Advanced emergency nursing journal
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The literature supports family presence during cardiopulmonary resuscitation (CPR) and its many perceived benefits for patients and their families. It also suggests that, overall, health care professionals are supportive of this practice. There have not been any published studies to date that have looked at the perception of family presence from the multidisciplinary resuscitation or code team's perspective. ⋯ Barriers remain related to family presence during resuscitation. Education is needed for all members of the health care team to facilitate collaborative changes in resuscitation practices. Education should include information regarding institutional policies, methods for incorporating family members into the code process, and interventions to support the psychosocial needs of family members.
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Multicenter Study
Attitudes toward patients with sickle cell disease in a multicenter sample of emergency department providers.
Patients with sickle cell disease (SCD) often seek care in the emergency department (ED) for pain associated with vaso-occlusive crises. Research has shown that negative provider attitudes serve as a barrier to care in this patient population. Our aim was to validate a survey that measures attitudes toward SCD patients among ED providers (nurses and physicians) and to compare differences in attitude scores between provider types. ⋯ Among ED providers, this scale identified a dimension not observed in research with the original instrument among internal medicine providers. Provider attitudes influence patient-provider interactions and quality of care. The scale we present here has major clinical implications, particularly for advanced practice nurses, who can use the scale not only to assess providers' attitudes toward SCD patients but also to determine the effectiveness of tailored interventions to improve those attitudes.
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Although several biological agents have been recognized as presenting a significant threat to public health if used in a bioterrorist attack, those that are of greatest importance are known as the Category A agents: Bacillus anthracis (anthrax); variola major (smallpox); Yersinia pestis (plague); Francisella tularensis (tularemia); ribonucleic acid viruses (hemorrhagic fevers); and Clostridium botulinum (botulism toxin). In the previous issue, Part I of this review focused on the clinical presentation and treatment of anthrax, plague, and tularemia. In this second part of this 2-part review of these agents, the focus is on the clinical presentation and treatment of smallpox, viral hemorrhagic fevers, and botulism toxin. The utilization of mass prophylaxis to limit the morbidity and mortality associated with all these agents is also discussed along with the role emergency care personnel play in its implementation.
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Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "The Effect of the Duration of Emergency Department Observation on Computed Tomography Use in Children With Minor Blunt Head Trauma." The study results showed that 49% of the patients were "observed" in the emergency department (ED). Of those "observed" (N = 676) in the ED, the authors found that 20% had a computed tomographic (CT) scan performed. However, "observed" patients did experience a lower rate of CT scan (5%) than "nonobserved" patients. The implications and clinical relevance of these findings for APNs are discussed, highlighting best practice evidence.
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In the emergency department (ED), one non-value-added task is transporting stable patients to telemetry units. This process improvement intervention introduces a decision tree to determine which patients are stable enough to be safely transported nonmonitored, thus more efficiently using valuable nursing time. A decision tree was utilized to determine which patients would be transported nonmonitored. ⋯ A total of 280 patients met the criteria to be transported nonmonitored from the ED to the inpatient unit during the data collection period, saving an average of 20.7 hr per month. With appropriate use of the decision tree, clinical staff successfully determined the need for monitored transport of patients admitted to non-intensive care unit telemetry units from the ED. There were no adverse patient events.