Journal of Trauma Nursing最新文献

Injury is the leading cause of death and a cause of disability in children and negatively affects physical health, mental health, and quality of life in both the short- and long-term. The goal of a pediatric trauma system is to optimize the care for children within a state, regional, or national trauma system across the entire continuum of care, regardless of where they live or where the traumatic event occurs. This continuum includes injury prevention, prehospital care, interfacility transport between hospitals providing different levels of care, acute and critical inpatient care, inpatient and outpatient rehabilitation, and reintegration into the community and primary care medical home. A systems-based approach, one that requires distinct elements of structure and function to perform together in an interrelated and cohesive manner to improve care quality, is essential. To improve outcomes after injury, a cohesive system must effectively provide optimal care for the "right child, at the right place, at the right time" across this continuum.

Background: As the aging population grows, individuals with cognitive impairment face increased challenges and a higher risk of poor outcomes. Although unpaid caregivers provide most of their care and help navigate hospitalizations and surgeries, their experiences in perioperative settings remain poorly understood.

Objective: This study explores the experiences of unpaid caregivers of individuals with memory impairment in the perioperative period.

Methods: This study used a qualitative descriptive approach to explore caregivers' experiences with perioperative care for individuals with cognitive impairment. Semi-structured interviews were conducted with purposefully sampled unpaid caregivers of individuals who had undergone a surgery within the past 6 months at a Southeastern U.S. trauma center (February-April 2021). Conventional content analysis was used to code transcripts and identify themes.

Results: Eight caregivers participated in semi-structured interviews. Caregivers reported being unprepared for postoperative complications, including delirium, cognitive changes, and functional decline. Communication deficits were prominent, with caregivers receiving inadequate information about surgical outcomes and postoperative expectations. Staff demonstrated knowledge gaps regarding dementia care, and 1 instance of verbal abuse toward a patient was reported. Five themes emerged: care recipients' perioperative experiences, caregivers' experiences, healthcare strengths and deficiencies, and improvement recommendations.

Conclusion: Caregivers of persons with cognitive impairment face significant challenges during the perioperative period, often unprepared for postoperative complications and lacking adequate communication from healthcare teams. Findings suggest targeted interventions, including preoperative caregiver education about delirium, enhanced communication protocols, and comprehensive hospital staff training on dementia care, could improve outcomes for this growing population requiring surgical intervention.

Background: Vicarious trauma results from repeated exposure to the emotional or physical suffering of others and is considered an occupational hazard for those in caring professions. It can negatively impact clinicians' personal and professional lives and the quality of patient care. However, research specifically examining vicarious trauma among trauma clinicians remains limited.

Objective: This study aims to examine vicarious trauma experienced by trauma clinicians providing direct care to trauma patients.

Methods: This is an explanatory sequential mixed-methods study involving trauma clinicians over a period of 5 months (May-October 2024) at a Level I trauma center in West Virginia. Quantitative data were collected through an electronic survey using Vicarious Trauma Scale items, followed by qualitative data from individual interviews.

Results: A total of 76 clinicians completed the survey, with nurses comprising the majority of participants, followed by attending physicians, resident physicians, and nurse practitioners. On average, trauma clinicians reported strong agreement with "exposure to distressing materials and experiences" [6.38 (1.08)] and "exposure to traumatized or distressed clients" [6.70 (0.78)]. Vicarious trauma appeared more pronounced among nurses compared to other clinical roles. Awareness and utilization of organizational well-being interventions were limited due to the added burden of responsibilities and fear of judgment.

Conclusion: Vicarious trauma was found to be evident among trauma clinicians, which could be consequential both professionally and personally. Health care organizations and trauma leadership need to consider the risk of vicarious trauma among trauma clinicians and proactively safeguard clinicians to mitigate its impact.

Background: Trauma is a leading cause of death and a significant financial burden, requiring highly skilled and confident nursing care to improve patient outcomes. Despite the increasing adoption of simulation for trauma training, evidence of its effectiveness in building comprehensive interdisciplinary trauma skills remains limited.

Objective: To synthesize current evidence on the effectiveness of trauma simulation in enhancing both technical and non-technical skills in interdisciplinary trauma teams.

Data sources: Source data were obtained from CINAHL, MEDLINE, the Cochrane Library, and Google Scholar literature review.

Study selection: Inclusion criteria included all study types from January 2018 to September 2023 addressing the use of trauma simulation, trauma simulation in nursing education, trauma training, interdisciplinary trauma teams, and high-fidelity trauma simulation, regardless of methodology. Exclusion criteria included those articles that were not related to the impact of trauma simulations, training, or education on technical or non-technical skills. The search strategy was last executed on December 10, 2023.

Data extraction: A total of 27 articles met the inclusion criteria.

Data synthesis: Four themes emerged from the data synthesis, including teamwork, non-technical skills, technical skills, and task completion.

Conclusion: The available evidence supports trauma simulation as an educational tool in improving teamwork, non-technical, and technical skills during trauma resuscitations, though more data is needed to determine its effect on patient outcomes.

Background: Proper triage and transport to trauma centers improve outcomes for severe trauma patients. However, little is known regarding these processes across Latin American healthcare systems, limiting regional improvement efforts.

Objective: This study aims to evaluate the association of prehospital care level and triage accuracy with hospital outcomes in trauma patients in Latin America.

Methods: This prospective cohort study was conducted in 14 hospitals across Argentina, Brazil, and Colombia. Inclusion criteria were adult trauma patients aged ≥18 years admitted directly from the scene of injury. Data collection occurred over 30 consecutive days at each hospital between 2019 and 2021. Predictor variables included the level of prehospital care (none, basic, or intermediate/advanced) and triage accuracy (correct, undertriage, or overtriage). The primary outcomes were hospital length of stay and mortality. Associations were analyzed using linear regression for hospital stay and logistic regression for mortality.

Results: A total of 1,193 trauma patients were included (62.4% male, mean age 43.5 years. Motor vehicle crashes (43.3%) and falls (36.1%) were the leading causes of injury. Emergency medical services assisted 58.7% of patients, mainly at a basic level ( n = 530). Overtriage occurred in 50.0%. Intermediate/advanced prehospital care was associated with longer hospital stays (β3.64, 95% CI [1.39, 5.89], p = .002). Neither prehospital care level nor triage accuracy was associated with hospital mortality ( p ≥.050).

Conclusions: In our study of 14 hospitals across Argentina, Brazil, and Colombia, intermediate/advanced prehospital care was associated with longer hospital stays. Neither prehospital care level nor triage categorization was associated with hospital mortality.

Objective: This systematic review aims to evaluate optimal early screening strategies, significant risk factors, and effective diagnostic and management approaches for delirium in critically ill geriatric surgical patients.

Data sources: A comprehensive search was conducted across five databases: PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

Study selection: Studies were included based on their relevance to early screening, risk factors, diagnostic accuracy, and management strategies for delirium in critically ill geriatric surgical patients. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Data extraction: A total of 31 studies met the inclusion criteria. Outcomes of interest included effective early screening/prevention strategies, significant risk factors, sensitive diagnosis tools, and effective management strategies.

Data synthesis: Early screening strategies, including advanced neural networks and E-PROD-NS, demonstrated high sensitivity and specificity (area under the receiver operating characteristic curve >0.76). Key risk factors included advanced age, renal dysfunction, cognitive impairment, prolonged intensive care unit length of stay (ICU-LOS), and mechanical ventilation time. Diagnostic tools such as the 4A's test and serum biomarkers exhibited superior accuracy compared to the ICU Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Management strategies effectively reduced delirium duration, including acetaminophen, environmental modifications, and family involvement.

Conclusions: E-PROD-NS and the 4A's test were associated with early delirium detection and intervention. Risk factors for delirium included advanced age, renal dysfunction, and existing cognitive dysfunction. Mitigating mechanical ventilation and ICU-LOS duration, treatment with acetaminophen, and environmental modifications reduced delirium duration in critically ill geriatric surgical patients.

Registration: PROSPERO #CRD42025632279.

Background: Trauma nursing is fast-paced and high-pressure work that can affect nurses' physical and mental health. However, these effects remain unexplored among novice trauma nurses in a newly established trauma center in India.

Objective: To examine relationships between professional quality of life, sleep disturbances, anxiety, and resilience and to explore the experiences of novice trauma nurses in a newly established trauma center in India.

Methods: This sequential mixed-methods study was conducted between April and June 2024 in a newly established trauma center in India. A purposive sample of 80 nurses was surveyed using a demographic questionnaire, the Brief Resilience Scale, the Generalized Anxiety Disorder Scale, the Insomnia Severity Index, and the Professional Quality of Life Scale. Nine nurses were interviewed to explore their trauma experiences. The analysis included descriptive and inferential statistics, bootstrap-based mediation testing, and thematic content analysis.

Results: A total of 80 nurses completed the survey (response rate: 67.8%) with a mean age of 27.7 years (standard deviation [SD] = 2.89) and average years of trauma experience of 2.08 years (SD = 1.93). Higher compassion satisfaction correlated with fewer sleep disturbances (r = -.23, p = .037). Burnout positively correlated with anxiety (r = .24, p = .033) and sleep disturbances (r = .34, p = .023), and negatively with nurses' resilience (r = -.12, p = .049). Professional quality of life significantly correlated with resilience (r = .18, p = .048). Resilience mediated the relationship between anxiety and both burnout (β = .24, bootstrap confidence interval [BCI] = 0.04, 0.46, p = .041) and secondary traumatic stress (β = .24, BCI = 0.03, 0.52, p = .029). Qualitative analysis revealed three major themes: personal and professional adaptation to trauma life, adverse physical and psychological issues, and challenges faced in trauma care.

Conclusion: Our findings highlight the adverse impact of trauma nursing on sleep, resilience, anxiety, and professional quality of life among novice nurses in a newly established Level I trauma center in India. Targeted interventions are required to enhance resilience and mitigate the impact of caring for trauma patients.

Objective: This study aims to evaluate fluid resuscitation strategies including volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

Data sources: A comprehensive search was conducted across five databases including PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

Study selection: Studies were included based on their relevance to volume assessment measures, conservative versus aggressive fluid resuscitation, and multifocal fluid resuscitation protocols in critically ill geriatric trauma patients.

Data extraction: A total of 14 studies met the inclusion criteria. Outcomes of interest included mortality, intensive care unit length of stay, ventilator days, and in-hospital complications.

Data synthesis: The initial query identified 1,257 studies, and after inclusion/exclusion criteria, a total of 14 studies were evaluated. On average, serum lactate levels above 2.5 mmol/L were found to be significantly associated with mortality. Conservative approaches to fluid resuscitation that were on average <1,500 cc were also found to decrease mortality and incur no increase in in-hospital complications. Additionally, goal-oriented geriatric fluid resuscitation protocols utilizing multiple measures for hemodynamic stability were found to reduce mortality in patients following the implementation of the protocol.

Conclusion: Serum lactate level kept on average below 2.5 mmol/L has shown to be an effective volume assessment measure and associated with decreased mortality. Additionally, conservative fluid resuscitation with volume maintained on average <15,000 cc was also associated with decreased mortality compared to aggressive fluid resuscitation measures. Lastly, goal-oriented geriatric fluid resuscitation protocols that aimed to maintain multiple volume assessment measures were associated with decreased mortality and complication rates. Implementation of these protocols has the potential to significantly improve outcomes in this vulnerable population.