Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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Comparative Study
Novel Use of a Nurse-Led Telemedicine Team in Acute Stroke: A Retrospective Review of the Impact on a Regional Health Care System.
Despite the increasing incidence of acute ischemic stroke in the United States, many health care facilities remain unprepared to manage patients with acute stroke, including the administration of intravenous alteplase (recombinant tissue plasminogen activator [rTPA]). This has led to an opportunity for telemedicine systems to facilitate these evaluations and acute medical stroke treatment decisions. However, even telemedicine systems can fail to provide timely evaluation and management of the patient with acute stroke. The purpose of this retrospective study was to compare stroke outcome metrics pre- and postimplementation of a hybrid, local nurse-led "stroke-responder" telemedicine system. ⋯ In an acute stroke telemedicine system, implementation of a local nurse-led "stroke responder" system resulted in significantly decreased acute stroke metrics for a community hospital within a regional hospital system.
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Randomized Controlled Trial
The Effect of Parental Presence on Pain and Anxiety Levels During Invasive Procedures in the Pediatric Emergency Department.
Parental presence during invasive procedures is important in family-centered-care. Family-centered-care is a basic principle of pediatric nursing. ⋯ Parental involvement is effective in reducing the pain felt during invasive procedures. Moreover, anxiety levels of children during the procedure were not affected in all groups; however, the children of parents with high trait anxiety levels had higher preprocedural pain and trait anxiety levels.
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Although death is common in emergency departments, there is limited research regarding ED design as an obstacle to end-of-life care. This study identifies emergency nurses' recommendations regarding ways designs have negative or positive impact on care for dying patients and their families. ⋯ Emergency nurses understand the need for family presence during resuscitation, for secure body stowage areas, and for more resuscitation rooms so that families have time to grieve before being removed because of the immediate needs of a second trauma patient. Nurses can evaluate existing facilities to identify areas in which potential change and remodeling could improve care, increase patient privacy, or further utilize space. Understanding ED design's impact on EOL care is crucial. Modifications to ED layout and design may be challenging; however, improvements to space, layout, and privacy need to be considered when planning new emergency departments or remodeling existing departments. Further research is required to determine the impact of ED design on EOL care.
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The use of the emergency department by uninsured patients with chronic health problems may adversely affect those patients' health outcomes. Successful interventions have involved the use of patient navigators to connect the uninsured adult population with medical coverage and a medical home. The aim of this project was to use principles of patient navigation in a nurse-led process improvement intervention to connect uninsured patients to medical homes. ⋯ The role of patient navigators is essential in the emergency department. They assist patients to navigate through the various health care resources available in their communities, which can help to reduce ED overuse.
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Identifying patients with sepsis at triage can lead to a decrease in door-to-antibiotic time. Our community hospital emergency department's mean door-to-antibiotic time was 105.3 minutes, falling short of the Surviving Sepsis Campaign guideline's benchmark goal of 60 minutes. One of the most common reasons for treatment delays was that patients with sepsis were not identified upon entrance to the emergency department. A solution to the delay was to implement a practice improvement project by having the triage nurse screen all patients for sepsis upon entrance to the emergency department. ⋯ The simple change in patient throughput improved door-to-antibiotic time with minimal obstacles. The sepsis-screening tool implemented at triage decreased the door-to-antibiotic time by 33.4 minutes, without affecting triage time, and enhanced patient throughput of potentially septic patients.