to the emergency department with combative behavior because of conditions such as psychosis, dementia, withdrawal syndromes, and/or alcohol or drug intoxication. Combative individuals can present a significant threat to themselves, their families, other ED patients, and the ED staff.

Music as Distraction in a Pediatric Emergency Department - Corrected Proof

Tiffany Young, Elizabeth Griffin, Erin Phillips, Erin Stanley — 2010-06-18

Pain reduction methods are under-utilized in children, especially in emergency settings. After attending a nursing conference where complementary therapies such as music and humor were discussed, we decided to explore non-pharmacological pain management techniques for our pediatric patients. This project, The iPod Intervention, describes what we believe is a best practice use of music as a distraction from pain and anxiety for children in emergency departments. Research has shown that music is an effective distraction; in addition, patients and investigators report that music helps reduce pain.

Our Experience in Earthquake-ravaged Haiti: Two Nurses Deployed With a DMAT Team - Corrected Proof

Karen Ketchie, Elizabeth Breuilly — 2010-06-18

The United States Department of Health and Human Services (DHHS) identifies each regional Disaster Medical Assistance Team (DMAT) by its state letters and team number. The FL-4 disaster team, based in the Jacksonville area of Florida, received the long-anticipated call to activate and report to staging on January 22, 2010. We reported to an Atlanta airport hotel, where Headquarters staff provided the pre-deployment briefings that included vaccinations, behavioral health issues, Haiti hazard assessment, and physical screenings. Most of us on the FL-4 team have trained and deployed together for many years on missions relating to previous disasters, but this was our first international mission.

Nurse Practitioner Delphi Study: Competencies for Practice in Emergency Care - Corrected Proof

2010-06-14

The Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation describes the title APRN as nurse anesthetists, nurse midwives, clinical nurse specialists, and nurse practitioners (NPs). The APRN NP role, as part of the Consensus Model, recognizes 6 specialties, which include neonatal, pediatrics, women's health/gender related, psychiatric/mental health, adult/gerontology, and family/individual across the lifespan. NPs in emergency care fall within the population foci of family across the lifespan and provide health care services in the subspecialty of emergency care.

High-alert Medications: Shared Accountability for Risk Identification and Error Prevention - Corrected Proof

Susan Paparella — 2010-06-14

In an ideal world, medical error would never occur and all patients would be discharged from the emergency department remarkably better than when they arrived. Although this may certainly sound like a fairytale, the risks associated with providing care in most ED settings are very common and very real. Don't be fooled. Risk is everywhere, and it can come from many sources, both internal and external to the department, making risk difficult in some situations to anticipate or control. Risk can sometimes be subtle or not easily recognizable, and it is often disguised as a common alteration in procedure or process that is easily bypassed and unnoticed for what it really is . . . an error waiting to happen. Because the majority of emergency departments around the country successfully navigate risk every day, it is often accepted as “that's the way it is around here.” It is human nature to get used to the risk. It is also especially easy for the experienced staff member to become complacent to the risk and to not see it or recognize it as “risk” until something goes terribly wrong. The challenge in many departments is to bring awareness to the risk that is inherent in our everyday processes, motivate and energize the ED team to speak up when they recognize risk, and work to create improved processes and systems, making the emergency department more reliable in risk identification and the prevention of error.

Multigenerational Workforce: Are We Using the Literature Effectively? - Corrected Proof

Andrew D. Harding — 2010-06-14

There has been a lot of attention paid to the multigenerational work force in the nursing media over the last 10 years. Typical articles discuss the 4 categories of workers as determined by the year they were born. The 4 groups and their birth years include are as follows: Veterans, 1925-1945; Baby Boomers, 1946-1964; Generation X, 1963-1980; and Millennial Generation, 1980-2000. This breakout is explained as different generations related to the circumstances faced by these nurses during their formidable years. Ensue from the articles is a discussion and graph about the differences between the generations related to their styles and behaviors and what nurses should know about working within a multigenerational environment.

The Impact of Time from ED Arrival to Surgery on Mortality and Hospital Length of Stay in Patients With Traumatic Brain Injury - Corrected Proof

Young Ju Kim — 2010-06-11

Introduction: The previous studies examining the benefits of timely surgery in patients with traumatic brain injury (TBI) have yielded inconsistent conclusions. This study examined how time from ED arrival to surgery in patients with TBI influenced two patient outcomes: hospital mortality and length of hospital stay.Methods: Using a multivariate and cross-sectional research design, the study sample included 493 patients from the 17 level I and II trauma centers that met inclusion criteria in the National Trauma Data Bank 4.0. The patient characteristics (eg, age, Glasgow Coma Scale score, Injury Severity score, and ED arrival time) and trauma center characteristics (eg, ownership, designation type, and center level) were examined. Student t test, χ2 test, analysis of variance, and multilevel regression models were used to analyze data.Results: Patients who underwent craniotomy or drainage of hematoma within 4 hours of arrival had half the likelihood of mortality when compared with those who underwent surgery more than 4 hours after ED arrival (odds ration = .49; 95% confidence interval = .24 to .99). When patients had surgery within 4 hours of arrival, they had a significantly shorter length of hospital stay than did patients who had surgery more than 4 hours after arrival in the emergency department (Estimate = –.10, 95% confidence interval = –.19 to –.01).Discussion: Based on the results of this study using a large sample from multiple centers and advanced statistics, benefits of early clinical assessment and quick access to neurosurgical surgery are substantiated in patients with TBI.

Characteristics of Patients Who Leave the ED Triage Area Without Being Seen By a Doctor: A Descriptive Study in an Urban Level II Italian University Hospital - Corrected Proof

2010-06-07

Objective: In this paper, we describe demographic and clinical features of patients who left the triage area before the visit in the emergency department of Azienda Ospedaliera Universitaria Careggi in 2006.Methods: This is a descriptive retrospective study. Data was collected from electronic medical charts.Results: We recorded 45,019 patients who arrived in the emergency department. Of those, 904 left without being seen (2%; Male 51.5%; Female 48.2%). The mean age was 41 years (median 37; range 14-95). We found that this was more common during June and July (114 and 107 cases) and on Mondays (20.5%), with lower rates on Saturdays and Sundays (11.3% and 9%). Two-hundred thirty-nine patients were not Italian. Patients' waiting times before leaving without being seen collected from the nursing notes were recorded in 457 cases (50.5%), and showed a median of 70 minutes (range 0-386). There was a significant difference between this value and the median of waiting times (95 minutes) calculated from the ending time of medical charts in the same group of patients (Wilcoxon Signed Rank Test - P < 0.0001). It confirms the hypothesis that the patients' length of stay before leaving the triage area, gathered from medical charts, isn't reliable because of the delayed ending of charts. After 72 hours from the leave, 17 patients returned. The outcome were: 2 admissions in general ward and 6 new cases of leaving without being seen.Conclusions: There was a prevalence of low-priority triage-level patients compared to the general ED case mix. The rate of patients' leaves follows the indications of Tuscany Region (patients' leaves <5% total ED population).

Walking Wounded: If They Can Still Walk, Are They Really Wounded? - Corrected Proof

Lisa M. Robinson — 2010-06-07

One evening when I was working as the initial triage nurse, a 21-year-old ambulatory man presented to triage, stating, “I got stabbed,” and pointed to his left lateral lower rib area. His mother stated, “He just needs a few stitches.” The patient was shirtless and had a normal respiratory rate, work of breathing, gait, and skin color. He was not splinting or wincing when he spoke or moved. The stab wound was covered with a four-inch square gauze secured with roller gauze that was wrapped around his chest (which, he reported, had been applied by a paramedic). His pulse oximetry was 100% and his heart rate was 115. I had the patient sit in a wheelchair and looked at his chest wound. It was a clean laceration approximately 1.5 cm in length and was not sucking or bleeding. I felt his radial pulse, which was strong (2+) and regular, and asked an assessment registered nurse (RN) to take him back to a trauma room.

Understanding Qualitative Evidence for Emergency Nursing Practice - Corrected Proof

Tania D. Strout — 2010-06-07

Sackett and colleagues define evidence-based practice (EBP) as “the integration of best research evidence with clinical expertise and patient values,” presenting 3 essential ideas: a synergy between research evidence, the expertise of clinicians, and the values of the patients we serve. It acknowledges the tensions that exist in developing a balance between our clinical expertise, developed over years of practice at the bedside, and scientific evidence that may or may not be able to be generalized to our patients. This definition also gives credence to a voice formerly silent—that of our patients and their families. It takes into account their cultures, ethnicities, ideas about health and wellness, and all of the other unique attributes that make them who they are.

A 7-Year-Old Child Witnesses CPR - Corrected Proof

Barbara B. Ott, Michelle A. McKay — 2010-06-01

A 52-year-old man was brought to the emergency department after a motorcycle crash. On arrival, his abdomen was firm and distended. Abdominal and pelvic computed tomography scans showed free fluid throughout his belly. The trauma surgeon explained the patient's condition and treatment recommendations to the patient's wife and 7-year-old daughter before taking him to the operating room for emergent laparotomy. During surgery, the patient was hypotensive and hypoxic.

Geriatric Emergency Nurses: Addressing the Needs of an Aging Population - Corrected Proof

Jennifer Baumbusch, Maureen Shaw — 2010-06-01

Introduction: Older adults account for up to 14.5% of ED visits. Presentation of older adults can differ from younger adults. Emergency visits by older adults that are characterized by comorbidity, cognitive and functional impairment, and complex social issues. In addition, older adults present with subtle, atypical symptoms making diagnosis and discharge more challenging. The purpose of this study was to describe an innovative geriatric emergency nurse role that has been implemented to address the unique needs of older adults in the emergency department.Methods: This was an exploratory, descriptive study. The study sample was comprised of two groups: Geriatric Emergency Nurses (N=5) and key informants (N=15). The study was based at a tertiary hospital in Vancouver, Canada. Data was collected using semi-structured interviews. Data were analyzed using thematic analysis.Results: The findings are organized into three sections: defining the role and its functions; a collaborative relationship: fitting in to the larger emergency department; and recommendations for future role development.Conclusion: Findings from the study have led to further considerations about the role in relation to communication about older patients both within the emergency department and with community stakeholders. We also discuss the importance of this role in relation to the continuum of care and recognizing the central role of the emergency department as a place for intervention. Lastly, we consider the need for further integration of gerontological knowledge and expertise within the emergency department beyond a specialized role.

A Program to Minimize ED Violence and Keep Employees Safe - Corrected Proof

Susan Rees, Darci Evans, Dianna Bower, Heidi Norwick, Tami Morin — 2010-05-21

The incidence of violence in emergency departments is well documented in the literature. In fact, emergency departments are thought to be the most frequent location for violence in health care, along with psychiatric wards, waiting rooms, and geriatric units. One of the most frequent targets of that violence is the nurse. According to the International Council of Nurses, nurses are 3 times more likely to experience violence than any other professional group. In 1991, ENA acknowledged the problem of workplace violence in emergency departments with the release of a position statement on Violence in the Emergency Care Setting. This position statement clearly articulates that health care organizations have a responsibility to provide a safe and secure environment for their employees and the public. Additionally, the position statement emphasizes that an interdisciplinary approach with strong emergency nurse involvement is necessary to develop an effective workplace violence prevention program.

“I Want To See The Doctor”: Meeting Patients' Expectations in the Emergency Department - Corrected Proof

Monique Lott Roper — 2010-05-20

One of the primary reasons a patient presents to the emergency department is to see a doctor. Patients expect rapid or immediate treatment for their symptoms. Many think there is a doctor waiting to immediately see them and take care of them once they arrive at the emergency department. When this expectation is not met, patient satisfaction significantly decreases. Waiting to see the doctor promotes aggravation, anxiety, and stress to the patient and his or her family and friends. Waiting room times for emergency departments across the country are at the highest levels ever. This creates unsafe environments for our patients. We have all heard the news stories about patients who had serious complications and even died while sitting in waiting rooms, waiting to see a physician or other provider. Decreasing door-to-provider times is a major and significant undertaking for any emergency department. However, if successful, emergency departments can see significant improvements in patient outcomes as well as patient and staff satisfaction.

Sickle Cell Disease Management in the Emergency Department: What Every Emergency Nurse Should Know - Corrected Proof

CDR Christopher Reddin, Elizabeth Cerrentano, Paula Tanabe — 2010-05-20

In 2004, the Agency for Healthcare Research and Quality reported that nearly 80% of the 80,000 hospital admissions for acute sickle cell disease (SCD) began their course in the emergency department. SCD is a chronic disease associated with serious pathophysiologic complications (eg, stroke, pulmonary embolus, sepsis, and acute chest syndrome [ACS]), severe pain crises, debilitating chronic pain, and a shortened life span. Morbidity and mortality rates remain high, as reflected by the median age of death: 42 years for men and 48 years for women. Because of the potential for underlying pathophysiologic complications, in addition to the severe pain crises, patients should be evaluated rapidly in the emergency department and receive emergent intervention. The frequency of pain episodes and the need for hospital re-admission after ED visits has been associated with an increased risk of death, suggesting that rapid and thorough evaluation and management of these episodes is indicated.

Compassion Satisfaction, Burnout and Compassion Fatigue Among Emergency Nurses Compared With Nurses in Other Selected Inpatient Specialties - Corrected Proof

2010-05-19

Introduction: Today the proportion of acute patients entering the health care system through emergency departments continues to grow, the number of uninsured patients relying primarily on treatment in the emergency department is increasing, and patients' average acuities are rising. At the same time, support resources are constrained, while reimbursement and reputation depends increasingly on publicly available measures of patient satisfaction. It is important to understand the potential effect of these pressures on direct care staff. This study explores the prevalence of compassion satisfaction, burnout, and compassion fatigue among emergency nurses and nurses in other selected inpatient specialties.Methods: Emergency nurses and nurses from 3 other specialty units self-selected participation in a cross-sectional survey. Participants completed a sociodemographic profile and the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV. Scale scores were summed for compassion satisfaction, burnout, and compassion fatigue for emergency nurses and compared with those of nurses in other specialties.Results: Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue. Differences between emergency nurses and those working in 3 other specialty areas, that is, oncology, nephrology, and intensive care, on the subscales for compassion satisfaction, burnout, or compassion fatigue did not reach the level of statistical significance. However, the scores of emergency nurses evidenced a risk for less compassion satisfaction, while intensive care nurses demonstrated a higher risk for burnout and oncology nurses reflected a risk for higher compassion fatigue.Discussion: ED nurse managers, along with other nurse leaders, are faced with the competing demands of managing the satisfaction of patients, recruitment and retention of experienced nurses, and provision of quality and safe care customized to patients' needs and preferences. Understanding the concepts of compassion satisfaction, burnout, and compassion fatigue, recognizing the signs and symptoms, and identifying best practice interventions, will help nurses maintain caring attitudes with patients and contribute to patient satisfaction.

Treatment of Hemophilia with Inhibitors: An Advance in Options for Pediatric Patients - Corrected Proof

Joan McCarthy, Prasad Mathew — 2010-05-17

Hemophilia is a rare genetic (X-linked) bleeding disorder caused by lack of specific clotting factors in blood. It is estimated to affect around 18,000 persons in the United States. There are 2 forms: hemophilia A, caused by a deficiency in clotting factor VIII (FVIII), and hemophilia B, in which factor IX (FIX) is deficient. Most patients (around 90%) have hemophilia A, and 70% of these patients will have a severe form of the disorder (<1% of normal clotting factor levels). Patients with severe hemophilia may have frequent and spontaneous bleeding episodes in response to even minor trauma. Treatment is aimed at replacing the missing clotting factor with regular or as-needed infusions. Complicating the treatment of patients with congenital hemophilia A and B is the development of neutralizing alloantibodies (“inhibitors”) to FVIII and FIX, respectively. FVIII inhibitor development is estimated to occur in approximately 20% to 40% of patients with severe hemophilia A and 1% to 13% of patients with mild or moderate type A disease. Patients are at the highest risk for the development of alloantibody inhibitors during the first 50 to 100 days of exposure to therapeutically administered FVIII or factor FIX, so this period typically occurs during childhood; however, inhibitors can develop at any age, and a second peak period of risk occurs in patients aged in their 50s and 60s. Risk factors reflect a mix of patient- and treatment-related factors and include, but are not limited to, age at first treatment, hemophilia severity, the genetic mutation associated with hemophilia, black or Hispanic race, and a family history of inhibitors. Development of inhibitors makes management of bleeding episodes difficult, because regular factor infusions are not efficacious in treating or preventing a bleed. Bypassing agents are used to manage these patients. Two currently available bypassing agents are Factor Eight Inhibitor Bypassing Activity Anti-inhibitor Coagulant Complex (FEIBA; Baxter Healthcare, Deerfield, IL) and recombinant activated coagulation factor VII (NovoSeven; Novo Nordisk, Princeton, NJ).

Anxiety Levels and Related Symptoms in Emergency Nursing Personnel in Greece - Corrected Proof

2010-04-23

Introduction: Several studies provide evidence for the association between work stress and mild psychiatric morbidity among emergency nurses. These symptoms have not been explored in Greek nursing personnel employed in emergency departments. The aim of this descriptive correlational study was to investigate the presence of anxiety and stress symptoms among emergency nursing personnel in Greece.Methods: The sample was composed of nursing personnel employed in emergency departments of 8 adult General hospitals in Greece (N = 213). The Hamilton Anxiety Scale was applied for the quantitative assessment of anxiety symptoms, along with demographic, vocational, and educational data. Descriptive statistics were explored, and nonparametric comparisons, as well as correlational tests, were performed.Results: Anxiety levels were found to be mild (1.102 ± 0.53), with women (P = .021, Mann-Whitney U test) and nursing personnel employed in public sector hospitals (P = .029, Mann-Whitney U test) having higher anxiety level scores. In addition, a statistically significant mild correlation was observed between work experience in the emergency department and anxiety states (τ = 0.178, P = .011). The most commonly reported manifestations of mild psychiatric symptomatology were sleep disturbances (2.32 ± 1.2), anxious mood (1.57 ± 1.1), and depressed mood (2.38 ± 1.2), with 24.8% of the participants reporting very severe sleep disturbance, 23.9% reporting very severe depressive mood, and 10.7% reporting very severe anxious mood.Discussion: Hospital administrators need to be aware of the extent of workplace stress and subsequent anxiety symptoms that exist in emergency nurses. Staff counseling, continuing professional education, and empowerment strategies may need to be implemented to prevent psychiatric morbidity, as well as job dissatisfaction and resignations.

An Australian Audit of ED Pain Management Patterns - Corrected Proof

Margaret Fry, Scott Bennetts, Sue Huckson — 2010-04-19

Introduction: Timely and appropriate pain management is an important quality indicator of ED performance. Emergency health care workers are well positioned to become active leaders and innovatively responsive in reducing human suffering. A pain management audit was conducted to determine Australia practice patterns.Methods: A 12-month retrospective descriptive cohort audit was undertaken. Through the randomization process a medical record audit tool was completed for each record identified. Ethical approval for the study was obtained.Results: Seventy-four hospitals agreed to conduct the audit, 36 (48%) provided data. The total number of patient notes reviewed was 2,066. Ninety-five percent (1,966) of patients arrived by ambulance. Of the patients (n=547; 56.4%) with a documented triage pain score the majority arrived in severe pain (n=300; 41.3%). Of the total number of patients (1,966) documented arriving in pain 1,473 (74.9%) received an analgesic. Six hundred and forty-four (32.7%) patients received an opioid. From time of emergency department arrival, the median time for analgesic administration was 70 minutes (IQR 58 minutes to 92 minutes). Twenty-five emergency departments (69.4%) had pain management policies that enabled nurses to initiate a pharmacological analgesia without medical consultation.Discussion: The Australian pain management audit highlighted current practices and potential areas for further research. While the audit demonstrated that nurse initiated pain management interventions promoted better analgesic response, greater consistency of triage pain assessment, code allocation, and documentation of pain scores may go some way to improving the timeliness of analgesia.

A 3-year-old Trauma Patient With Progressive Paralysis - Corrected Proof

Christine M. Linder — 2010-04-14

A3-year-old boy was struck on the left side of his body by the front bumper of a slow-moving passenger vehicle. Upon arrival at the trauma center, the child was awake and crying, with a Glasgow Coma Scale score of 15. Initial inspection was negative for gross injuries. Peripheral sensation was intact, and the boy was moving all extremities. A secondary survey revealed no skull or scalp trauma, but he sustained abrasions and swelling on the left side of the face and an extensive left ear laceration. No deformities of the cervical spine were palpable, and the child's abdomen was soft, non-tender, and not bruised. The only other injuries noted were abrasions on the lower portion of the right leg, and the boy reported having pain in the right leg.

Palliative and End-of-Life Care in the Emergency Department: Guidelines for Nurses - Corrected Proof

Colleen K. Norton, Gwen Hobson, Elaine Kulm — 2010-04-12

An ambulance arrives at the emergency department with an unconscious, unresponsive 40-year-old man. After intubation and stabilization, an intracranial hemorrhage with a brain shift is found on a computed tomography scan of the head. The family, arriving shortly after the computed tomography scan is performed, states that the patient fell in the bathroom. They report that he has a history of end-stage multiple myeloma with metastasis, which he manages with daily doses of methadone for pain.The family is presented with the option of surgical intervention with the high risk of death as a result of hemorrhage or to provide comfort measures for the patient and allow death to occur. The family chooses to proceed with the surgery. Thirty-six hours later, in the intensive care unit, the patient dies without clinical improvement.

Effect of Education on a Chest Pain Mnemonic on Door-to-ECG Time - Corrected Proof

Nancy Ballard, Annette Bairan, Lorene Newberry, Lewis Van Brackle, Gwen Barnett — 2010-04-09

Introduction: Acute myocardial infarction (AMI) continues to contribute to both death and disability in both men and women. The first step in early intervention is an ECG. Atypically presenting patients, especially those who present by self-transport, are more likely to experience delays. The purpose of this study was to evaluate the effect of a new chest pain mnemonic (CPM) as a teaching tool for rapid recognition of AMI patients arriving by self-transport in ED triage in an effort to improve door-to-ECG (DTE) time.Methods: This study is a longitudinal, quasi-experimental quantitative study. Instruction and evaluation of nurses' knowledge related to identification of AMI before and after instruction on the CPM education (intervention) were coordinated by the emergency clinical nurse specialist. The study sample for the educational intervention included 26 nurses (15% of total population) from 4 emergency departments. Ad hoc queries of the National Registry for Myocardial Infarction database for patients arriving by self-transport to the emergency department were done to examine DTE before and after intervention. The pretests and post-tests of the nurses were analyzed with a paired t test, and the pre- and post-intervention DTE times were analyzed by log-linear modeling.Results: Evaluation of nurses' knowledge before and after CPM education indicated an improvement in DTE time, although it was not statistically significant. There was a significant improvement in DTE time for 2 hospitals that was somewhat negated in the aggregate data. There was a noted trend that showed an advantage in DTE time associated with male patients.Discussion: Inclusion of tools such as the CPM in education programs for emergency nurses improved rapid recognition of AMI patients presenting via self-transport to the emergency department. Attention to gender differences in patient presentation should be included in future CPM education, and tools to assist nurses in the early recognition of AMI need to be developed. Investigation regarding intra-hospital differences is warranted.

The Impact of Education on Provider Attitudes Toward Family-Witnessed Resuscitation - Corrected Proof

Lori M. Feagan, Nancy J. Fisher — 2010-04-08

Introduction: The majority of acute care facilities have not developed policies or guidelines to facilitate family presence during cardiopulmonary resuscitation. Prior studies have shown that the personal beliefs and attitudes of hospital personnel involved in resuscitation efforts are the primary reasons family presence is not offered.Methods: This 2-phase, before/after study was conducted in a 388-bed academic trauma center, and in a 143-bed community hospital in eastern Washington State in 2008. In phase I, a convenience sample of physicians and registered nurses from both facilities were surveyed about their opinions and beliefs regarding family-witnessed resuscitation (FWR). Spearman’s rho and independent t-tests were used to compare support of FWR between and within roles and practice location subgroups. In phase II of the study, clinician subgroups in the community hospital were re-surveyed following an educational program that used evidence-based information. Independent t-test and one-way ANOVA were used to compare pre and post-education mean scores of subgroups on indicators of effective teaching strategies and improved FWR support.Results: Opinions on FWR vary within and between practice roles and locations, with the strongest variable of support being prior experience with FWR. Following FWR education, mean scores improved for survey variables chosen as indicators of FWR support and teaching effectiveness.Discussion: When CPR providers are presented with FWR education, their opinion-based beliefs may be modified, decreasing barriers to family witnessed resuscitation and improving overall support of FWR as an extension of family-centered care.

A 26-year-old Woman With Sudden Onset Cerebral Edema - Corrected Proof

Colleen Claffey — 2010-04-07

A 26-year-old woman presented to the emergency department by ambulance at 2:30 in the morning. Upon returning home from a party that evening, family members noted that the patient was confused and intermittently unresponsive. A fellow party-goer had witnessed the woman dancing, drinking large quantities of water, and consuming what were assumed to be ecstasy tablets. Approximate time of ingestion was 10:30 pm. There was no history of alcohol or other illicit drug use.

Who Is Sleeping in Our Beds? Factors Predicting the ED Boarding of Admitted Patients for More Than 2 Hours - Corrected Proof

Marilyn J. Hodgins, Nicole Moore, Laura Legere — 2010-04-01

Introduction: Although the provision of inpatient care is not typically associated with emergency nursing, it is the new reality in many departments. Given the number of admitted patients boarded in the emergency department for part or all of their hospital stay, it is important to know who these patients are. The purpose of this analysis was to determine whether the occurrence of ED boarding could be predicted by factors specific to the type and timing of the ED visit or whether patient characteristics also affected these decisions.Methods: A retrospective review of administrative data for a 1-year period was conducted. Chi-square and logistic regression analyses were used to determine whether the likelihood of being boarded for more than 2 hours could be predicted by factors specific to the type of visit (ie, triage level and admission type) and timing of the visit (ie, time of day and day of week) or whether patient characteristics (ie, sex and age group) also played a role.Results: Slightly more than half of patients remained in the emergency department for more than 2 hours following receipt of an admission order. Results suggest the likelihood of boarding was highest for those who were medical admissions and admitted on a weekday or during the night shift. Even after accounting for these factors, patient characteristics improved the ability to predict ED boarding. Female patients and those 65 years of age or older were more likely to be boarded.Conclusions: Findings suggest that in addition to their usual responsibilities, emergency nurses are providing care to a group of inpatients who tend to have high medical and nursing care needs.

Evidence-Based Practice and Family Presence: Paving the Path for Bedside Nurse Scientists - Corrected Proof

2010-03-22

Evidence-based practice (EBP) has emerged as a call to action for health care systems to ensure best practice and optimize patient care and outcomes. In nursing EBP concepts are being readily integrated into bedside clinical practice through a variety of methods. In 2006 a team composed of a nurse research scientist, a clinical nurse specialist, and 2 nursing faculty members developed the Evidence Equals Excellence Program at Barnes-Jewish Hospital, St Louis, Missouri. This intensive 2-day workshop provided the attendees with training in the concepts of EBP and techniques for searching and critiquing the literature and implementing practice changes based on the findings. The goal for this team was to infuse the concepts of EBP into bedside clinical practice in each patient care division of the hospital.

Using a Single-item Rating Scale as a Psychiatric Behavioral Management Triage Tool in the Emergency Department - Corrected Proof

2010-03-11

Introduction: Proper monitoring of patients' behavior is essential for effective treatment and efficient disposition of psychiatric cases in the adult emergency department. The goal of the current study was to examine an attempt to implement the Behavioral Activity Rating Scale, an existing single-item measure of behavioral activity, as part of a behavioral management triage strategy for psychiatric patients in an emergency department.Methods: For the period beginning approximately 2 months after use of the behavioral activity measure was initiated in the emergency department, charts from 284 consecutive patients who presented to the department with a chief complaint that was psychiatric in nature were reviewed.Results: Level of adoption of the measure by emergency nurses was lower than desired; only 46% of charts reviewed contained a behavioral activity rating. Ratings were less likely to be recorded during the night shift than during other shifts. As predicted, ratings indicative of elevated behavioral activity were associated with physician orders for formal behavioral management (ie, intramuscular, intravenous, or orally dissolving sedating medications or physical restraint).Discussion: The findings of this study suggest that a single-item behavioral activity measure may be an efficient, effective, and discreet way for emergency nursing staff to communicate with one another and with physicians about psychiatric patients in need of behavioral management in adult emergency departments. The findings also suggest that a broad implementation approach is needed to achieve desired levels of adoption by emergency nursing staff.

Barriers to Screening and Intervention for ED Patients at Risk For Undiagnosed or Uncontrolled Hypertension - Corrected Proof

2010-03-08

Objectives: We describe clinician-reported knowledge of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure definitions of Stage I hypertension; perceived causes of elevated blood pressure; barriers to blood pressure re-assessment; risk of adverse events associated with the elevated blood pressure.Methods: Health care providers from five emergency departments completed a questionnaire assessing knowledge of blood pressure criteria for hypertension, perceived causes of elevated blood pressures, barriers to re-assessment, and perceived risk of an adverse event at one year in a patient within three defined systolic and diastolic blood pressure ranges. Descriptive statistics were used to analyze the data.Results: Seventy-two percent (379/524) of providers (68 attending physicians, 87 residents, 209 nurses, and 15 nurse practitioners) completed questionnaires. One hundred and four providers (27%) correctly listed the systolic and diastolic criteria for Stage 1 hypertension. Nurses and physicians rated uncontrolled, known hypertension [mean (standard deviation)] [8.7 (2.1), 8.9 (1.9)] the highest and pain [8.3 (2.3), 8.3 (2.1)] as the second highest cause of elevated BP. Nurses and physicians rated the lack of time to perform a reassessment [5.2 (3.4), 4.7 (2.8)] and a lack of adequate staffing [4.7 (3.4), 4.6 (2.9)] the highest as barriers to re-assessment. Nurses' mean adverse risk assessment twice that of physicians.Discussion: Twenty seven percent of providers were aware of the JNC7 criteria and often attributed elevated blood pressures to chronic, uncontrolled hypertension, pain or anxiety. No single barrier to repeating elevated blood pressures was identified.

“Stand Clear!” Tracing the Practice and Principles of Human Revival - Corrected Proof

Keith Stephens-Borg — 2010-03-08

In essence, people often stumble across discoveries of scientific significance during a caprice of Mother Nature, aided by our extraordinary drive forward in the quest for immortality. The moral fiber of human intuition impels us to preserve hopes and dreams by passing on the baton of knowledge gathered in our lifetime and by joining pieces of a jigsaw, assembling the means to continue our existence.

Family Presence During Resuscitation and/or Invasive Procedures in the Emergency Department: One Size Does Not Fit All - Corrected Proof

Renae L. Dougal, Jill H. Anderson, Kathy Reavy, Christine C. Shirazi — 2010-03-08

Family presence during resuscitation and/or invasive procedures is receiving more attention today because it speaks to the heart of patient- and family-centered care. Family members are the most important support for their loved ones during vulnerable times such as a life-threatening event. Although family presence during resuscitation and/or invasive procedures is becoming more accepted in hospital settings than in the past, only 5% of hospitals in the United States have unit policies guiding the practice of family presence in specialty settings. There is a need for family presence to be studied in non-academic hospitals and in other specialty settings such as emergency departments and adult intensive care units. These environments are unpredictable, and professionals have varying opinions regarding benefits of family presence during resuscitation and/or invasive procedures in adults. Currently, there is no hospital policy to guide practice of family presence at our 381-bed non-academic hospital in the Northwest. Acknowledging family presence as central to patient care inspired our Evidence-Based Practice (EBP) Committee to craft a hospital policy that provides guidance for the health care team in determining when it is appropriate to offer the option of family presence.

ED Services: The Impact of Caring Behaviors on Patient Loyalty - Corrected Proof

2010-02-24

Introduction: This article describes an observational study of caring behaviors in the emergency departments of 4 Ascension Health hospitals and the impact of these behaviors on patient loyalty to the associated hospital. These hospitals were diverse in size and geography, representing 3 large urban community hospitals in metropolitan areas and 1 in a midsized city.Methods: Research assistants from Purdue University (West Lafayette, IN) conducted observations at the first study site and validated survey instruments. The Purdue research assistants trained contracted observers at the subsequent study sites. The research assistants conducted observational studies of caregivers in the emergency departments at 4 study sites using convenience sampling of patients. Caring behaviors were rated from 0 (did not occur) to 5 (high intensity). The observation included additional information, for example, caregiver roles, timing, and type of visit. Observed and unobserved patients completed exit surveys that recorded patient responses to the likelihood-to-recommend (loyalty) questions, patient perceptions of care, and demographic information.Results: Common themes across all study sites emerged, including (1) the area that patients considered most important to an ED experience (prompt attention to their needs upon arrival to the emergency department); (2) the area that patients rated as least positive in their actual ED experience (prompt attention to their needs upon arrival to the emergency department); (3) caring behaviors that significantly affected patient loyalty (eg, making sure that the patient is aware of care-related details, working with a caring touch, and making the treatment procedure clearly understood by the patient); and (4) the impact of wait time to see a caregiver on patient loyalty. A number of correlations between caring behaviors and patient loyalty were statistically significant (P < .05) at all sites.Discussion: The study results raised considerations for ED caregivers, particularly with regard to those caring behaviors that are most closely linked to patient loyalty but that occurred least frequently. The study showed through factor analysis that some caring behaviors tended to occur together, suggesting an underlying, unifying dimension to that factor.

Interruptions Experienced by Registered Nurses Working in the Emergency Department - Corrected Proof

Lisa Kosits, Katherine Jones — 2010-02-22

Introduction: A descriptive, observational study was performed to determine (a) the frequency (number of interruptions per hour) that a typical ED nurse experiences interruptions, (b) the type of interruptions a typical ED nurse experiences, and (c) the percentage of interruptions that take place during medication related activities.Methods: A convenience sample of 30 nurses from 3 emergency departments of a major metropolitan academic medical center were each observed for 120 minutes to determine how many interruptions per hour the ED nurse experienced, the type of interruptions and what percentage of these interruptions took place during medication-related activities. A data collection tool was developed to record tasks performed by the nurses and the type of interruptions experienced. Interrater reliability was established with a Kappa of 0.825.Results: A total of 200 interruptions occurred during the 60 hours of observation, or 3.3 interruptions per hour per RN. Of the 20 possible types of interruptions that were identified a prior to the observation period, 11 different types of interruptions were actually observed. The majority of interruptions (95%) were related to face-to-face communications with others in the ED. The total number of interruptions related to medication activities was 55 (27.5% of the total number of interruptions).Discussion: The results of this study can serve as the basis for subsequent, larger studies that examine more closely the relationship between interruptions and errors in the ED, with the ultimate goal of developing interventions to reduce medication errors and other adverse events that occur due to nurse interruptions.

A Study of the Workforce in Emergency Medicine: 2007 Research Summary - Corrected Proof

Vicki C. Patrick, JoAnn Lazarus — 2010-02-17

Introduction: This paper summarizes nurse-specific elements reported in a study of the emergency medicine workforce in 2007.Methods: In 2008, surveys were distributed to over 2600 emergency department (ED) medical directors and nurse managers in the United States.Results: The response rate was 21% from nurse managers. Registered nurses (RN) in staff positions are 37.9 years of age. The most common highest level of education is and associate degree (46%). The predominant workforce is RNs with a fixed assignment to the emergency department. Geographic relocation (46%) was the most common reason cited for resignations. Nurse practitioner positions continue to increase.Emergency department volumes continue to increase. Study respondents reported the largest increase in urgent care/fast track service areas. Throughput time from registration to discharge was reported as 158 minutes. Boarding patients in the emergency department is a common practice, and nurse managers reported boarding as an issue that impacts quality care 67% of the time.Conclusion: Emergency department volumes continue to increase significantly. Innovative nurse staffing and retention programs are required to meet future challenges of emergency patient care.

Assessing Emergency Nurses' Geriatric Knowledge and Perceptions of Their Geriatric Care - Corrected Proof

Courtney Roethler, Toby Adelman, Virgil Parsons — 2010-02-08

Introduction: Persons aged 65 years or older have up to a 45% increased functional dependence and a 10% mortality rate within the first 3 months after being discharged from the emergency department. It has been demonstrated that when elderly individuals are cared for by nurses with specialized training in geriatrics, their outcomes improve. However, few registered nurses have this specialized training. This study was designed to conduct a needs assessment of an emergency department concerning registered nurses' knowledge and self-assessment of geriatric emergency care.Methods: A quantitative, descriptive study utilizing a survey tool was conducted at a large, acute-care teaching hospital in northern California during a 2-week period. The questionnaire consisted of 2 separate sections, a knowledge section with 15 questions and 16 self-evaluated practice assessment questions utilizing a Likert scale.Results: Thirty-two emergency nurses participated in the study. The knowledge section scores ranged from 4 to 12. The mean score was 8.53 (SD ± 1.866). More than 80% of the participants rate themselves as either “very good” or “good” in the self-assessment section in 13 of the 16 categories. No participants rated themselves as “very poor” in any category.Discussion: The high ratings in the self-assessment section demonstrate a perception among the sample of being very capable in geriatric care. In contrast, the knowledge section revealed low scores throughout. This study revealed a clear lack of consistency between the nurses' knowledge about geriatric care and their perception of their ability to provide this care.