Finger Thoracostomy for Tension Pneumothorax.

One of the injuries associated with chest trauma is pneumothorax, a condition where air accumulates between the parietal and visceral pleura in the chest leading to collapse of the lung due to pressure. Left untreated, a tension pneumothorax may develop leading to cardiovascular collapse. This article reviews the development of a tension pneumothorax, discusses the clinical recognition of the diagnosis, and outlines the procedure for performing a finger (or simple) thoracostomy. A simple mnemonic for the procedure is offered as a memory aid to reduce cognitive load for this procedure.

Analysis of nurse practitioner practice in US emergency departments: Evidence supporting educational preparation, credentialing, scope of practice, and outcomes.

ABSTRACT: The nurse practitioner (NP) role within emergency care has grown in recent years and now there are an estimated 25,000 NPs employed in diverse emergency care settings. Despite this significant growth and expansion of the NP within emergency care areas, challenges exist. In addition to the pervasive confusion regarding the NP role in emergency care, data and statistics detailing characteristics and outcomes of NP practice in emergency care are either lacking or misrepresented. This article explores barriers and provides current and accurate information describing the current educational preparation, credentialing, scope of practice, and outcomes among NPs in US emergency departments. The totality of available evidence reviewed supports safe, timely, efficient, and patient-centered care provided by NPs in emergency care.

Consideration of the emergency nurse practitioner as a population within the APRN Consensus Model: A SWOT analysis.

ABSTRACT: After adoption of the 2008 Consensus Model for Advanced Practice Registered Nurse (APRN) Regulation, evolution of the nurse practitioner (NP) role and emergency NP (ENP) specialty has outpaced regulatory standards. Lack of uniformity among regulators, health insurance providers, and employers in acknowledging the ENP specialty has created barriers to practice and access to care. This article serves to identify potential outcomes if the ENP specialty was transitioned to a population within the Consensus Model of Regulation. A strengths, weaknesses, opportunities, and threats (SWOT) analysis methodology was used to assess ENP specialty current state, specifically focusing on the licensure, accreditation, certification, and education model for APRN regulation. The data were collected from peer-reviewed literature, clinical subject-matter experts, and academic and advanced practice executive leaders. Variances in ENP licensure, recognition, and acknowledgment among State Boards of Nursing leave the ENP specialty in a precarious position. For each of the strengths and opportunities that could exist in recognizing the ENP at the population level of the Consensus Model, there are abundant weaknesses and threats. Although full acknowledgment of the ENP specialty is lacking, regulatory implications are highly variable, and employers' understanding of the APRN educational model is limited, our findings reveal that the ENP specialty is an evolving role that deserves regulatory legitimization. Although ideal placement for the ENP within the Consensus Model remains to be determined, challenges and opportunities exist with both specialty and population options.

Utilization of Phone Simulations to Assess Competency Within Nursing Education.

BACKGROUND: Phone simulations offer educators unique opportunities for teaching and assessment with reduced scheduling and location barriers. PROBLEM: Challenges to learner assessments are multifaceted, including decreased availability of clinical sites, preceptors, and, at times, clinical instructors. APPROACH: This article describes the creation and implementation of diverse phone simulations at multiple levels of nursing education and provides suggestions for broader replication and adaptation. OUTCOMES: Phone simulations are easily implemented, well received, and helpful in assessing student learning and progression. At the generalist level, telephone SBAR (situation, background, assessment, and recommendation) simulations promote essential communication skills imperative in the delivery of safe and effective care. For advanced practice learners, phone simulations are easily applied across multiple populations and specialties. Guided reflections following simulation offer learners an opportunity to immediately self-remediate. CONCLUSIONS: Phone simulations provide adaptable opportunities to support learning and assess knowledge and competency within educational and clinical settings.

Postpartum Hemorrhage: Emergency Management for Uncontrolled Vaginal Bleeding.

Postpartum hemorrhage (PPH) represents total cumulative blood loss in excess of 1,000 ml or blood loss accompanied by signs and/or symptoms of hypovolemia within 24 hr following birth (The American College of Obstetricians and Gynecologists [ACOG], 2017). As a large number of PPHs occur in low-risk women (ACOG, 2019), the emergency nurse practitioner must be prepared to identify and manage this uncommon but life-threatening condition. The etiology, pharmacological management strategies, and other interventions are reviewed in an algorithmic approach. This organized approach not only supports maternal survival during PPH but is also applicable to postprocedural bleeding of obstetric and gynecological etiologies.

Bridging Didactic Learning and the Complexity of Practice Through Clinical Immersion: Evaluating the Sexual Assault Nurse Examiner Trainee Experience.

ABSTRACT: In this article, we discuss the development and evaluation of the Vanderbilt Nursing Education Program for Sexual Assault Nurse Examiners (VEP-SANE), a 3-day clinical immersion (CI) program, including the lessons learned and the challenges experienced with the completion of two trainee cohorts. To bridge didactic learning and the complexity of practice, the VEP-SANE team designed an innovative, competency-based CI. Fifteen trainees from Cohort 1 and 19 trainees from Cohort 2 met requirements for CI participation. Trainees in Cohort 1 represented the advanced practice registered nurse specialties of emergency, women's health, and pediatrics. For Cohort 2 recruitment, enrollment was expanded to include family and midwifery advanced practice registered nurse specialties. Trainees were required to complete online training modules before CI participation. Online surveys assessed trainee perceptions about levels of knowledge and confidence related to sexual assault nurse examiner competencies (pre/post CI), each CI session, and the overall CI experience. Separate focused discussions were conducted with trainees and faculty after each CI. Both cohorts rated CI sessions as "excellent" or "very good" over 93% of the time. Perceived levels of knowledge and confidence increased from pre-CI to post-CI for both cohorts. Similar CI strengths were identified across trainees and faculty including speakers, high interactivity, safe environment, reality of cases, and surrogate practice. All trainees indicated readiness for preceptorships and interest in a virtual community of practice. Suggestions included more time for laboratory sessions, documenting photos, and interaction with individuals from the lesbian, gay, bisexual and transgender (LGBT) community and presenters. Future efforts focus on CI conversion to a virtual format because of the impact of COVID-19, increased VEP-SANE community of practice interaction, and expanded engagement with practicing sexual assault nurse examiners.

Supporting program rigor in newly developed specialty academic programs: Use of a self-evaluation reporting tool for emergency nurse practitioner academic programs.

The emergency nurse practitioner (ENP) specialty has grown rapidly, responding and adapting to changes in emergency care. Designation and advancement of nurse practitioner (NP) specialties follows a systematic process as defined by the profession. This includes establishment of scope and standards of practice, educational standards, and policy initiatives to ensure quality and safety within the profession. This article serves to detail a process of self-evaluation for newly developed ENP academic programs, including resources and key documents to be considered in the development of NP specialty programs. A transformative tool is included that serves as a model for use in development and self-evaluation of other emerging graduate academic NP specialty programs.

Dental Pain Relief in the Age of ALTO.

The opioid public health crisis necessitates that health care providers seek alternatives to opioid pain control. For patients presenting with dental pain, a dental nerve block provides effective, long-lasting pain relief without the use of opioid pain medications. This article presents the techniques required to safely and effectively administer 3 types of dental nerve blocks, allowing the emergency nurse practitioner to provide effective pain control to patients with dental pain.

Word Catheter Placement for Bartholin's Gland Abscess: Applications for Clinical Practice and Simulation.

For women who present with Bartholin's abscesses, placement of a Word catheter offers a minimally invasive approach for effective management in urgent care and emergency department settings. Although the procedure is relatively simple, the frequency of placement in the ED setting varies. Provider familiarity with both the device and the procedure can be enhanced using simulation techniques. This article presents the diagnostic and treatment approaches to Bartholin's abscesses and describes in detail both low- and high-fidelity simulations for Word catheter placements.