Journal of Trauma Nursing最新文献

Background: Acute care hospitalization has been associated with older adult home falls after discharge, but less is known about the effects of hospital- and patient-related factors on home fall risk.

Objectives: This study compares the effects of hospital length of stay, medical condition, history of falls, and home health care on period rates of home falls after discharge from acute care hospitalization.

Methods: This was a retrospective cohort study comparing period rates of home injury falls among older adults (age ≥ 65) occurring after discharge from an acute care hospitalization. Data were collected from state health care utilization administrative records between January 1, 2016, and December 31, 2018. We used log-linear Poisson regression to model post-discharge injury fall incidence rates as a function of days since discharge and patient-level covariates.

Results: A total of 736,230 older adults were included in the study cohort. Absolute risk for post-discharge home falls was 7%. Fall rates were highest the first week after discharge at 0.05 per 100 person-days, with a period incidence rate 74.29 times higher than the >90-day discharge period. Fall risk increased with age, with the highest risk in the ≥85 age group. Fall risk increased for a 2-day hospital stay but decreased for 5- to 30-day stays, compared to a 1-day length of stay. Discharge to home health care and history of falls were associated with increased risk.

Conclusions: Older adults are at highest risk for a home fall the first 7 days after discharge from acute care hospitalization. These findings describe patient-related risk factors that acute care hospitals can use to develop geriatric-specific discharge guidelines intended to reduce home fall risk during the early care transition to home.

Background: The psychological resilience of patients with traumatic lower extremity fractures is relevant and has been studied in the postoperative rehabilitation phase; yet, few studies have focused on the early preoperative phase.

Objective: This study aims to explore preoperative psychological resilience in patients with traumatic lower extremity fractures.

Methods: This single-center cross-sectional survey design study was conducted over 5 months from December 2022 to April 2023 in a tertiary hospital in Shanghai, China. We used a convenience sampling method to assess psychological resilience in traumatic lower extremity fracture patients electronically. We administered the online surveys using the Questionnaire Star applet prior to surgery using the following tools: (a) general information questionnaire, (b) Numerical Rating Scale, (c) Connor-Davidson Resilience Scale, and (d) General Self-Efficacy Scale.

Results: A total of N = 175 patients were studied, of which n = 166 patients fully completed the survey for a response rate of 95%. Patients with traumatic lower extremity fractures demonstrated a low degree of psychological resilience preoperatively (M = 49.28, SD = 13.64). Patients' psychological resilience and self-efficacy showed a significant positive correlation (r = .577). Factors associated with patients' psychological resilience in multivariate linear analyses included level of education, medical insurance, and self-efficacy (p < .05).

Conclusion: We found that preoperative psychological resilience in patients with traumatic lower-extremity fractures is poor and influenced by various factors; thus, future efforts should focus on providing timely, targeted interventions.

Background: Spinal immobilization, a widely used trauma prehospital intervention, is known to cause discomfort, yet little is known about interventions to reduce this discomfort.

Objective: This scoping review aims to evaluate prehospital interventions to reduce discomfort from spinal immobilization in adult trauma patients.

Method: This scoping review assessed prehospital pharmacological and nonpharmacological interventions to address discomfort from spinal immobilization in adult trauma patients. We searched sources published in English, French, Spanish, and Portuguese without time restrictions. Two reviewers independently screened sources against the inclusion criteria and extracted data using a specified extraction instrument. The databases MEDLINE, CINAHL, Scopus, Embase, APA PsycINFO, International Paramedic Practice, Amber: the Home of Ambulance Service Research, JBI Evidence Synthesis, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, RCAAP, and CAPES Thesis Bank were used.

Results: Two articles were deemed eligible, identifying two interventions. One focused on the choice of immobilization device, while the other addressed the hemodynamic implications of immobilization discomfort, considering factors such as oxygen saturation, blood pressure, and pulse.

Conclusions: Only two interventions were found, and both only indirectly addressed spinal immobilization discomfort. More well-designed research is needed to address patient-centered concerns regarding the discomfort from spinal immobilization in trauma care.

Background: Patient transitions in critical care require coordination across provider roles and rely on the quality of providers' actions to ensure safety. Studying the behavior of providers who transition patients in critical care may guide future interventions that ultimately improve patient safety in this setting.

Objective: To establish the feasibility of using the Theory of Planned Behavior in a trauma environment and to describe provider behavior elements during trauma patient transfers (de-escalations) to non-critical care units.

Methods: This cross-sectional study surveyed a convenience sample of 103 multidisciplinary providers who do the cognitive and physical work of transitioning trauma patients from critical care to another non-critical care unit at a U.S. Level I trauma center. Descriptive methods for survey development, analysis, and administration were evaluated.

Results: A total of 72 respondents completed the survey; they included registered nurses, nurse practitioners, and medical doctors, demonstrating a 70% response rate. Statistically significant differences among ICU roles were observed in perceived control (Eta-squared = 0.09, p = .001) and in several anchors in the attitude, subjective norms, and behavioral intent theoretical domains (Cohen's d ranging from 0.36 to 2.03, p < .05).

Conclusions: This study demonstrated variability in theory domains, signaling an opportunity to study a representative sample. It can serve as a blueprint for future behavioral studies designed to examine the Theory of Planned Behavior elements in trauma critical care providers.

Background: Trauma population health indicators are worsening in the United States. Nurses working in trauma care settings require specialized training for patient care. Little is known about national enumeration of nurses who hold skill-based trauma certificates.

Objective: The purpose of this project was to estimate (1) skill-based certificate status among U.S. nurses who primarily work with emergency or trauma patients, (2) demographic and work characteristic differences between those who report skill-based trauma certificates and those who do not, and (3) continuing education learning needs among nurses who hold skill-based trauma certificates.

Methods: This was an applied epidemiologic analysis of the 2022 National Sample Survey of Registered Nurses.

Results: The weighted analysis of 239,893 emergency nurses indicated 57% held skill-based trauma certificates with disparities by rural practice, racial identity, age, and marital status. Among those who held skill-based trauma certificates, the greatest need for continuing education was on topics of mental health, quality improvement, and substance use disorders. Approximately 87% of emergency nurses with trauma skill-based certificates only spoke English fluently.

Conclusions: Population health management interventions are needed to enhance workforce equity and continuing education opportunities for trauma nurses. Professional nursing organizations, emergency nursing employers, and academic settings should offer continuing education in mental health and quality improvement. These findings also support the need for ongoing activities to enhance language accessibility for non-English speaking patients in the trauma care system.

Background: Traditional nursing care often fails to meet the complex needs of hypertensive cerebral hemorrhage patients. Limited evidence exists on the efficacy of structured nursing frameworks such as the Omaha System in postoperative care for these patients.

Objective: This study aims to evaluate the efficacy of Omaha-based extended nursing care in improving patients' outcomes.

Methods: This randomized controlled trial included 53 patients with hypertensive cerebral hemorrhage admitted to the neurosurgical department of a large tertiary hospital in Chengdu, China, from March to September 2023. Participants were randomly assigned to either the traditional nursing care (n = 26) or the Omaha-based nursing care in addition to the traditional nursing care (n = 27). Outcomes included self-health management abilities, anxiety and depression levels, quality-of-life, and functional independence. Data were collected before nursing care and 1- and 3-months post-nursing care.

Results: Omaha-based nursing care demonstrated improvements in self-health management abilities, with cognition scores increasing from a baseline of 31.65 (4.37) to 57.32 (5.11) at 3-months (mean difference: 25.67, 95%CI [23.45, 27.89], p = .01). Anxiety levels decreased in the Omaha-based nursing group, with SAS scores reducing from 45.71 (3.48) to 28.26 (2.74) at 3-months (mean difference: -17.45, 95% CI [-19.02, -15.88], p < .01). Quality-of-life scores improved in the Omaha-based nursing group, increasing from 6.3 (1.2) to 7.9 (0.9) at 3-months (mean difference: 1.6, 95% CI [1.12, 2.08], p = .03). Functional independence scores were also higher in the Omaha-based nursing group at 3-months (mean difference: 9.2, 95% CI [6.11, 12.29], p = .03).

Conclusion: Our findings support the integration of the Omaha System into postoperative care protocols for this patient population. However, further validation is warranted by larger trials.