Accurate triaging of patients in emergency departments (EDs) is crucial, since triage determines how quickly patients are assessed and treated. Understanding the factors that influence ED nurses' triage decisions is important to ensure that patients are prioritised appropriately and cared for in a timely manner. This article reports and discusses the findings of a literature review on the factors that affect nurses' triage decisions in the ED. Triage decisions by nurses in EDs are influenced by several factors relating to the patient, the nurse, the triage algorithm and the environment where triage takes place. Nurses' ability to triage patients accurately is negatively affected by high patient numbers, inadequate staffing levels, lack of privacy and lack of training.
{"title":"Factors that affect nurses' triage decisions in the emergency department: a literature review.","authors":"Hugh Gorick","doi":"10.7748/en.2022.e2123","DOIUrl":"https://doi.org/10.7748/en.2022.e2123","url":null,"abstract":"Accurate triaging of patients in emergency departments (EDs) is crucial, since triage determines how quickly patients are assessed and treated. Understanding the factors that influence ED nurses' triage decisions is important to ensure that patients are prioritised appropriately and cared for in a timely manner. This article reports and discusses the findings of a literature review on the factors that affect nurses' triage decisions in the ED. Triage decisions by nurses in EDs are influenced by several factors relating to the patient, the nurse, the triage algorithm and the environment where triage takes place. Nurses' ability to triage patients accurately is negatively affected by high patient numbers, inadequate staffing levels, lack of privacy and lack of training.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88949816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The use of conducted energy devices - better known under the brand name Taser - by police officers is subject to scrutiny. Consequently, the clinical assessment and management of people who have been exposed to Taser discharge is also subject to scrutiny. In 2021 the Conducted Energy Device Joint Working Group published a new guideline on assessment in police custody after Taser discharge. The guideline enables any appropriately trained and competent healthcare professional, including nurses, to undertake post-Taser assessments and determine the person's fitness to be detained in police custody. This would be done in the first instance by nurses working in police custody suites, but emergency department (ED) nurses may also be involved, as people who have been 'tasered' may need referral to the ED. This article explains how Tasers work, their physiological effects and potential complications, and the required approaches to clinical assessment and management as outlined in the new guideline.
{"title":"Assessing and managing people exposed to conducted energy device (Taser) discharge.","authors":"Matthew Peel, David Tremlett","doi":"10.7748/en.2022.e2125","DOIUrl":"https://doi.org/10.7748/en.2022.e2125","url":null,"abstract":"The use of conducted energy devices - better known under the brand name Taser - by police officers is subject to scrutiny. Consequently, the clinical assessment and management of people who have been exposed to Taser discharge is also subject to scrutiny. In 2021 the Conducted Energy Device Joint Working Group published a new guideline on assessment in police custody after Taser discharge. The guideline enables any appropriately trained and competent healthcare professional, including nurses, to undertake post-Taser assessments and determine the person's fitness to be detained in police custody. This would be done in the first instance by nurses working in police custody suites, but emergency department (ED) nurses may also be involved, as people who have been 'tasered' may need referral to the ED. This article explains how Tasers work, their physiological effects and potential complications, and the required approaches to clinical assessment and management as outlined in the new guideline.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91014248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
If you ever need to find out more about skin rashes then try clicking on dermatlas.med.jhmiedu/derm/.
如果你想了解更多关于皮疹的信息，请点击dermatlas.med.jhmiedu/derm/。
{"title":"Skin problems.","authors":"Sarah Gear","doi":"10.7748/en.13.10.6.s10","DOIUrl":"https://doi.org/10.7748/en.13.10.6.s10","url":null,"abstract":"If you ever need to find out more about skin rashes then try clicking on dermatlas.med.jhmiedu/derm/.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"4 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2022-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90397713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Taking ownership.","authors":"C. Beck","doi":"10.7748/en.10.6.2.s4","DOIUrl":"https://doi.org/10.7748/en.10.6.2.s4","url":null,"abstract":"Nurse prescribing would allow ENPs to 'take ownership' of work they are undertaking already, an NHS Scotland official urged delegates.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"38 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80336793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-01DOI: 10.1891/9780826185235.0009l
A. Summers
{"title":"Testicular torsion.","authors":"A. Summers","doi":"10.1891/9780826185235.0009l","DOIUrl":"https://doi.org/10.1891/9780826185235.0009l","url":null,"abstract":"","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"28 1","pages":"22-3"},"PeriodicalIF":0.0,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89862412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-02DOI: 10.1002/9781119057840.ch90
Gillian A. Corbett, T. McGuigan
To the Editor: In their survey of patient satisfaction with intravenous PCA or epidural morphine, Egan and Ready conclude that satisfaction is very high with both modalities, but the perceived advantages and disadvantages differ, t While I share the authors' enthusiasm for both techniques, I feel there are some methodological concerns which may limit the validity of the conclusions. The authors reported differences between the two patient groups with respect to advantages, disadvantages and patient satisfaction. I question if such comparisons are valid when the demographics of the two groups studied are so clearly different; the PCA group was, on average, nine years younger than the epidural group, and presumably represented a different case mix. Although not reported, it is reasonable to assume that the patients undergoing more serious surgery were also more likely to receive epidural narcotics postoperatively. Within each group the authors have identified relative advantages and disadvantages perceived by the patients. However, on the basis of the very considerable demographic differences, I would argue that no valid between-group comparisons of PCA versus epidural narcotics are possible. The authors also state that" ... patients converted from one form of therapy to the other for any reason were excluded." This would seem to bias the reported satisfaction scores, since the only obvious reason for a change in therapy is patient or physician dissatisfaction. It would be useful to know how often this occurred. Quite tightly, Egan and Ready point out that, "Although patients willingly offer (satisfaction) ratings, it is by no means clear what such ratings represent." This is further illustrated in a randomized prospective study of PCA versus im morphine in patients following hip arthroplasty. 2 In both groups, the patients reported satisfaction scores of approximately nine out of ten, yet pain control assessed using visual analogue scores for both intensity and distress was often inadequate. In fact, the highest satisfaction score was coincident with the worst reported pain. Barring the most egregious errors, one suspects that if your patient likes you, reported satisfaction will be high.
{"title":"Patient satisfaction.","authors":"Gillian A. Corbett, T. McGuigan","doi":"10.1002/9781119057840.ch90","DOIUrl":"https://doi.org/10.1002/9781119057840.ch90","url":null,"abstract":"To the Editor: In their survey of patient satisfaction with intravenous PCA or epidural morphine, Egan and Ready conclude that satisfaction is very high with both modalities, but the perceived advantages and disadvantages differ, t While I share the authors' enthusiasm for both techniques, I feel there are some methodological concerns which may limit the validity of the conclusions. The authors reported differences between the two patient groups with respect to advantages, disadvantages and patient satisfaction. I question if such comparisons are valid when the demographics of the two groups studied are so clearly different; the PCA group was, on average, nine years younger than the epidural group, and presumably represented a different case mix. Although not reported, it is reasonable to assume that the patients undergoing more serious surgery were also more likely to receive epidural narcotics postoperatively. Within each group the authors have identified relative advantages and disadvantages perceived by the patients. However, on the basis of the very considerable demographic differences, I would argue that no valid between-group comparisons of PCA versus epidural narcotics are possible. The authors also state that\" ... patients converted from one form of therapy to the other for any reason were excluded.\" This would seem to bias the reported satisfaction scores, since the only obvious reason for a change in therapy is patient or physician dissatisfaction. It would be useful to know how often this occurred. Quite tightly, Egan and Ready point out that, \"Although patients willingly offer (satisfaction) ratings, it is by no means clear what such ratings represent.\" This is further illustrated in a randomized prospective study of PCA versus im morphine in patients following hip arthroplasty. 2 In both groups, the patients reported satisfaction scores of approximately nine out of ten, yet pain control assessed using visual analogue scores for both intensity and distress was often inadequate. In fact, the highest satisfaction score was coincident with the worst reported pain. Barring the most egregious errors, one suspects that if your patient likes you, reported satisfaction will be high.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"6 1","pages":"26-35"},"PeriodicalIF":0.0,"publicationDate":"2020-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81839108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The site of the Surgical Materials Testing Laboratory, at www.smtl.co.uk , holds frequentlyupdated, comprehensive information on wound products.
外科材料测试实验室的网站，www.smtl.co.uk，经常更新，关于伤口产品的全面信息。
{"title":"Materials testing.","authors":"K. Ambrose","doi":"10.7748/en.13.1.6.s10","DOIUrl":"https://doi.org/10.7748/en.13.1.6.s10","url":null,"abstract":"The site of the Surgical Materials Testing Laboratory, at www.smtl.co.uk , holds frequentlyupdated, comprehensive information on wound products.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"35 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2020-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84402889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-12-31DOI: 10.1525/9780520939554-008
D. Fox
Here’s the right way to get oxygen to your muscles. By Terry Laughlin The rules of breathing are simple in sports like cycling or running. You need a breath? You take a breath. You need more? You take more. Oxygen is there for the asking. A regular no-brainer. And then there is for swimming, where it sometimes seems, to frustrated novices and crosstrainers, that the simple act of getting oxygen to your muscles is a monumental task. And the stakes are high. Wiped out by just a few laps? It might not be your conditioning that’s at fault. It might be your lack of breathing technique that gets in the way of a good workout or discourages you from swimming altogether.
{"title":"Breathing easy.","authors":"D. Fox","doi":"10.1525/9780520939554-008","DOIUrl":"https://doi.org/10.1525/9780520939554-008","url":null,"abstract":"Here’s the right way to get oxygen to your muscles. By Terry Laughlin The rules of breathing are simple in sports like cycling or running. You need a breath? You take a breath. You need more? You take more. Oxygen is there for the asking. A regular no-brainer. And then there is for swimming, where it sometimes seems, to frustrated novices and crosstrainers, that the simple act of getting oxygen to your muscles is a monumental task. And the stakes are high. Wiped out by just a few laps? It might not be your conditioning that’s at fault. It might be your lack of breathing technique that gets in the way of a good workout or discourages you from swimming altogether.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"41 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2019-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86865880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.
cut The Gordian knot这个短语描述的是对一个复杂问题大胆而直接的解决方案。护理存在被定义为护士关注病人的能力，并使他们感到他们的需求得到了考虑。在急诊科(ED)，护理存在可能会受到疲劳，工作场所欺凌，道德困扰和人员配备不足等因素的不利影响，这可能导致患者预后不佳并损害护理目标。护理存在对护士的工作满意度也很重要，因此对员工留任也很重要。本文探讨了疲劳、职场欺凌、道德困扰和人员配备不足对急诊护士的综合影响。为了解决棘手的问题，它还提供了建议，通过考虑患者敏锐度和技能组合的安全人员配置决策来减轻急诊科的这些问题。
{"title":"How safe staffing can improve emergency nursing: time to cut the Gordian knot.","authors":"L. Wolf","doi":"10.7748/en.2019.e1928","DOIUrl":"https://doi.org/10.7748/en.2019.e1928","url":null,"abstract":"The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"2003 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89659539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In 2016, definitions of sepsis and septic shock were updated to focus on organ dysfunction rather than systemic inflammatory response as the identifying trait. This article aims to compare and evaluate the effectiveness of systemic inflammatory response syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) in detecting sepsis in emergency department (ED) patients. A systematic search of the literature was undertaken using four databases. A total of 307 articles was identified. After the selection process, 13 articles met the inclusion criteria for the review. Five themes emerged from the meta-analysis: SIRS; qSOFA; timeliness and simplicity; sensitivity versus specificity; and adding lacate. SIRS offered users greater sensitivity when assessing for sepsis. However, qSOFA is a simple bedside tool with greater specificity, which does not require any blood test results. The author created a new qSOFA screening tool, which incorporated the use of point-of-care serum lactate measurement. He found that qSOFA outperforms SIRS as an ED sepsis screening tool with its strengths of efficacy, efficiency and ease. It was also found to differentiate better between uncomplicated infection and sepsis, which can commonly cause trigger fatigue in EDs.
{"title":"Screening for sepsis: SIRS or qSOFA? A literature review.","authors":"Benjamin Feist","doi":"10.7748/en.2019.e1939","DOIUrl":"https://doi.org/10.7748/en.2019.e1939","url":null,"abstract":"In 2016, definitions of sepsis and septic shock were updated to focus on organ dysfunction rather than systemic inflammatory response as the identifying trait. This article aims to compare and evaluate the effectiveness of systemic inflammatory response syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) in detecting sepsis in emergency department (ED) patients. A systematic search of the literature was undertaken using four databases. A total of 307 articles was identified. After the selection process, 13 articles met the inclusion criteria for the review. Five themes emerged from the meta-analysis: SIRS; qSOFA; timeliness and simplicity; sensitivity versus specificity; and adding lacate. SIRS offered users greater sensitivity when assessing for sepsis. However, qSOFA is a simple bedside tool with greater specificity, which does not require any blood test results. The author created a new qSOFA screening tool, which incorporated the use of point-of-care serum lactate measurement. He found that qSOFA outperforms SIRS as an ED sepsis screening tool with its strengths of efficacy, efficiency and ease. It was also found to differentiate better between uncomplicated infection and sepsis, which can commonly cause trigger fatigue in EDs.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82076472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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