Journal of Trauma Nursing最新文献

Injury is the leading cause of death and a frequent 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 or region encompassing the entire continuum of care, regardless of where children live or where traumatic events occur. This continuum includes injury prevention, prehospital care, emergency department care, interfacility transport, acute and critical inpatient care, inpatient and outpatient rehabilitation, and reintegration into the community and primary care medical home. A systems-based approach requires distinct elements of structure and function to perform together in an interrelated and cohesive manner to improve care quality. In this case, it represents a sequential practice of evidence-based evaluation and management along the continuum of care. 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.

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: Failure to rescue (FTR), defined as mortality following major complications, has become a critical quality metric across medical specialties.

Objective: This study aimed to evaluate temporal trends, predictors, and disparities in FTR among geriatric trauma patients using a national trauma database.

Methods: A retrospective cohort study was conducted using the American College of Surgeons Trauma Quality Improvement Program dataset (2017-2021). Patients aged 65 years and older with major complications were included. FTR was defined as in-hospital mortality following complications. Demographic and clinical variables, including Injury Severity Score (ISS), Modified Frailty Index (mFI), and insurance status, were analyzed. Trauma center level and temporal trends in FTR rates were also assessed.

Results: Among 13,744 patients with major complications, the overall FTR rate was 44.5%, with rates increasing annually from 41.8% in 2017 to 47.2% in 2021 ( p < .001). Older age, higher ISS, and treatment at Level II and III trauma centers were significant predictors of FTR. Disparities in FTR were observed, with Asian, Black, and Hispanic patients demonstrating higher odds of FTR compared to their respective counterparts, as well as patients covered by public insurance (Medicaid and Medicare). mFI was not significantly associated with FTR.

Conclusion: Findings showed a significant increase in FTR rates over time among geriatric trauma patients, with findings highlighting disparities such as race and insurance status associated with FTR, as well as predictors such as age, injury severity, and trauma verification level. Increasing access to high-level trauma centers, enhancing resource allocation, and refining care protocols are critical to mitigating FTR risk in this vulnerable population.

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.