Journal of Trauma Nursing最新文献

Background: There are 3 pillars upon which the foundation of a teaching program in health care is founded: research, education, and clinical care. However, in a busy academic trauma practice, the unfortunate reality is that research is often a low priority in the frenzy of mandates for clinical productivity.

Objective: The purpose of this report is to advise hospitals on how to create a modest trauma research program that supports research interests without significantly impacting the overall clinical productivity of the department.

Methods: Relevant literature related to the development of an academic trauma research department was reviewed. Relevant articles were then compared to this manuscript to assess the novelty of the topic.

Results: There are 4 essential components of a trauma research program: (1) a zealot, (2) institutional commitment and support, (3) a statistician, and (4) registry data access.

Conclusion: The creation of a trauma research program may seem like a herculean effort, but this work is necessary for institutions hoping to achieve status as a Level I/II trauma center. Following the steps outlined in this report, trauma providers can create a robust research program at their institution without sacrificing clinical productivity.

Background: Timely angiographic embolization of abdominopelvic injuries is a hallmark of a high-functioning trauma center. Yet, the process depends on the timely mobilization of interventional radiology staff. Smartphone technology to notify and mobilize staff may be a viable option.

Objective: To describe the incorporation of a smartphone application into our trauma workflow process previously developed for stroke care.

Methods: In 2022, our Level I trauma center implemented a smartphone application with three simultaneously occurring functions: (a) high-definition image viewing on the phone; (b) text messaging thread for all parties; and (c) a single-call activation system for staff mobilization. The application was initially developed to notify interventional radiologists of large-vessel occlusions in victims of stroke and, at our request, was modified to fit our trauma workflow process. The smartphone application company developed a new program, installed the application on trauma service smartphones, and provided educational in-services over a 1-month period. The application was then integrated into our trauma workflow process.

Results: The trauma surgeon and the interventional radiologist can now simultaneously view high-definition images on their smartphones. Text messages are accessible to all team members. The staff is notified and mobilized with the singlecall smartphone application, preventing the placing and returning of phone calls.

Conclusion: Smartphone technology enhances timely interventional radiology staff response for hemorrhagic patients requiring emergent angioembolization.

Background: While the needs of family members have previously been studied, the needs of families of trauma patients have received less attention.

Objective: This study aims to assess the needs of family members of trauma patients in the emergency department.

Methods: This cross-sectional survey study was conducted over 4 months (February-May 2022) with family members of trauma patients admitted to the emergency department of a state hospital in Istanbul, Turkey. The validated Critical Care Family Needs Inventory - Emergency Department survey was administered face-to-face to a convenience sample of consenting family members.

Results: A total of 248 family members participated, representing 84 patients. The mean age of the participants was 33 (8.18) years, with a gender distribution of 50% women. On average, 76.5% of the family members' needs were met. The most important needs reported as mean (SD) were as follows: communication, 3.52 (0.68); participation in care, 3.52 (0.68); comfort, 3.36 (0.65); and support needs, 3.21 (0.72). These needs were met to varying degrees: communication 85%, participation in care 81.2%, comfort 75.4%, and support needs 65.2%.

Conclusion: The study findings indicate that the needs of family members of emergency department trauma patients are not fully met. Families report needing communication the most and comfort the least.

Background: Adolescent substance abuse is a well-acknowledged and increasing concern. Screening brief intervention and referral to treatment for alcohol and drug use in adolescent trauma is a requirement, but program implementation remains a challenge for many trauma centers.

Objective: This study aims to examine the effect of an integrated electronic health record screening tool and staff training on screening, brief intervention, and referral to treatment compliance in adolescent trauma.

Methods: This is a single-center, pre- and postintervention study of substance use screening compliance in adolescent trauma patients (age 12-21) conducted at a Level I pediatric trauma center in the Southeastern United States following the integration of the CRAFFT substance abuse screening tool into the electronic health record. The study compared 12 months of preintervention data (January 2021 through January 2022) to 15 months of postintervention data (February 2022 through May 2023).

Results: A total of N = 241 patients met inclusion criteria, of which most were male, n = 168 (69.7%), White n = 185 (76.8%), and Hispanic n = 179 (74.3%). Screening compliance increased from preintervention 81% to postintervention 92%.

Conclusion: Our study demonstrates that integrating a digital screening tool into the electronic health record resulted in an average increased screening compliance of 11%.

Background: Secondary traumatic stress and compassion fatigue have been studied among trauma clinicians yet have not been explored in trauma registry professionals (TRPs).

Objective: The purpose of this study is to describe the secondary traumatic stress component of compassion fatigue among TRPs.

Methods: A qualitative, phenomenological study was conducted to examine TRPs' experiences with the secondary traumatic stress component of compassion fatigue. The primary investigator assembled a multidisciplinary team of researchers, including nursing leadership, registry educators, mental health experts, and qualitative researchers. Two focus groups were held virtually in January 2021, using an interview guide designed by the research team. Participants were recruited via an email sent to a list of colleagues known to the research team from training classes held nationally and selected for their diverse clinical experiences, years in the role, demographic background, and trauma center representation. The recorded sessions were independently transcribed and analyzed by a five-member subgroup of the research team; the analysis concluded in December 2022.

Results: Nine TRPs participated in the focus groups. Participants came from Level I, II, and III adult and pediatric trauma centers and military centers. Four themes emerged from the data: disquieting and rewarding work, reactions and emotional responses, the influence of personal histories and background, and coping strategies.

Conclusion: A qualitative analysis of focus group discussions revealed the secondary traumatic stress component of compassion fatigue is present in the TRP.

Background: Comprehensive and multidisciplinary discharge planning can improve trauma patient throughput, decrease length of hospitalization, increase family and patient support, and expedite hospital discharge.

Objective: This study aimed to assess the feasibility and acceptability of implementing a patient-centered discharge plan form for adult trauma patients.

Methods: A single-center pilot study was conducted with adult trauma patients on a neurosurgical medical-surgical floor at a Level II trauma center in the Western United States from January to February 2023. The study had three phases: observation, pilot intervention, and follow-up. The key pilot intervention was the development of a standardized patient-centered discharge plan form, pilot tested by a trauma advanced practice provider and an inpatient discharge nurse. The primary outcome was the frequency of discharge orders being written before noon on the day of discharge. Qualitative and quantitative outcomes are reported.

Results: The discharge form was used for eight patients during the pilot intervention phase; an advanced practice provider and an inpatient discharge nurse each completed the forms for four patients. Five of eight observed patients had discharge orders before noon; the incidence of orders before noon was slightly higher when the form was completed by the discharge nurse (three of four patients) than by the advanced practice provider (two of four patients).

Conclusions: The pilot study found that the patient-centered discharge plan form was feasible and acceptable to help improve the discharge process for trauma patients. Additional work to further refine the form's content and administration is warranted.

Background: Gun-related injury is now the number one cause of death in pediatric trauma patients. Many hospitals lack dedicated forensic nurses or updated protocols for handling ballistic evidence. Evidence not collected, handled improperly, or misplaced may deny a victim the basic human right to justice.

Objective: This article aims to describe an initiative to highlight the importance of proper management of ballistic evidence and to educate medical providers on best practices for the documentation, handling, removal, and transfer of ballistic evidence.

Methods: After discovering 24 "orphaned" bullets and bullet fragments in our hospital that had not been turned over to law enforcement, we sought to turn in evidence to the proper authorities and implement protocols to prevent this error in the future. New protocols were written by forensic staff, and education on new protocols was provided via in-person training, grand rounds, emails, and other collaborative initiatives.

Results: Evidence was matched to police reports using the patient name and date of birth on evidence labels. The median (interquartile range [IQR]) time of lost ballistic evidence was 1,397 (903, 1604) days, with the oldest bullet removed in 2015. All bullets were successfully returned to law enforcement with a median (IQR) time from bullet discovery to collection of 78 (78, 174) days.

Conclusions: Ballistic evidence handling protocols are essential for all hospitals. Dedicated, trained forensic staff should be employed to ensure proper evidence handling.