Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association最新文献

Breaking bad news is a challenging yet essential part of the role of healthcare professionals who care for major trauma patients and their families. This service evaluation investigated healthcare professionals' attitudes and experiences regarding breaking bad news in the context of major trauma. Healthcare professionals were recruited from the South Wales Trauma Network and their views collected via an online survey based on the Breaking Bad News Attitudes Scale. The survey was completed by 149 healthcare professionals and the responses demonstrated a range of experiences of breaking bad news in major trauma care, with challenges such as the environment, building rapport and setting expectations.

Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors' acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention.

Nurses working with major trauma patients in ward environments in the UK are expected to evidence their knowledge and skills in a set of national competencies. This article describes a bespoke major trauma course and a coaching and portfolio development programme designed to enhance ward nurses' knowledge and skills, help them evidence their competence and support their professional development. Evaluation of the course showed an overall improvement in nurses' self-rated competence and confidence in a range of relevant major trauma topics and clinical skills. Evaluation of the coaching and portfolio development programme showed that nurses believed their knowledge and skills had improved after taking part and that they valued the opportunity for professional development.

Demand for ambulances has increased significantly in recent years due, for example, to ongoing public health issues and lack of availability of alternative healthcare services. However, as demand increases, so too do ambulance waiting times, partly due to significant pressures on emergency departments (EDs) resulting in handover delays. People experiencing mental health distress who cannot access the care they need often contact ambulance services or present to the ED. Ambulance trusts across the UK are attempting to address this by employing mental health professionals (MHPs) in various capacities. In this article, the authors explore some of the issues related to mental health-related calls to 999 services. The authors then describe a service improvement initiative in Wales which involves MHPs working in 999 call centre clinical support desk services to improve the quality of care delivered to people with mental health issues and reduce demand on ambulance and ED services.

Nurses and other emergency department (ED) staff often experience verbal and physical abuse as part of their everyday work. Body-worn cameras are one tool that ED staff can use to try to reduce workplace violence and abuse and have been shown to be effective in other healthcare environments, such as mental health units. This article describes a pilot service evaluation which used a survey to assess the effectiveness of using body-worn cameras for staff in the author's ED. Findings suggest that nurses believed the cameras provided support when they were confronted by abusive or aggressive patients or relatives and in some instances diffused potentially violent situations.

Triage is the first stage of a patient's journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient's presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff.

Nitrous oxide (N 2 O) has become one of the most popular recreational drugs in Europe. While N 2 O is often used in medical settings as an analgesic and anaesthetic agent, its recreational use was documented many years before its introduction into clinical practice. The desired effects from inhaling N 2 O for recreational purposes include rapid feelings of relaxation, calmness and euphoria, which can be accompanied by giddiness and laughter. There are various adverse effects associated with N 2 O use, including headache, nausea, vomiting, drowsiness and the development of permanent neurological damage. Furthermore, its use is associated with cold burns and road accidents. This article details the case of a patient who sustained an N 2 O tank burn to his forearm from recreational use. It also discusses the prevalence, legal status and adverse effects of N 2 O use as well as the pathophysiology and management of cold burn injuries.

Vaginal bleeding during pregnancy is a common patient presentation in emergency departments (EDs), and in some cases this will occur due to miscarriage. However, there are several barriers to effective and sensitive communication with patients experiencing a miscarriage. Women presenting to EDs who are experiencing a miscarriage are more likely to be psychosocially vulnerable and less satisfied with their care compared with those seeking care in the outpatient setting. There is a gap in nursing and advanced practice provider preparation regarding techniques for breaking bad news to patients in the ED setting. At one high-volume, urban ED in the US, an education programme for staff regarding best practice in breaking bad news to patients experiencing a miscarriage was developed based on an established protocol. The intention was to increase the confidence levels of nurses and other healthcare professionals in breaking bad news to these patients. After the education programme, many participants self-reported increased confidence in breaking bad news and comfort in managing patients' emotions. The results can be used to inform education for healthcare professionals who deliver bad news in the ED and other departments.

Malnutrition can have significant negative effects on older people's health, as well as a cost burden for health and social care services. Accurate, reliable and regular measurement of a patient's weight is important for prompt identification and management of malnutrition. This article discusses a quality improvement project that was undertaken in an emergency assessment unit for patients aged over 74 years in Northern Ireland. The aim of the project was to improve completion of Malnutrition Universal Screening Tool (MUST) scores for patients attending the unit by nursing staff recording actual weight rather than recalled weight. A simple intervention of relocating weighing scales in the unit's triage bay resulted in an increase in completed MUST scores from 60% ( n =18) to 97% ( n =29) in the six months following the intervention. Feedback from members of the multidisciplinary team indicated that the intervention had a positive effect on the care they provided to patients and on their working relationships with colleagues.

Emergency departments (EDs) provide critical opportunities for nurses to support suicide prevention. This article details a service evaluation that was undertaken to explore the characteristics and outcomes of people in suicidal crisis at two EDs in the East of England during June 2023. Data routinely collected by the ED mental health liaison team were combined with a retrospective case note review of the local NHS mental health trust's electronic patient records. Attendees had a mean age of 35 years and seven months, and were often diagnosed with depression or emotionally unstable personality disorder. Most had a history of self-harm and were currently known to mental health services. Suicide-specific interventions were rarely recorded by nurses and relapse behaviours were prevalent after presentation. Local and national suicide prevention strategies should encourage nurses to address gaps in support, thereby improving patients' experiences in and beyond the ED.