Tibial plateau fractures are complex injuries and relatively common presentations in emergency departments (EDs), yet the diagnosis is not always obvious. Patients with this injury are managed increasingly in EDs by registered advanced nurse practitioners (RANPs), who are recognised in Ireland as senior clinical decision-makers. RANPs are broadening their scope of practice to maximise their responses to current and emerging challenges in healthcare services. They use a range of skills, including taking comprehensive health histories, problem solving, clinical decision-making and using their expert judgement to diagnose and create management plans for patients who attend EDs. In Ireland, RANP is a protected title and practitioners work within an agreed scope of practice, meeting criteria set by the Nursing and Midwifery Board of Ireland to register. RANPs ensure continuity of care, improve the quality of care, provide a quick response to patient care, reduce waiting times and improve flow of patients through EDs. The main scope of RANPs' practice in emergency care includes management of patients with non-life-threatening limb conditions or injures, such as a tibial plateau fracture. This article gives an overview of tibial plateau fractures, including anatomy, and presents a case study to analyse critically the management of a patient with this injury and the care provided by a RANP. In the context of the case study, the article reviews the RANP's diagnostic decisions and the available management options.
{"title":"Assessment and management of patients with tibial plateau fractures in emergency departments.","authors":"Barry McBrien","doi":"10.7748/en.2019.e1981","DOIUrl":"https://doi.org/10.7748/en.2019.e1981","url":null,"abstract":"Tibial plateau fractures are complex injuries and relatively common presentations in emergency departments (EDs), yet the diagnosis is not always obvious. Patients with this injury are managed increasingly in EDs by registered advanced nurse practitioners (RANPs), who are recognised in Ireland as senior clinical decision-makers. RANPs are broadening their scope of practice to maximise their responses to current and emerging challenges in healthcare services. They use a range of skills, including taking comprehensive health histories, problem solving, clinical decision-making and using their expert judgement to diagnose and create management plans for patients who attend EDs. In Ireland, RANP is a protected title and practitioners work within an agreed scope of practice, meeting criteria set by the Nursing and Midwifery Board of Ireland to register. RANPs ensure continuity of care, improve the quality of care, provide a quick response to patient care, reduce waiting times and improve flow of patients through EDs. The main scope of RANPs' practice in emergency care includes management of patients with non-life-threatening limb conditions or injures, such as a tibial plateau fracture. This article gives an overview of tibial plateau fractures, including anatomy, and presents a case study to analyse critically the management of a patient with this injury and the care provided by a RANP. In the context of the case study, the article reviews the RANP's diagnostic decisions and the available management options.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81774468","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}
This article explores secondary traumatic stress (STS) and the emotional challenges that emergency nurses face when dealing with traumatised patients. The few studies on STS have shown a higher occurrence of STS symptoms in emergency nurses but provide limited evidence on how personal experiences may contribute to STS. Risk factors identified include repeated exposure to trauma; morbidity and mortality; personal trauma; chronic stressors; workload and emergency department pressures. STS can lead to reduced job satisfaction, sick leave and burnout. Protective factors include awareness and self-care, emotional intelligence, social support and education about STS. Strategies to minimise STS include balancing personal and professional life and the support of employers to help reduce compassion fatigue and aid staff retention.
{"title":"Awareness of secondary traumatic stress in emergency nursing.","authors":"Donna Barleycorn","doi":"10.7748/en.2019.e1957","DOIUrl":"https://doi.org/10.7748/en.2019.e1957","url":null,"abstract":"This article explores secondary traumatic stress (STS) and the emotional challenges that emergency nurses face when dealing with traumatised patients. The few studies on STS have shown a higher occurrence of STS symptoms in emergency nurses but provide limited evidence on how personal experiences may contribute to STS. Risk factors identified include repeated exposure to trauma; morbidity and mortality; personal trauma; chronic stressors; workload and emergency department pressures. STS can lead to reduced job satisfaction, sick leave and burnout. Protective factors include awareness and self-care, emotional intelligence, social support and education about STS. Strategies to minimise STS include balancing personal and professional life and the support of employers to help reduce compassion fatigue and aid staff retention.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73198705","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}
AIM Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients' satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients' perspectives. The aim was to determine patients' preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries. METHOD A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was 'there is no significant difference in satisfaction levels between the two devices'. FINDINGS There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t-test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients). CONCLUSION Patients' preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.
{"title":"A comparison of two interventions in the treatment of severe ankle sprains and lateral malleolar avulsion fractures.","authors":"S. Powell","doi":"10.7748/en.2019.e1945","DOIUrl":"https://doi.org/10.7748/en.2019.e1945","url":null,"abstract":"AIM\u0000Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients' satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients' perspectives. The aim was to determine patients' preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries.\u0000\u0000\u0000METHOD\u0000A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was 'there is no significant difference in satisfaction levels between the two devices'.\u0000\u0000\u0000FINDINGS\u0000There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t-test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients).\u0000\u0000\u0000CONCLUSION\u0000Patients' preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76130367","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}
Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.
{"title":"Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology.","authors":"Anne J. Hunt","doi":"10.7748/EN.2019.E1926","DOIUrl":"https://doi.org/10.7748/EN.2019.E1926","url":null,"abstract":"Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"340 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77317858","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}
Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.
{"title":"How the emergency department four-hour target affects clinical outcomes for patients diagnosed with a personality disorder.","authors":"Michael Brian Haslam","doi":"10.7748/EN.2019.E1930","DOIUrl":"https://doi.org/10.7748/EN.2019.E1930","url":null,"abstract":"Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"148 1","pages":"20-24"},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82273038","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}
This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.
{"title":"Full-thickness burns due to contact with gastric acid.","authors":"R. Fenwick, R. Price","doi":"10.7748/EN.2019.E1941","DOIUrl":"https://doi.org/10.7748/EN.2019.E1941","url":null,"abstract":"This article describes the case of a 33-year-old man with cerebral palsy who sustained a full-thickness burn to his thorax as a result of lying in gastric acid that had leaked from a damaged percutaneous endoscopic gastrostomy feeding tube. The patient required referral to a tertiary burns centre for specialist management. The article highlights the potential harm caused by gastric acid and why some patients may be particularly vulnerable to such injuries.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78650552","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}
Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis. It also explores the evidence base for commonly prescribed anticoagulants.
{"title":"Non-medical prescribing: a reflective case study on prescribing anticoagulation for deep vein thrombosis.","authors":"S. Gonet","doi":"10.7748/EN.2019.E1897","DOIUrl":"https://doi.org/10.7748/EN.2019.E1897","url":null,"abstract":"Prescribing is a high-risk, complex skill. There are more than 50,000 nurse prescribers in the UK, and it is important that they undertake regular reflection on their clinical practice to enhance their skills. This article reflects on the clinical factors that influenced the author's decision-making when prescribing anticoagulation medication for a patient with deep vein thrombosis. It also explores the evidence base for commonly prescribed anticoagulants.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85298935","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}
AIM To identify the views and experiences of emergency nurses and doctors of the presence of family members during invasive procedures and resuscitation events. METHODS 84 staff members from three emergency departments in one UK trust responded to a paper-based 22-item questionnaire developed by the authors. FINDINGS Staff expressed positive views about family presence during such traumatic events, but also expressed non-evidenced concerns about negative aspects of family presence. CONCLUSION Future research should focus on exploring the views of patients and their families in culturally diverse societies or across culturally different countries. Such data could underpin culturally sensitive policies to guide the practice of family presence and identify the education required to support successful development of such policies. Using simulation-based learning methodology integrated with existing advanced life-support/advanced trauma life-support training could support successful implementation of family presence policies.
{"title":"A survey of emergency department staff's opinions and experiences of family presence during invasive procedures and resuscitation.","authors":"E. Magowan, V. Melby","doi":"10.7748/EN.2019.E1908","DOIUrl":"https://doi.org/10.7748/EN.2019.E1908","url":null,"abstract":"AIM\u0000To identify the views and experiences of emergency nurses and doctors of the presence of family members during invasive procedures and resuscitation events.\u0000\u0000\u0000METHODS\u000084 staff members from three emergency departments in one UK trust responded to a paper-based 22-item questionnaire developed by the authors.\u0000\u0000\u0000FINDINGS\u0000Staff expressed positive views about family presence during such traumatic events, but also expressed non-evidenced concerns about negative aspects of family presence.\u0000\u0000\u0000CONCLUSION\u0000Future research should focus on exploring the views of patients and their families in culturally diverse societies or across culturally different countries. Such data could underpin culturally sensitive policies to guide the practice of family presence and identify the education required to support successful development of such policies. Using simulation-based learning methodology integrated with existing advanced life-support/advanced trauma life-support training could support successful implementation of family presence policies.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78151253","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 : 2019-04-08DOI: 10.1542/aap.ppcqr.396256
A. T. Andreasen
Last summer, the National Institute for Clinical Excellence (NICE) published Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. The recommendations on computed tomography (CT) in this guidance for minor head injuries are similar to the Canadian CT head rule published in 2001.
{"title":"Head injuries.","authors":"A. T. Andreasen","doi":"10.1542/aap.ppcqr.396256","DOIUrl":"https://doi.org/10.1542/aap.ppcqr.396256","url":null,"abstract":"Last summer, the National Institute for Clinical Excellence (NICE) published Head Injury: Triage, assessment, investigation and early management of head injury in infants, children and adults. The recommendations on computed tomography (CT) in this guidance for minor head injuries are similar to the Canadian CT head rule published in 2001.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"2 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2019-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88792822","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 aim of this article is to review the literature on pre-hospital assessment of pain in paediatric patients. Many articles highlight the under-treatment of pain in paediatrics by pre-hospital clinicians, showing that this is an area falling short of best practice. This article evaluates the effectiveness of two established pain assessment tools authorised for the pain assessment of children in pre-hospital environments.
{"title":"Pre-hospital pain assessment in paediatric patients.","authors":"M. Parker, Nicola Brown","doi":"10.7748/EN.2019.E1905","DOIUrl":"https://doi.org/10.7748/EN.2019.E1905","url":null,"abstract":"The aim of this article is to review the literature on pre-hospital assessment of pain in paediatric patients. Many articles highlight the under-treatment of pain in paediatrics by pre-hospital clinicians, showing that this is an area falling short of best practice. This article evaluates the effectiveness of two established pain assessment tools authorised for the pain assessment of children in pre-hospital environments.","PeriodicalId":94315,"journal":{"name":"Emergency nurse : the journal of the RCN Accident and Emergency Nursing Association","volume":"6 1","pages":"16-20"},"PeriodicalIF":0.0,"publicationDate":"2019-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82534411","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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