Assistência de urgência e emergência: desafios no atendimento a múltiplas vítimas / Urgency and emergency assistance: challenges in caring for multiple victims / Urgencias y emergencias: retos en la atención a múltiples víctimas

A urgência e emergência, por sua vez, se faz como ocorrência imprevista com ou sem risco potencial à vida, onde o indivíduo necessita de assistência e pressupõem atendimento rápido, proporcional a sua gravidade. O presente trabalho tem o objetivo de promover reflexões acerca dos desafios que surgem diante do atendimento a múltiplas vítimas nos serviços médicos de urgência e emergência. Trata-se de uma revisão integrativa da literatura. Realizou-se uma análise de materiais já publicados na literatura e artigos científicos divulgados em bases de dados: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online e Localizador de informação em Saúde. Foram encontradas nas bases de dados, 25 estudos completos, após a leitura dos resumos, 21 artigos foram selecionados para análise na íntegra, sendo 17 eleitos para integrar a revisão integrativa. Diante dos resultados obtidos, observou que as equipes de atendimento pré- hospitalar vivenciam desafios para atender múltiplas vítimas, e dentro desse paradigma existem várias etapas que devem ser seguidas, que envolvem comunicação desde um protocolo de atendimento inicial ao transporte final. Portanto, observa-se a necessidade de maiores estudos e desenvolvimento de novas tecnologias que auxiliam na assistência a múltiplas vítimas, como também o prepara e atualização dos profissionais.

Urgency and emergency, in turn, is made as an unforeseen occurrence with or without potential risk to life, where the individual needs assistance and quick care, in turn, proportional to its severity. The work of emergency care and the need to respond to problems presented in urgent and emergency services. This is an integrative literature review. An analysis was performed of materials already published in the literature and articles published in databases: Scientific Electronic Library Online, Medical Literature Analysis and Retrieval System Online and Health Information Locator. All studies were complete, after reading the studies,21 articles were selected for full analysis, with 17 studies elected to integrate the integrative review. Results obtained, observed that pre care teams experience challenges to support various hospital communication protocols, and within these paradigms from initial care to transport. Therefore, there is a need for studies and development of technologies that assist in the installation of larger and more up-to-date devices, there is a need for studies and development of new technologies, as well as preparation.

La atención de urgencia y emergencia es un suceso imprevisto con o sin riesgo potencial para la vida, en el que el individuo necesita asistencia y requiere una atención rápida, proporcional a su gravedad. Este documento pretende promover la reflexión sobre los retos que surgen al tratar con múltiples víctimas en los servicios médicos de urgencia y emergencia. Se trata de una revisión bibliográfica integradora. Se ha realizado un análisis de los materiales publicados en la literatura y los artículos científicos divulgados en las bases de datos: Scientific Eletronic Library Online, Medical Literature Analysis and Retrieval System Online y Localizador de información en Salud. Se encontraron en las bases de datos, 25 estudios completos, después de leer los resúmenes, se seleccionaron 21 artículos para el análisis en su totalidad, siendo 17 elegidos para integrar la revisión integradora. A partir de los resultados obtenidos, se observa que los equipos de atención prehospitalaria viven desafíos para atender a múltiples víctimas, y dentro de este paradigma existen varias etapas que deben seguirse, que implican la comunicación desde un protocolo de atención inicial hasta el transporte final. Por lo tanto, se observa la necesidad de realizar más estudios y desarrollar nuevas tecnologías que ayuden en la asistencia a las múltiples víctimas, así como la preparación y actualización de los profesionales.

Entraves e desafios na atuação do enfermeiro nos serviços de urgência e emergência / Barriers and challenges in nursing's performance in emergency and emergency services / Barreras y retos en el desempeño de enfermería en servicios de emergencia y emergencia

Objetivo: identificar os principais entraves e desafios enfrentados pelo enfermeiro atuante nos serviços de urgência e emergência. Método: trata-se de uma revisão narrativa. Utilizou-se artigos publicados nos últimos cinco anos, disponíveis nas principais bases de dados, em três idiomas, contemplando a temática em seu título, resumo ou assunto. Inicialmente encontrou-se 12.370 arquivos, que ao passarem pelos critérios de exclusão e leitura simplificada culminou na abordagem de 28 artigos. Resultados: dentre os principais achados destacam-se: a grande demanda do serviço, carga horária exaustiva, baixos salários, situações de estresse, eventos adversos, além da falha na comunicação e relação interprofissional. Conclusão: há a prevalência dos entraves nos diversos serviços de urgência e emergência, contudo, são apontadas diversas soluções com potencial de aplicabilidade, na tentativa de gerir os entraves e sanar os desafios identificados

Objective: to identify the main obstacles and challenges faced by nurses working in urgent and emergency services. Method: this is a narrative review. Articles published in the last five years, available in the main databases, in three languages, covering the theme in its title, abstract or subject, were used. Initially, 12,370 files were found, which when passing through the criteria of exclusion and simplified reading culminated in the approach of 28 articles. Results: among the main findings, we highlight: the great demand for the service, exhaustive workload, low wages, stressful situations, adverse events, in addition to the failure in communication and interprofessional relationship. Conclusion: there is a prevalence of obstacles in the various urgency and emergency services, however, several solutions with potential applicability are pointed out, in an attempt to manage the obstacles and solve the identified challenges

Objetivo: identificar los principales obstáculos y desafíos que enfrentan los enfermeros que trabajan en los servicios de urgencias y emergencias. Método: esta es una revisión narrativa. Se utilizaron artículos publicados en los últimos cinco años, disponibles en las principales bases de datos, en tres idiomas, cubriendo el tema en su título, resumen o tema. Inicialmente se encontraron 12.370 expedientes, que al pasar por los criterios de exclusión y lectura simplificada culminaron en el abordaje de 28 artículos. Resultados: entre los principales hallazgos se destacan: la gran demanda del servicio, la carga de trabajo exhaustiva, los bajos salarios, las situaciones estresantes, los eventos adversos, además de fallas en la comunicación y relación interprofesional. Conclusión: existe un predominio de obstáculos en los distintos servicios de urgencia y emergencia, sin embargo, se señalan varias soluciones con potencial aplicabilidad, en un intento de gestionar los obstáculos y resolver los desafíos identificados

Association between Manchester Triage System discriminators and nursing diagnoses. / Associações entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfermagem.

OBJECTIVE: To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD: Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test. RESULTS: 16 discriminators and 14 nursing diagnoses were identified. Associations were found between seven discriminators and five problem-focused nursing diagnoses, including the discriminator Cardiac pain and the diagnosis Acute pain. Three discriminators were associated with four risk nursing diagnoses, among these Acute neurological deficit with the diagnosis Risk of ineffective cerebral tissue perfusion. CONCLUSION: Significant associations were found between Manchester Triage System discriminators and the nursing diagnoses most frequently established in the emergency department.

Outcomes following emergency laparotomy in Australian public hospitals.

BACKGROUND: International studies reporting outcomes following emergency laparotomies have consistently demonstrated wide inter-hospital variation and a 30-day mortality in excess of 10%. The UK then prioritized the funding of the National Emergency Laparotomy Audit. In a prospective Western Australian audit there was minimal inter-hospital variation and a 6.6% 30-day mortality. In the absence of any multi-hospital Australian data the aim of the present study was to compare national administrative data with that previously reported. METHODS: Data on emergency laparotomies performed in Australian public hospitals during 2013/2014 and 2014/2015 were extracted from admitted patient activity and costing data sets collated by the Independent Hospital Pricing Authority. The data sets, containing episode-level data relating to admitted acute and sub-acute care patients, included administrative, demographic and clinical information such as patient age, cost, length of stay, in-hospital mortality, diagnosis and surgical procedure details. RESULTS: Ninety-nine public hospitals undertaking at least 50 emergency laparotomies performed 20 388 procedures over the 2 years. The overall in-hospital mortality was 5.2%. There was a wide interstate and inter-hospital variation in risk-adjusted in-hospital mortality (4.8-6.6% and 0-9.3%, respectively), length of stay (12.5-16.8 days and 5.8-18.9 days, respectively) and intensive care unit admissions (24.5-40.2% and 0-75.7%, respectively). CONCLUSION: This data suggest the wide variation in outcomes and care process observed overseas exist in Australia. However, administrative data has considerable limitations and is not a substitute for high quality prospective data. Minimizing variations through prospective quality improvement processes will improve patient outcomes.

Associações entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfermagem / Asociación entre el Sistema de Triage Manchester y el diagnóstico de enfermería / Association between Manchester Triage System discriminators and nursing diagnoses

Resumo OBJETIVO Analisar associações entre discriminadores do Sistema de Triagem de Manchester e Diagnósticos de Enfermagem em pacientes adultos, classificados com prioridade clínica I (emergência) e II (muito urgente). MÉTODO Estudo transversal realizado na unidade de emergência do sul do Brasil, entre abril e agosto de 2014. Amostra de 219 pacientes. Os dados foram coletados no prontuário online e analisados estatisticamente, com teste exato de Fisher ou qui-quadrado. RESULTADOS Encontrou-se 16 discriminadores e 14 diagnósticos de enfermagem. Houve associação entre sete discriminadores e cinco diagnósticos de enfermagem do tipo foco no problema, dentre Dor precordial ou cardíaca com o diagnóstico Dor aguda. Também houve associação entre três discriminadores com quatro diagnósticos de enfermagem de risco, dentre Déficit neurológico agudo com o diagnóstico Risco de perfusão tissular cerebral ineficaz. CONCLUSÃO Existem associações significativas entre discriminadores do Sistema de Triagem de Manchester e diagnósticos de enfermagem mais frequentemente estabelecidos na Unidade de Emergência.

Resumen OBJETIVO Analizar asociaciones entre los discernidores del Sistema Triaje de Manchester y los Diagnósticos de Enfermería en pacientes adultos con prioridad clínica I (emergencia) y II (muy urgente). MÉTODO Estudio transversal realizado en la unidad de emergencia del sur de Brasil, entre abril y agosto de 2014, con la muestra de 219 pacientes. La colecta de datos fue realizada en el prontuario online de los pacientes. El análisis estadístico fue realizado con el uso del Test Exacto de Fisher o chi-cuadrado. RESULTADOS Fue identificado el uso de 16 discernidores y 14 diagnósticos de enfermería. Hubo una asociación entre siete discernidores y cinco diagnósticos de enfermería del tipo foco en el problema, entre estos Dolor precordial o cardíaca y Dolor agudo. También hubo asociación entre tres discernidores y cuatro diagnósticos de enfermería de riesgo, entre estos Déficit neurológico agudo con el diagnóstico Riesgo de perfusión tisular cerebral ineficaz. CONCLUSIÓN Existen asociaciones significativas entre los discernidores del Sistema Triaje de Manchester y los diagnósticos de enfermería más frecuente establecidos en la Unidad de Emergencia.

Abstract OBJECTIVE To analyze the association between Manchester Triage System flowchart discriminators and nursing diagnoses in adult patients classified as clinical priority I (emergency) and II (very urgent). METHOD Cross-sectional study conducted in an emergency department in southern Brazil between April and August 2014. The sample included 219 patients. Data were collected from online patient medical records and data analysis was performed using Fisher's exact test or the chi-square test. RESULTS 16 discriminators and 14 nursing diagnoses were identified. Associations were found between seven discriminators and five problem-focused nursing diagnoses, including the discriminator Cardiac pain and the diagnosis Acute pain. Three discriminators were associated with four risk nursing diagnoses, among these Acute neurological deficit with the diagnosis Risk of ineffective cerebral tissue perfusion. CONCLUSION Significant associations were found between Manchester Triage System discriminators and the nursing diagnoses most frequently established in the emergency department.

Demanda de pacientes com diabetes mellitus em unidade de urgência de um hospital universitário / Perfil de los pacientes con diabetes mellitus en el servicio de urgencias de un hospital universitario / Profile of patients with diabetes mellitus in the emergency unit of a university hospital

RESUMO Este é um estudo transversal, cujo objetivo foi identificar o perfil de pacientes com diabetes mellitus em Unidade de Urgência. A amostra probabilística foi constituída por 247 pacientes de um hospital do interior paulista, Brasil, em 2009. Um formulário estruturado, contendo variáveis sociodemográficas, clínicas e relacionadas às orientações de enfermagem, oferecidas na alta hospitalar, foi utilizado para obtenção dos dados nos prontuários de saúde. Para análise dos dados, foi utilizada estatística descritiva. Os resultados mostraram que os pacientes admitidos eram predominantemente do gênero feminino (53,4%), brancos (79,8%), com baixa escolaridade (76,6%) e idade entre 58 e 77 anos (50,2%); média de 62 anos e desvio-padrão de 15,3 anos. Quanto à procura pelo atendimento, os diagnósticos mais prevalentes foram: problemas cardiovasculares (22,3%) e cerebrovasculares (13%). O diabetes foi considerado motivo secundário para admissão no serviço, o primário foi relacionado apenas à queixa principal do paciente. O tempo de internação foi, em média, de quatro dias, com mediana de nove dias e desvio-padrão de 21,7. As orientações de enfermagem registradas em prontuário na alta hospitalar se restringiram aos retornos ambulatoriais. Há necessidade de melhor articulação da rede de atenção primária e hospitalar para redução da demanda evitável de pacientes com diabetes em unidade de urgência.

RESUMEN Este es un estudio transversal, cuyo objetivo fue identificar el perfil de pacientes con diabetes mellitus en Unidad de Urgencias. La muestra probabilística fue constituida por 247 pacientes de un hospital del interior del estado de São Paulo, Brasil, en 2009. Un formulario estructurado, conteniendo variables sociodemográficas, clínicas y relacionadas con las orientaciones de enfermería, ofrecidas en el alta hospitalaria, fue utilizado para la recolección de los datos en los registros médicos. Para el análisis de los datos fue utilizada la estadística descriptiva. Los resultados señalaron que los pacientes ingresados eran predominantemente mujeres (53,4 %), blancos (79,8 %), con un bajo nivel de educación (76,6 %), y de edades comprendidas entre 58 y 77 años (50,2 %); promedio de 62 años y desviación estándar de 15,3 años. En cuanto a la demanda por la atención de salud, los diagnósticos más frecuentes fueron: problemas cardiovasculares (22,3 %) y cerebrovasculares (13%). La diabetes fue considerada la segunda razón para el ingreso en el servicio; el objetivo primario fue relacionado solo a la queja principal del paciente. La duración de la hospitalización fue de un promedio de cuatro días, con una media de nueve días y una desviación estándar de 21,7 días. Las orientaciones de enfermería encontradas en los registros médicos en el alta hospitalaria se restringieron a los regresos al hospital. Es necesaria una mejor coordinación entre la red de atención primaria y hospitalaria para reducir la demanda evitable de los pacientes con diabetes en la unidad de urgencias.

ABSTRACT This cross-sectional study aimed to identify the profile of patients with diabetes mellitus cared for by the Emergency Room of a university hospital in the interior of São Paulo, Brazil, in 2009. The probabilistic sample was composed of 247 patients. A structured form addressing sociodemographic and clinical variables and those related to nursing orientation provided at discharge was used to collect data. The results show that patients admitted to the unit were predominantly women (53.4%), Caucasian (79.8%), with a low educational level (76.6%), and aged between 58 and 77 years old (50.2%); 62 years old on average with a standard deviation of 15.3 years. Regarding demand for care, the most prevalent diagnoses were cardiovascular (22.3%) and cerebrovascular (13%) conditions. Diabetes was considered the secondary reason for being admitted to the service, while the primary reason was related only to the patients' main complaints. The length of hospitalization was four days on average, with a median of nine days and a standard deviation of 21.7 days. The nursing orientations recorded in the discharge records were restricted to return visits. Cooperation between primary healthcare and hospital networks needs to be improved to decrease avoidable demand of patients with diabetes for the emergency room.

A cost-effective approach to simulation-based team training in obstetrics.

Many larger facilities regularly stage obstetric drills in modern simulation departments equipped with expensive simulators. Despite lacking these resources, we wanted to provide effective simulation training at our rural hospital. A team of clinicians and educators developed a cost-effective and time-efficient simulation drill for nurses, which included both a didactic review and a simulation day. The drill included obstetric providers and incorporated scenarios for shoulder dystocia, neonatal resuscitation and postpartum hemorrhage. This was a successful multidisciplinary learning experience that was high in creativity and teamwork, but low in cost.

Planning a collaborative conference to provide interdisciplinary education with a focus on patient safety in obstetrics.

Collaboration is an important component of evidence-based practice in modern health care. A number of publications have touted the benefits of "team training" to improve obstetric outcomes during emergent situations. In August 2011, the Ohio sections of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the American Congress of Obstetricians and Gynecologists (ACOG) held a joint conference that focused on interdisciplinary education to promote patient safety. This joint venture drew more than 120 attendees, 12 exhibitors and 17 poster displays. Evaluations were positive and attendees cited planned practice changes for themselves as well as for their respective institutions.

Developing a process to support perinatal nurses after a critical event.

The work of perinatal nurses sometimes includes emergencies involving death, or near death, which can leave health care providers with feelings of stress and grief. After experiencing a particularly stressful period, nurses at our organization identified processes to help themselves recover and to support each other. The result of this work is a written plan to facilitate the support of perinatal nurses after critical events. This article describes the development and implementation of this plan.

Itinerários terapêuticos em urgências e emergências pediátricas em uma comunidade quilombola / Itinerarios terapéuticos en urgencias y emergencias pediátricas en una comunidad quilombola / Therapeutic itineraries in pediatric urgencies and emergencies in a quilombola community

O Itinerário Terapêutico (IT) compreende o conjunto de práticas e estratégias de cuidado adotadas por pessoas e famílias, englobando a motivação que direciona a busca por cuidados, que está associada ao contexto sociocultural e à disponibilidade de recursos. O objetivo foi conhecer os IT em situações de urgência e emergência pediátricas adotados por uma comunidade quilombola. Trata-se de um estudo descritivo, com abordagem qualitativa, que teve como suporte teórico a Teoria Transcultural do Cuidado de Madeleine Leininger. Para contextualizar o objeto de estudo, buscou-se aprofundamento nas temáticas: urgências e emergências pediátricas, condições de vida e saúde da população negra no Brasil e itinerários terapêuticos na busca por cuidados em saúde. O estudo foi desenvolvido na comunidade quilombola de Praia Grande, localizada na Ilha de Maré, em Salvador-BA, com doze mães de crianças para as quais já prestaram alguma assistência em situação de urgência/emergência. Os dados foram coletados de dezembro/2013 a junho/2014 por meio de entrevista semiestruturada, após aprovação da pesquisa pelo comitê de ética da Universidade Federal da Bahia, sob o protocolo nº 420.096. Para tratamento dos dados foi utilizada a técnica de análise temática de Bardin, que deu origem a três artigos: 1) Percepções de urgência e emergência pediátrica entre quilombolas: uma abordagem à luz de Leininger; 2) Itinerário terapêutico em situações de urgência e emergência pediátrica em uma comunidade quilombola; e 3) Funcionamento de ambulanchas em uma comunidade quilombola ilhéus: percepção da população. Os resultados demonstram que as percepções acerca das situações de urgência/emergência pediátrica são plurais e abarcam desde fatores biológicos até problemas e necessidades relacionadas ao contexto social e geográfico da comunidade, que também influenciam na construção do IT. As situações caracterizadas como urgência/emergência neste estudo foram crise convulsiva febril, febre alta, desidratação, crise asmática e queimadura. O IT teve início no subsistema popular, a partir dos cuidados prestados pela família e a rede de suporte social inerente a este subsistema, com recursos da vida diária, como chás, remédios caseiros, banhos, automedicação e massagens. A passagem pelo subsistema profissional ocorreu após tentativas de cuidado no subsistema popular e se revelou como uma peregrinação pelas instituições de saúde, caracterizando a dificuldade de acesso dos quilombolas aos serviços do sistema formal. Ficou evidenciado que a atenção primária não funciona como porta de entrada do SUS naquela comunidade no que se refere às situações de urgência/emergência e também que o serviço de ambulanchas não é efetivo, visto que as pessoas não obtêm resposta aos seus chamados, demonstrando desvirtuação do seu propósito e consequente descrédito da população. Com este estudo, permitimos que as mães compartilhassem suas experiências e expressassem as dificuldades enfrentadas no acesso aos serviços de saúde do subsistema formal, o que serviu de diagnóstico das fragilidades e insuficiência deste subsistema. Com isso, alertamos para a necessidade de elaboração de políticas públicas que garantam à comunidade quilombola de Praia Grande o acesso integral aos serviços ofertados pelo sistema formal, possibilitando o alcance do cuidado congruente referido por Leininger. (AU)

Involving traditional birth attendants in emergency obstetric care in Tanzania: policy implications of a study of their knowledge and practices in Kigoma Rural District.

INTRODUCTION: Access to quality maternal health services mainly depends on existing policies, regulations, skills, knowledge, perceptions, and economic power and motivation of service givers and target users. Critics question policy recommending involvement of traditional birth attendants (TBAs) in emergency obstetric care (EmoC) services in developing countries. OBJECTIVES: This paper reports about knowledge and practices of TBAs on EmoC in Kigoma Rural District, Tanzania and discusses policy implications on involving TBAs in maternal health services. METHODS: 157 TBAs were identified from several villages in 2005, interviewed and observed on their knowledge and practice in relation to EmoC. Quantitative and qualitative techniques were used for data collection and analysis depending on the nature of the information required. FINDINGS: Among all 157 TBAs approached, 57.3% were aged 50+ years while 50% had no formal education. Assisting mothers to deliver without taking their full pregnancy history was confessed by 11% of all respondents. Having been attending pregnant women with complications was experienced by 71.2% of all respondents. Only 58% expressed adequate knowledge on symptoms and signs of pregnancy complications. Lack of knowledge on possible risk of HIV infections while assisting childbirth without taking protective gears was claimed by 5.7% of the respondents. Sharing the same pair of gloves between successful deliveries was reported to be a common practice by 21.1% of the respondents. Use of unsafe delivery materials including local herbs and pieces of cloth for protecting themselves against HIV infections was reported as being commonly practiced among 27.6% of the respondents. Vaginal examination before and during delivery was done by only a few respondents. CONCLUSION: TBAs in Tanzania are still consulted by people living in underserved areas. Unfortunately, TBAs' inadequate knowledge on EmOC issues seems to have contributed to the rising concerns about their competence to deliver the recommended maternal services. Thus, the authorities seeming to recognize and promote TBAs should provide support to TBAs in relation to necessary training and giving them essential working facilities, routine supportive supervision and rewarding those seeming to comply with the standard guidelines for delivering EmoC services.

Self-assessment or self deception? A lack of association between nursing students' self-assessment and performance.

AIM: The aim of this study was to examine senior year nursing students' ability to self-assess their performance when responding to simulated emergency situations. BACKGROUND: Self-assessment is viewed as a critical skill in nursing and other health professional programmes. However, while students may spend considerable time completing self-assessments, there is little evidence that they actually acquire the skills to do so effectively. By contrast, a number of studies in medicine and elsewhere have cast doubt on the validity of self-assessment. METHOD: In 2007, a one-group pre-test, post-test design was used to answer the question, 'How accurate are senior year nursing students in assessing their ability to respond to emergency situations in a simulated medical/surgical environment compared to observer assessment of their performance?' A total of 27 fourth year nursing students from a university in Ontario were asked to complete a questionnaire before and after an objective structured clinical examination which assessed their ability to respond to emergency situations. Self-assessments were compared with observed performance. FINDINGS: The experience of dealing with the simulated crisis situations significantly increased perceived confidence and perceived competence in dealing with emergency situations, although it did not affect self-perceived ability to communicate or collaborate. All but 1 of the 16 correlations between self-assessment and the objective structured clinical examination total scores were negative. Their self-assessment was also unrelated to several indices of experience in critical care settings. CONCLUSION: Self-assessment in nursing education to evaluate clinical competence and confidence requires serious reconsideration as our well-intentioned emphasis on this commonly used practice may be less than effective.

Immersive virtual reality simulations in nursing education.

This article explores immersive virtual reality as a potential educational strategy for nursing education and describes an immersive learning experience now being developed for nurses. This pioneering project is a virtual reality application targeting speed and accuracy of nurse response in emergency situations requiring cardiopulmonary resuscitation. Other potential uses and implications for the development of virtual reality learning programs are discussed.

Airway management for nurses:emergency assessment and care.

Within the hospital environment patients can deteriorate rapidly and for many different reasons. Maintaining a patient's breathing is the main priority in any emergency situation--although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management and the key to the management of an airway is through a thorough assessment, to firstly ensure whether the airway is patent or not. This article will discuss airway management--both acute and chronic--as well as associated nursing care.

Nurses' role in the early defibrillation of cardiac patients: implications for nursing in Hong Kong.

The time taken to initiate early defibrillation is crucial to improve survival, prevent neurological deficit and improve the quality of life of patients suffering from sudden cardiac arrest. Despite the extension of training and the authorization of nurses to perform early defibrillation (advocated by the American Heart Association), such practice has not been widely adopted in hospitals. Inadequate knowledge, lack of skill retention, insufficient organizational support and the passive culture of nurses are barriers preventing the move towards nurse-led defibrillation. This paper discusses the need to extend the registered nurses' role in the early defibrillation of cardiac patients in Hong Kong. Current nursing practice in emergency resuscitation care and the hurdles constraining early defibrillation will be discussed. Recommendations to facilitate the future development of nurse-led defibrillation will also be provided. The successful extension of the registered nurses' role in early defibrillation will enable them to possess broader knowledge to be clinically competent in providing efficient patient care.

Assessment of acutely ill patients in the criminal justice system.

This article, the third in a five-part series, explores the difficulties that nurses experience when dealing with an offender who becomes acutely ill within the prison setting. The authors compare and apply the recommendations from the National Institute for Health and Clinical Excellence, the National Patient Safety Agency and the Department of Health to offender health care. The article also explores how education and simulation can be used to equip nurses to deal with any difficulties they experience.

US Public Health Service Commissioned Corps Nurses: responding in times of national need.

The US Public Health Service (PHS) is one of 7 uniformed services operating for the nation. Nurses form the largest category of personnel in the PHS and are integral members of teams identified to deploy in times of national need. PHS nurses serve "in harm's way" to protect and defend the public health of the nation during national emergencies and disasters of great magnitude, such as 9/11, Hurricane Katrina, the H1N1 virus outbreak, and so forth. In this article, the authors discuss how active-duty Commissioned Corps nurses in the US PHS respond during times of national need. Military nurses may be asked to serve in war zones, participate in humanitarian missions, and care for military beneficiaries. By contrast, the role of nurses in the Commissioned Corps is to protect, defend, and advance the public health of the nation. PHS nurses are critical members of interdisciplinary health care teams organized to provide health care to diverse populations in the United States and abroad.

Nurse specialist treatment of eye emergencies: five year follow up study of quality and effectiveness.

The role of specialist nurses in triage, diagnosis and management of emergency eye conditions is well established, and encouraging reports of the safety and effectiveness of such services have been published. Specialist nurses in an emergency eye clinic in the UK seeing >7000 patients per year had been found at initial evaluation to treat 22% of the 1976 patients seen over a three month period without referring on to an ophthalmologist. A repeat of this evaluation five years later found this proportion had dropped to 17% (chi(2) = 16.7, p<0.01). In addition, the initial evaluation had found no incident of any patient having been treated and discharged by the specialist nurses returning to the department due to incorrect diagnosis or mismanagement. By contrast, from the sample 5 years later, 3 patients were identified who returned to the department due to possible misdiagnosis or sub-optimal management. We suggest that provision must be made for continuing professional development of nurses in this type of extended role, and the commitment to ongoing education should be backed up by a system of monitoring and critical incident reporting to facilitate skill maintenance and the life long learning process for specialist nurses.