Improving Nurse Practitioner Students' Knowledge and Confidence in the Identification and Management of Human Trafficking Victims.

Human trafficking is a global public health problem affecting millions of people worldwide. In the United States, many trafficking victims seek medical care for physical, sexual, and mental health concerns. Unfortunately, many of these individuals go unrecognized by health care providers as being victims of human trafficking and return to their trafficker without interventions for their safety and protection. To provide effective quality care for this patient population, health care providers must be knowledgeable regarding the identification of signs of trafficking, trauma-informed interventions to ensure the safety and protection of the victim(s), and methods to collaborate with interprofessional partners for the provision of appropriate medical and socioeconomic care following the exit from their trafficking situation. The purpose of this pilot study was to evaluate best practices in teaching Family Nurse Practitioner (FNP) students to identify and implement appropriate interventions for victims of human trafficking. The study was conducted in two phases using a mixed-method research design with repeated measures. In the first phase, education was provided through the validated HOPE Training modules produced by the Safe House Project using a pretest, posttest design. In the second phase, the students observed an interprofessional simulation followed by focus groups using a phenomenological approach to explore students' perceptions. Knowledge and confidence increased significantly following the implementation of this study. The results provide essential information regarding incorporating human trafficking education into FNP curricula. This study also contributes to the body of knowledge regarding the vital role that nurse practitioners play in the interprofessional management of human trafficking victims.

Improving Reporting Culture Through Daily Safety Huddles.

BACKGROUND AND OBJECTIVES: A major obstacle to safer care is lack of error reporting, preventing the opportunity to learn from those events. On an acute care unit in a children's hospital in southeastern United States, error reporting and Survey for Patient Safety Culture (SOPS 1.0) scores fell short of agency benchmarks. The purpose of this quality improvement project was to implement a Safety Huddle Intervention to improve error reporting and SOPS 1.0 scores related to reporting. METHODS: Marshall Ganz's Change through Public Narrative Framework guided creation of the project's intervention: A story of self, a story of us, a story of now. A scripted Safety Huddle was conducted on the project unit daily for 6 weeks, and nurses on the project unit and a comparison unit completed the SOPS 1.0 before and after the intervention. Monthly error reporting was tracked on those same units. RESULTS: Error reporting by nurses significantly increased during and after the intervention on the project unit ( P = .012) but not on the comparison unit. SOPS 1.0 items purported to measure reporting culture showed no significant differences after the intervention or between project and comparison units. Only 1 composite score increased after the intervention: communication openness improved on the project unit but not on the comparison unit. CONCLUSION: Using a Safety Huddle Intervention to promote conversation about error events has potential to increase reporting of errors and foster a sense of communication openness. Both achievements have the capacity to improve patient safety.

Atopic Dermatitis: A Common Pediatric Diagnosis That Is Not Just Another Rash.

Emergency nurse practitioners are expected to assess and manage a variety of patients. These patients may present with urgent care-type complaints to severe life-threatening illnesses or injuries. For some, dermatological problems can sometimes be just as challenging as a critically ill patient. Atopic dermatitis (AD) is one, if not, the most common chronic inflammatory disease. Its presentation can vary depending on the age of the patient, the patient's skin tone, and other comorbidities. Patients often seek emergency care related to the condition itself or associated complications. This article includes a review of the pathophysiology, clinical manifestations, and standard management of AD. Finally, the potential complications of AD are discussed. A better understanding of AD will allow emergency nurse practitioners to properly identify and treat this chronic condition, as well as its complications.

The Diagnostic Challenge of an Older Adult With Epigastric Pain in the Emergency Department: High Risk and High Volume.

Epigastric pain is a common complaint in patients who present to the emergency department (ED); abdominal pain is the most common chief complaint in older adult patients who request treatment by a provider (A. B. Friedman et al., 2022). These patients may experience atypical presentations, which can result in delayed or missed diagnosis altogether, increasing morbidity, and mortality. This is the case of an older adult man who presented with chest and epigastric pain. The clinical presentation, atypical signs, and symptoms of gangrenous gallbladder are presented herein along with the differential diagnoses and diagnostics for this patient. The care for and the "what not to miss" in the management of this patent are also examined in this article. It is imperative that ED providers diagnose gangrenous gallbladder early on, especially in the older adult population, who may present with covert signs and symptoms to prevent complications and avoid poor outcomes including death in this age group.

Urticaria Multiforme: An Uncommon Hypersensitivity Rash in Children.

The differential diagnosis of rashes in children is challenging. Pediatric rashes indicate a broad spectrum of clinical conditions and include those that are benign and self-limiting to those that may indicate a serious multisystem inflammatory response. It is essential that emergency nurse practitioners have the knowledge and skill set to accurately identify the spectrum of rashes in the pediatric population to arrive at the correct diagnosis for patient management and avoid costly and unnecessary diagnostic testing. The purpose of this article is to describe a case report of a young child with urticaria multiforme, a commonly misdiagnosed clinical condition, including the distinctive clinical features, differential diagnosis, and most current treatment recommendations. Other clinical conditions that present with skin lesions resembling urticaria multiforme conditions have also been discussed.

Implementing Safe and Effective Pediatric Procedural Sedation in the Emergency Department.

There has been a great increase in the number of diagnostic and therapeutic procedures performed in the emergency department (ED) setting over the past several decades. Most of these procedures are unscheduled, unplanned, and much more likely to be successful and result in a positive outcome when the child's pain, fear, anxiety, and movement are controlled. To promote patient quality and safety, increase the effectiveness and efficiency of care, and improve patient and caregiver satisfaction, there has been a proportionate increase in the number of pediatric procedural sedations performed in the ED. With proper education and skills verification, pediatric procedural sedation can be safely and efficaciously performed in the ED. The purpose of this article is to present an overview of pediatric analgesia, anxiolysis, and sedation to promote compassionate, evidence-based emergency care of children and optimize procedural performance and outcomes.

A Case of Nonfatal Strangulation Associated With Intimate Partner Violence.

Intimate partner violence (IPV) is a significant public health problem that has profound effects on the physical and psychological well-being of millions of Americans. It is known that strangulation is one of the most lethal forms of IPV. Frequently, a lack of visible external trauma is present, and attempted strangulation may be accompanied by other more severe injuries to the head and face; thus, the signs and symptoms of nonfatal strangulation may be overlooked. Because the emergency department (ED) is frequently the first point of contact for an individual who has experienced any type of IPV, it is imperative that providers have the knowledge and skill set for the identification and management of this patient population. The purpose of this article is to present a discussion of the challenges faced by ED providers in the clinical decision-making process when caring for a patient who has experienced nonfatal strangulation.

An Atypical Case of Abdominal Pain in a Toddler: A Diagnostic Challenge.

Abdominal pain in the pediatric patient presents a unique diagnostic challenge for emergency department (ED) providers due to the wide range of possible etiologies and sequelae. The list of differential diagnoses is extensive and includes the spectrum of conditions that range from benign and self-limiting to those that are potentially life-threatening. This article describes a case of a young toddler with an acute appendicitis complicated by perforation and abscess formation. Although acute appendicitis is uncommon in infants and younger children, it does occur and, as this case illustrates, is often misdiagnosed, which leads to delayed treatment and a higher incidence of complications. This article includes a discussion of the challenges faced by ED providers in the clinical-decision making process when caring for a pediatric patient with abdominal pain due to an acute appendicitis. This discussion includes the age-associated epidemiology, pathophysiology, clinical presentation, and evidence-based recommendations for diagnosis and treatment.

Staphylococcal Scalded Skin Syndrome: A Pediatric Dermatological Emergency.

Staphylococcal scalded skin syndrome (SSSS) is a major exfoliating skin infection primarily seen in neonates and young children that can lead to serious morbidity. Although this condition is not commonly encountered, evidence indicates that the incidence and prevalence of this infection is increasing. It is essential that emergency care providers are knowledgeable regarding the differential diagnosis and clinical-decision making process for accurate and timely diagnosis and treatment. This case study highlights the challenges faced in the emergency department in the diagnosis and management of SSSS, including pathophysiology, epidemiology, differential diagnosis and medical management.

Pediatric Sexual Abuse: An Interprofessional Approach to Optimizing Emergency Care.

INTRODUCTION: Pediatric sexual abuse can lead to devastating lifelong consequences for the child, their caregivers, and society at large. To achieve the goal of optimizing patient outcomes, strategies to enhance teamwork, education, and mentorship are essential. The ultimate goal of child safety and protection through an evidence-based approach will only be attained when interprofessional alignment of expertise and resources is implemented. METHODS: This project was implemented in a mixed-method design in two phases. Phase 1 was a face-to-face, evidence-based, 3.5-hour educational intervention involving members of the interprofessional emergency care team. Phase 2 consisted of focus groups to discover specific concerns emergency care providers encounter and to provide a forum for discussion on methods to improve care delivery. Data analysis was conducted to examine changes before and after education intervention and to identify themes discovered in focus groups. RESULTS: There was a significant increase in the knowledge, confidence, and self-efficacy of the interprofessional emergency care team regarding sexual abuse after the education intervention. General themes identified in the focus groups included (a) the importance of advancing one's knowledge and skill set in this specialized area, (b) the importance of interprofessional collaboration in the emergency department and with community partners, (c) implementation of evidence-based national guidelines, and (d) ideas for improved quality and safety in the care of the sexually abused child. DISCUSSION: Education and collaboration through an interprofessional approach are required for the promotion of quality and safety for the child presenting with alleged sexual abuse.

Evaluation of an Online Educational Intervention to Increase Knowledge and Self-efficacy in Disaster Responders and Critical Care Transporters Caring for Individuals with Developmental Disabilities.

OBJECTIVE: Disability-related education is essential for disaster responders and critical care transporters to ensure positive patient outcomes. This pilot study evaluated the effect of an online educational intervention on disaster responders and critical care transporters' knowledge of and feelings of self-efficacy about caring for individuals with developmental disabilities. METHODS: A 1-group, pretest-posttest, quasi-experimental design was used. A convenience sample of 33 disaster responders and critical care transporters participated. RESULTS: Of the 33 participants, only 24% had received prior education on this topic, and 88% stated that such education would be beneficial to their care of patients. Nineteen participants completed both the pretest and posttest, and overall performance on knowledge items improved from 66% correct to 81% correct. Self-efficacy for caring for developmentally disabled individuals improved, with all 10 items showing a statistically significant improvement. CONCLUSION: Online education is recommended to improve the knowledge and self-efficacy of disaster responders and critical care transporters who care for this vulnerable population after disasters and emergencies. (Disaster Med Public Health Preparedness. 2019;13:677-681).

A Case of Exertional Rhabdomyolysis: When Exertion Exceeds Capacity.

The purpose of this article is to present a discussion of a young adult patient with exertional rhabdomyolysis. Rhabdomyolysis is the process of muscle tissue destruction and damage to the cell membrane, with subsequent release of the intracellular myocyte contents into the systemic circulation. This leads to the potential for the life-threatening systemic complications of electrolyte abnormalities, cardiac dysrhythmias, acute kidney injury, compartment syndrome, and disseminated intravascular coagulopathy. Rhabdomyolysis as a syndrome can be difficult to recognize and diagnose in the emergency care setting due to the fact that there are many etiologies and variations in symptomatology. The emergency care provider must have an astute knowledge base of this disease process and consider this pathology in the differential diagnosis of any patient at risk to achieve optimum patient outcomes and reduce morbidity and mortality.

An Unusual Case of Chest Pain in an Adolescent Male: Important Cues to Differential Diagnosis.

Chest pain is a common presenting symptom in the pediatric population, and in contrast to adults, the etiology is rarely cardiac or life-threatening. The majority of chest pain complaints in children and adolescents are benign and can be managed with reassurance and follow-up. The emergency care provider must obtain a comprehensive history and physical examination, as the differential diagnosis of pediatric chest pain is extensive and serious underlying organic pathology may be present. This article describes the case of an adolescent male with an unusual case of chest pain with a serious underlying medical condition. A systematic approach to the clinical decision-making process is discussed to identify those patients who may have a serious underlying organic cause. Information is also included to guide the provider in the identification of red flags for cardiac etiologies of chest pain and indications for a pediatric cardiology consultation.

Child Maltreatment: Optimizing Recognition and Reporting by School Nurses.

School nurses perform a crucial role in the prevention, identification, intervention, and reporting of child maltreatment. The purpose of this article is to share the highlights of a research project conducted to (a) examine the effectiveness of an educational intervention program in increasing the knowledge, confidence, and self-efficacy in school nurses regarding children at risk of maltreatment; and (b) discover issues surrounding the comfort level engaging with children, communicating with teachers and other personnel, and ethical issues. The study consisted of two phases. Phase 1 was a face-to-face evidenced-based educational intervention. Focus groups implemented in Phase 2 discovered specific concerns of school nurses. Results indicate a significant increase in school nurse knowledge, confidence, and self-efficacy related to children at risk. Five themes were identified from the focus groups: the importance of interprofessional collaboration, identifiers of children at risk of maltreatment, the role of the school nurse as a mentor and leader, the importance of advancing one's knowledge and skill set, and constraints faced by school nurses.

A Case of Pertussis: What Emergency Health Care Providers Need to Know.

Pertussis is a highly contagious acute respiratory illness. Prior to the availability of the whole-cell pertussis vaccine in the late 1940s, pertussis was one of the most common infectious diseases of childhood in the United States and a major cause of infant morbidity and mortality. Although pertussis vaccination has resulted in a substantial reduction in the disease, the incidence has been steadily increasing since the 1990s. The clinical presentation of pertussis may be variable depending on the age and immunization status of the patient. The classic presentation includes a triad of symptoms: paroxysms of coughing; an inspiratory whoop following cough; and posttussive vomiting. Those most vulnerable are the ones not yet immunized and the ones most likely to transmit the illness who may not exhibit "classic" pertussis symptoms, delaying or preventing identification and treatment. Because pertussis carries known morbidity and mortality risks, prevention and early identification are paramount.

The effectiveness of a provider in triage in the emergency department: a quality improvement initiative to improve patient flow.

Hospital emergency departments (EDs) throughout the United States are faced with overwhelming challenges due to the high demand for services, an increasing number of visits, overuse and misuse of services, and escalating healthcare costs. The result of this situation is that EDs are overcrowded, patients are experiencing long wait times, ambulances are being diverted, admitted patients are being boarded, and patients in need of emergency medical care are leaving without treatment. The purpose of this article is to present a quality improvement initiative designed and implemented to improve patient flow through an ED by redesigning the triage process to increase the efficiency and timeliness of initial patient contact with a licensed medical provider, increasing patient satisfaction, and decreasing the number of patients who leave without being seen. To accomplish these goals, a nurse practitioner/physician assistant medical provider was reallocated to the triage area to perform an initial assessment and initiate diagnostic studies. The results of this initiative have proven to be positive in goal attainment. The time from patient arrival to initial contact with a licensed medical provider has decreased from 75 to 25 min. The percentage of patients who leave without being seen has decreased from 3.6% to 0.9%.

Pediatric sexual abuse: emergency department evaluation and management.

Pediatric sexual abuse is an overwhelming problem in the United States. It is estimated that 25% of females and 16% of males in the United States are sexually abused before the age of 18. The emergency department (ED) is frequently the point of entry for care of sexually abused children and adolescents. Personnel from the ED are usually the first "reporters" of sexual abuse, propelling these issues into the medicolegal system. Therefore, it is critical for ED practitioners to have the knowledge and skill set required to provide thorough, comprehensive care for this patient population. The ED holds a powerful position in the multidisciplinary approach to pediatric sexual abuse, involving social workers, child protective services, and law enforcement. This article presents the essential information required to assume a leadership role in the medical management of the sexually abused child/adolescent in the ED, including mandatory reporting, triage, assessment, treatment, and follow-up.