Experiences of rural nurses with emergency patient transport in a resource limited setting.

BACKGROUND: Registered nurses are primary care providers during most patient transfers from rural areas. Various local conditions and circumstances impact the provision of nursing care prior to and during transportation. These include clinic staffing, uneven access to functioning equipment and other necessary infrastructure across settings, the wide-ranging clinical need for specialty care, and complex social and interpersonal circumstances that play a role in care-seeking and transport decision-making. This study explored the experiences of nurses with emergency patient transport in rural health facilities in Botswana. METHOD: A qualitative descriptive approach was used using a semi structured interview. Twenty-six registered nurses from four remote, isolated rural health districts in Botswana participated in this study. Purposive convenience sampling technique was employed. RESULTS: The ten main themes under transporter were infringement of scope of practice, inadequate knowledge and skills, distressful practice, restriction from making decisions, challenges with staffing, Ineffective facilities clustering, lack of support from the managers, shortage of technology and tools, non-enabling infrastructure, and transport related tasks. DISCUSSION AND CONCLUSION: The perceived ineffective emergency transfer of patients was associated with work system shortfalls. The work system needs to be balanced and consider the requirements of the various stakeholders involved in the processes for optimal performance of patient transport.

Are You Ready for Some Football?

Football has become the most popular spectator sport in the United States today and attracts millions of players, both professional and amateur. This article discusses the risks of playing football. It is a contact sport and can result in a wide variety of injuries to the players. The rules of the game are based on adult participation; however, 2.8 million children participate in recreational tackle football every year. An understanding of the game and the risks associated with playing football is presented. The risks of the game are discussed with a focus on the prevention of injury. The most common injuries are presented, which include concussion and the major risk of traumatic brain injury. The importance of wearing appropriate protective gear and developing strategies to avoid head and neck injuries is presented. The role of parents and coaches is described, with tips on how to identify injuries and how to prevent them to guarantee the safety of players. Finally, the role of the nurse and other health care providers is discussed. This article presents an overview of the complexity of tackle football and strategies to keep the players safe.

Pediatric Femur Fractures.

Trauma is the leading cause of death and disability in children. Orthopaedic trauma has led to more than 84,000 hospital admissions annually and costs nearly a billion dollars. Femoral diaphyseal fractures account for nearly 2% of all bony injuries in children and are the most common orthopaedic injury requiring hospitalization. These injuries occur at an annual rate of 19 per 100,000, with an associated cost of millions of dollars. Emergency department (ED) visits for musculoskeletal injuries account for 10%-15% of the 100 million annual visits to U.S. pediatric EDs. Treatment of femur fractures in children vary on the basis of the mechanism of injury, the patient's age, weight, the fracture pattern, family circumstances, and cost. Treatment ranges from noninvasive to invasive and includes traction, casting, internal fixation, and external fixation. Complications can include infection, delayed or malunion, leg length discrepancy, ossification, and refracture. Attention to pain control and anxiety management becomes a major focus for nursing. Pediatric femur fracture can have a devastating impact on the child and the family and requires monitoring for 12-24 months. This injury is significant and can be a life-changing event for the child and the entire family. A case study is used as an example of the extent of the problem with pediatric patients and highlights the long-term effect of this injury.

Experiences of compassion fatigue in direct care nurses: a qualitative systematic review.

OBJECTIVE: The objective of this review was to describe the experiences of direct care nurses with work-related compassion fatigue. INTRODUCTION: The cumulative demands of experiencing and helping others through suffering have been considered to contribute to the potential of compassion fatigue. However, there is a lack of clarity on what specifically contributes to and constitutes compassion fatigue. Nurses suffering from compassion fatigue experience physical and emotional symptoms that leave them disconnected from patients and focused on the technical rather than the compassionate components of their role. This disconnect can also affect personal relationships outside of work. INCLUSION CRITERIA: This review included any qualitative studies describing the experiences of direct care nurses from any specialty or any nursing work setting. METHODS: This review followed the Joanna Briggs Institute (JBI) approach for qualitative systematic reviews. Studies included in this review include those published in full text, English and between 1992, when the concept of compassion fatigue was first described, and May 2017, when the search was completed. The main databases searched for published and unpublished studies included: PubMed, CINAHL, Academic Search Premiere, Science Direct, Scopus, PsycINFO, Web of Science and the Virginia Henderson Library. RESULTS: Twenty-three papers, representing studies conducted in seven countries and 821 total nurse participants, met the criteria for inclusion. From these, a total of 261 findings were extracted and combined to form 18 categories based on similarity in meaning, and four syntheses were derived: i) Central to the work of nursing and the professional environment in which nurses work are significant psychosocial stressors that contribute to compassion stress and, if left unchecked, can lead to compassion fatigue; ii) Protection against the stress of the work and professional environment necessitates that the individual and team learn how to respond to "the heat of the moment"; iii) Nurses and other administrative and colleague staff should be alert to the symptoms of compassion fatigue that present as profound, progressive, physical and emotional fatigue: a feeling that the nurse just can't go on and a sense of being disconnected and drained, like a gas tank on empty; and iv) Keeping compassion fatigue at bay requires awareness of the threat of compassion fatigue, symptoms of compassion fatigue, and the need for work-life balance and active self-care strategies. CONCLUSIONS: The major conclusions of this review are that compassion fatigue prevention and management must be acknowledged, and both personal and organizational coping strategies and adaptive responses are needed to keep nurses balanced, renewed and able to continue compassionate connection and caring.

School-Based and Community-Based Gun Safety Educational Strategies for Injury Prevention.

BACKGROUND: Nearly 1,300 children in the United States die because of firearm-related injury each year and another 5,790 survive gunshot wounds, making the prevention of firearm-related unintentional injury to children of vital importance to families, health professionals, and policy makers. OBJECTIVE: To systematically review the evidence on school-based and community-based gun safety programs for children aged 3 to 18 years. STUDY DESIGN: Systematic review. METHOD: Twelve databases were searched from their earliest records to December 2016. Interventional and analytic studies were sought, including randomized controlled trials, quasi-experimental studies, as well as before-and-after studies or cohort studies with or without a control that involved an intervention. The low level of evidence, heterogeneity of studies, and lack of consistent outcome measures precluded a pooled estimate of results. A best evidence synthesis was performed. RESULTS: Results support the premise that programs using either knowledge-based or active learning strategies or a combination of these may be insufficient for teaching gun safety skills to children. CONCLUSIONS: Gun safety programs do not improve the likelihood that children will not handle firearms in an unsupervised situation. Stronger research designs with larger samples are needed to determine the most effective way to transfer the use of the gun safety skills outside the training session and enable stronger conclusions to be drawn.

Pediatric Emergence Delirium: A Case Study.

The pathophysiology of emergence delirium (ED) remains a mystery. Using a case study approach, ED is discussed from a clinical perspective. The case is a 4-year-old male who had myringotomy tube placement while anesthetized with sevoflurane. The negative outcome for this child is presented. The epidemiology of the phenomena is reviewed and definitions are examined. Several methods to assess ED are presented, accompanied by a discussion of the development of assessment tools. Research findings are included that address the possible causes of ED including preoperative anxiety, rapid awakening, pain, and a predisposition for this phenomenon in certain children. Various interventions, both pharmacologic and nonpharmacologic are considered. The impact of anesthesia on pediatric brain development is discussed and finally some possible solutions are hypothesized.

Perioperative Delirium Protocol for the Older Patient.

PURPOSE: Delirium is an acute change in cognition and attention. It may affect any age group. It is most common in older patients and is associated with a significant increase in mortality. The purpose of this project was to implement an assessment protocol to identify patients at risk for postoperative delirium. DESIGN: A case study approach was used. METHODS: The Confusion Assessment Method (CAM) tool for screening and diagnostic purposes was used to train surgeons, anesthesia providers, and nurses. A standardized delirium assessment and management protocol was developed and implemented. FINDINGS: The CAM and geriatric preoperative assessment was used with the patient discussed in the case study. The patient did not experience postoperative delirium and was discharged from perioperative services on the same day. CONCLUSION: Evidence informs us that early recognition and multifaceted interventions can prevent postoperative delirium in the elderly.

Bilateral Patellar Tendon Rupture.

The knee is the most complex and largest joint in the body. Injuries to any part of this joint affect the entire body. There are multiple injuries that can occur to the knee, with the most common being ligament and meniscus tears. A not-so-common injury to the knee is a patellar tendon rupture. A bilateral patellar tendon rupture is extremely rare. A case study of a 43-year-old man who sustained a bilateral patellar tendon rupture while playing softball is used to present this devastating injury. This discussion includes the incidence and diagnosis of the tear, surgical repair, as well as a description of the comprehensive rehabilitation process necessary to allow the patient to return to normal physical activity. Risks and complications of this surgery and the expected outcomes are also presented.

Strategies that reduce compassion fatigue and increase compassion satisfaction in nurses: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE: The objective of this quantitative systematic review is to determine effective strategies to reduce compassion fatigue and improve compassion satisfaction among nurses.

Experiences of compassion fatigue in direct care nurses: a qualitative systematic review protocol.

REVIEW QUESTION/OBJECTIVES: The objective of this qualitative systematic review is to examine available evidence on the experiences of direct care nurses of compassion fatigue (CF) within any nursing specialty or care setting. Specifically, this review will identify evidence on the following.

A 52-Year-Old Man With a Tuft Fracture and Hand Cellulitis.

A 52-year-old man presented to the emergency department (ED) 1 week after getting his right index finger shut in a car door. The patient complained of right index finger pain. His entire hand was edematous and reddened. After evaluation in the ED and x-ray, the patient was diagnosed with a tuft fracture, right index finger/hand cellulitis, and possible osteomyelitis. The patient received tetanus diphtheria i.m., vancomycin 1 g i.v., and ceftriaxone (Rocephin) 2 g i.v. while in the ED and was admitted with referral to a hand specialist. The patient was discharged after 10 days of parental antibiotics. He has a history of sarcoidosis, hypertension, diabetes mellitus, and scleroderma. He is currently not taking any medications and denies allergies to medications and latex. The patient had no significant somatic findings. He was afebrile.

Disorders of the hand: a case study approach.

Using a case study approach, 2 disorders of the hands are presented. Dupuytren's contractures and bilateral trigger finger are described with a discussion of the interventions, including injection and surgical repair. Dupuytren's disease is a contracture of the connective tissue in the hand. It is also known as palmar fibromatosis and can occur bilaterally. This is a progressive disorder and causes deformity of the hands and eventually results in a decrease of functionality. Trigger finger is a common finger ailment that also causes deformity of the hand. This disorder is often referred to as stenosing tenosynovitis and can occur in several fingers bilaterally. The inflammation and hypertrophy of the sheath restricts the motion of the flexor tendon that results in triggering of the affected finger. It is painful and disabling. The etiology, prevalence, incidence, diagnosis, treatment, and nursing care of these disorders are discussed.

Generational differences and learning style preferences in nurses from a large metropolitan medical center.

Nursing educators face the challenge of presenting educational programs to meet the learning needs of four diverse generational groups of nurses. This cross-sectional survey examined if there is a relationship between staff nurses' generation and their learning styles. Results show that a combination of years in practice, time lapsed since last educational program ended, current school enrollment, degree earned, and generation influences preferred learning style. Implications for educators are discussed.

The silent thief: diagnosis and management of osteoporosis.

Osteoporosis causes approximately 1.5 million fractures every year in the United States. Not only can these fractures be painful and disfiguring but they may reduce a person's ability to lead an active life as well. Osteoporosis affects every bone in the body, but the most common places where fractures occur are the back, hips, and wrists. Because osteoporosis thins bones, weakening them and making them more susceptible to fractures, practitioners must understand the risk factors and the diagnosis and management of this very common problem. This article, geared toward advanced practice nurses, presents a summary of the latest diagnostic tests and medication treatments available and approved by the Food and Drug Administration for the management of osteoporosis.

Barriers and perceived needs for understanding and using research among emergency nurses.

INTRODUCTION: Nurses are involved in conducting research and incorporating evidence into their practice. However, barriers exist at the individual, unit, and organizational level related to understanding, conducting, and evaluating the evidence. The Emergency Nurses Association (ENA) conducted a study to understand levels of education in research, the extent of experience, and needs and barriers to research at the individual and organizational levels in emergency nursing. METHODS: A cross-sectional survey design was used to poll members of the ENA. A 62-item survey instrument was designed to assess five areas: 1) nurses' research values, skills, experience, and awareness; 2) organizational settings' opportunities, barriers, and limitations to research; 3) nurses' understanding and comprehension of research and evidence; 4) presentation and accessibility of research; and 5) continuing educational topics to improve knowledge of the research process. RESULTS: Respondents (n = 948) identified barriers at the individual level that included lack of knowledge about critiquing research studies and familiarity with the research process. Barriers at the unit level included obtaining help from administrators and other staff in starting a project or having the authority to change practice. Barriers at the institution level included lack of support systems such as protected time to conduct research or implement changes in practice. DISCUSSION: Emergency nurses are highly motivated and interested in learning more about conducting and utilizing research to improve practice. Perceived personal, unit-based, and organizational barriers were identified through this research in an effort to highlight areas for improvement at the local and national levels.

Introducing medical students to the interdisciplinary health care team: piloting a case-based approach.

Medicine in the 21st century requires expanded multidisciplinary problem-solving in order to deliver cost-effective, quality health care, yet many medical schools still educate their students in relative isolation with little interaction or understanding of other health care professionals. To begin to address this issue, the University of Medicine and Dentistry of New Jersey (UMDNJ) School of Health Related Professions and School of Nursing were invited by the New Jersey Medical School to introduce medical students at the New Jersey Medical School to a cross-section of health professions they are likely to encounter. These health professions included medical imaging, dietetics-nutrition, laboratory technology, nursing, physical therapy, physician assistant, respiratory therapy and social work. During a 60-min educational session, a simulated case-based approach heightened medical school students' awareness of the function and value of interdisciplinary collaboration. Faculty from each of the eight disciplines gave a brief summary of their profession, including their scope-of-practice and academic requirements. At the end of the session, participants were given a brief 12-item survey to evaluate the experience. Though this was only a small, explorative project, survey results suggested that participants increased their understanding of other health professions, including when to refer to and collaborate with these professions. Feedback from this pilot project may be used to optimize future initiatives of this type.