Journal of Trauma Nursing最新文献

Background: Ultrasound-guided fluid management is increasingly used in the intensive care unit, yet it's benefits in septic shock remains unknown.

Objective: To evaluate the use of critical care ultrasound for individualized volume management in septic shock patients.

Methods: A single-center, randomized controlled, prospective study was conducted on patients with septic shock admitted to the intensive care unit in Xi'an Daxing Hospital, Xi'an City, China, from September 2022 to December 2023. Upon intensive care unit admission, the patients were resuscitated according to the latest sepsis and septic shock guidelines and early goal-directed therapy. The study group additionally underwent critical care ultrasound examination to monitor and guide the adjustment of fluid resuscitation in real-time. The two groups' physiological and biochemical indexes and prognoses were compared before (T0) and 6 hours after (T6) fluid resuscitation.

Results: A total of 113 patients with septic shock were selected and randomly allocated into study (n = 57) and control (n = 56) groups. The central venous oxygen saturation, heart rate, mean arterial pressure, blood lactate, and lactate clearance rate of the two groups at T6 were significantly improved compared to T0 (P < .05). At T6, the study group's blood lactate was significantly lower and the lactate clearance was significantly higher than the control group (P < .05). At T6, the incidence of pulmonary edema, incidence of left heart failure, Sequential Organ Failure Assessment (SOFA) score and length of the intensive care unit hospitalization in the study group were significantly lower than the control group (P < .05).

Conclusion: The application of critical care ultrasound improved the outcome and helped guide individualized management of patients with septic shock.

Background: Survivors of interpersonal violence have specific, unique, and complex psychosocial and forensic needs, yet nurses often lack adequate training in providing comprehensive care to this vulnerable population.

Objective: This study aims to explore emergency department nurses' experience caring for survivors of interpersonal violence to revise an interpersonal violence training module and then evaluate nurses' knowledge of pretraining and posttraining implementation.

Methods: This two-phase mixed-methods study was conducted with nurses from 4 emergency departments in a U.S.-Mexico border region from February to May 2023. Phase one comprised semi-structured interviews with emergency department nurses about their experiences caring for interpersonal violence survivors. Phase two integrated this feedback with sexual assault nurse examiner best practices to revise the forensic evidence collection training program. Nurses' knowledge was then assessed pretraining and posttraining.

Results: Six experienced nurses completed interviews, identifying key themes in survivor care. Subsequently, 65 nurses participated in the revised training program across two cohorts. Knowledge scores improved significantly in both groups: Cohort 1 increased from 39.6% to 80.0% (SD = 13.87), and Cohort 2 from 49.5% to 82.1% (SD = 16.47).

Conclusion: Integrating nurse feedback into forensic evidence collection training significantly improved participant knowledge of interpersonal violence survivor care and evidence collection practices.

Background: Motor vehicle crashes are a leading cause of preventable death in the United States, but properly used child safety seats significantly reduce the risk of injury and mortality. In-person car safety seat installation programs were suspended during the COVID-19 pandemic, prompting the development of virtual alternatives. However, the effectiveness of these virtual installation programs remains unknown.

Objective: The study aims to evaluate the effectiveness of a virtual car seat installation and safety check program on parental satisfaction, perceived value, confidence, and correct child safety seat installation.

Methods: This single-center retrospective cohort study was conducted over 2 years (2020-2022) at a Level I pediatric trauma center in the Northeastern United States for parents participating in child safety seat programs. The pilot study evaluated the effectiveness of virtual car seat installation and safety checks on parental self-reported satisfaction, perceived value, and confidence levels before and after the intervention.

Results: A total of n = 375 study participants received the intervention and follow-up surveys, with n = 129 respondents completing the survey for a 34% response rate. The study included child safety seats from 18 manufacturers and vehicles representing 25 brands. Before the intervention, 57% of parents reported the inability to install their child's safety seat safely. Following intervention, 100% of parents achieved proper car seat installation (p < .0001).

Conclusion: We found that offering a virtual car seat installation and verification program is a viable option when in-person options are not feasible.

Background: Interpersonal violence occurs frequently and has devastating effects on the health of Hispanic trauma survivors. However, the incidence and risk factors associated with interpersonal violence remain understudied in U.S.-Mexico border communities.

Objective: This study aims to identify the incidence and factors associated with interpersonal violence in trauma patients in a U.S.-Mexico border city.

Methods: A single-center, retrospective cohort study design was used to explore interpersonal violence in patient records from the sexual assault nurse examiner trauma registry in a Southwestern Level I trauma center from 2017 to 2022. Inclusion criteria included all interpersonal violence trauma survivors seen by the sexual assault nurse examiner department. Exclusion criteria included specific data points in the trauma registry, such as types of injury, zip code of interpersonal violence survivor residency, and outreach services that could reidentify trauma survivors. Variables of interest included survivor and interpersonal violence incident characteristics.

Results: Of the total N = 1,249 patients studied, the mean age was 23; 86% (N = 1,077) were female, and 69.7% (N = 870) were Hispanic/Latino/Spanish. Interpersonal violence events were more likely to occur in May, June, and October, on the weekends, and between 12 a.m. and 6 a.m. Significant associations were noted between age and gender, race and ethnicity, hearing status, and disability.

Conclusion: This study demonstrates the importance of assessing regional patterns of interpersonal violence to identify local population trends that can inform staff training and community outreach efforts for targeted interpersonal violence prevention.

Background: Cervical spine clearance of pediatric trauma patients requires consistent, clear documentation for multidisciplinary trauma team members to provide safe care. Yet, cervical spine clearance often remains inconsistently and inappropriately documented.

Objective: This study evaluated the effects of a cervical spine clearance documentation initiative on documentation adherence rates.

Methods: This quality improvement study used a Plan-Do-Study-Act with iterative cycles and prospective data collection conducted from May 2022 to September 2023 in a large urban freestanding, Midwestern, U.S. Level I pediatric trauma center. The inclusion criteria were pediatric trauma patients aged 0-18 years with Glasgow Coma Scale scores ≥14 at clearance who required cervical collar placement. The multicomponent intervention comprised a standardized electronic note, enhanced multidisciplinary education, updated clinical guidelines, and weekly chart reviews with Pareto analysis. Outcome measures were adherence rates with a goal set at greater than 80% compliance.

Results: A total of 550 patients were included in the study time period. The cervical spine documentation rate improved from a baseline pre-implementation rate of 10% to a post-implementation rate of 85% and has been sustained for the past 13.5 months.

Conclusions: Implementing a standardized cervical spine clearance note increased the percentage of appropriate documentation, reducing the uncertainty regarding safe collar removal.