Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach.

BACKGROUND: Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses. OBJECTIVE: The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses. METHODS: We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts. Data were collected from February 2023 to May 2023. The sample for Round 1 was recruited from members of the Emergency Nurses Association reporting job titles, including trauma coordinator, trauma nursing core course instructor, and vice president of trauma services (n = 829). Participants in subsequent rounds were drawn from respondents to the initial invitation to participate (n = 131). Members of an emergency nursing research council with clinical and research expertise reviewed the results and provided expert input. RESULTS: An initial sample of 131 experts identified 17 elements that were assigned a median score equivalent to "agree/strongly agree" (i.e., median 4/5 or 5/5) in Round 2 (n = 69). These elements were presented in Round 3 (n = 43) to determine a rank order. Critical thinking/clinical judgment was the overall priority, followed by assessment/reassessment and early recognition of trauma. CONCLUSIONS: Emergency department trauma care experts identified priority content for advanced trauma education. Heterogeneity in the final ranking of components for this advanced trauma course, specifically differences by facility, regional, or demographic characteristics, suggests that training and education may not conform to a one-size-fits-all model.

Fast-Track Training in Emergency Department During the COVID-19 Pandemic: Evaluation of a Hybrid Education Model.

INTRODUCTION: Emergency department (ED) fast track (FT) for the ambulatory, minor injury patient cohort requires rapid patient assessment, treatment, and turnover, yet specific nursing education is limited. The study aimed to test the feasibility and staff satisfaction of an education program to expand nursing skills and knowledge of managing FT patients during the COVID-19 pandemic. METHODS: This quasi-experimental study, including self-rating surveys and interviews, assessed the pre- and postimplementation of an education program for nurses working in FT in a metropolitan hospital ED in Australia. Hybrid (face-to-face and Teams) education sessions on 10 topics of staff-perceived limited knowledge were delivered over 8 months. RESULTS: Participants demonstrated higher knowledge scores after the implementation of short online education sessions to cover the core facets of minor injury management. Overall staff satisfaction with the program was high. Interview discussions involved three key themes, including "benefits to staff learning," "positive impact on patient care and flow," and "preferred mode of delivery." CONCLUSIIONS: Recorded education sessions on minor injury topics for nurses working in FT have proved effective, and this program has now become a core facet of ED education in our hospital.

Evaluating the Oncology-Related Education Needs of Emergency Nurses.

INTRODUCTION: Treatment for patients with cancer in the emergency department ranges from treating life-threatening emergencies to symptom management or issues unrelated to their cancer, but for which cancer and its treatment may be complicating factors. Nurses are expected to manage the care of this population and be aware of risk factors for complications that may be unique to cancer patients. To date, education for emergency nurses regarding oncologic emergencies and the care for patients with cancer has been limited. METHODS: We conducted a cross-sectional needs assessment to establish emergency nurses' educational needs (knowledge, skills, and attitudes) related to the care of patients with cancer and to evaluate if there are different educational needs for emergency nurses associated with the care of the cancer patient by practice setting type. RESULTS: Of 237 nurses surveyed, only 28% of nurse respondents indicated receiving any cancer-specific education or training. Overall, scores on a knowledge assessment were relatively low (mean 53%; range 9.5-85.7%; SD 13%). Nurses reported variable confidence and skills, with the weakest areas being in the triage of complications and oncologic emergencies, assessment of complications related to cancer treatment, and end-of-life conversations. Nearly all of the respondents (97%) indicated a need for oncologic education for emergency nurses with moderate-high priority in relation to other educational needs. DISCUSSION: Our findings suggest that emergency nurses need a stronger foundation of the knowledge and skills required to care for patients with cancer. Results from this study can inform future curriculum development efforts.

Emergency Department Discharge Teaching Interventions: A Scoping Review.

INTRODUCTION: Emergency department discharge education is intended to provide patients with information to self-manage their condition or injury, identify potential complications, and follow-up or referral. However, most patients cannot recall the discharge information provided, leading to adverse clinical outcomes, return visits, and higher costs. A scoping review was undertaken to explore discharge education interventions that have been studied in the emergency department setting and outcomes that have been used to evaluate the effectiveness of the interventions. METHODS: A literature review was conducted using the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center, with search terms focused on emergency nursing and patient discharge education interventions. RESULTS: Of the publications identified, 18 studies met the inclusion criteria. There was variation among studies on the conditions/injuries and populations of focus for the intervention. The interventions were categorized by learning styles, including auditory (n=10), kinesthetic (n=1), visual (n=15), reading/writing (n=1), and multimodal (n=7). Outcomes evaluated included those that were patient-specific (education, self-management, clinical, and adherence) and metrics of the health system and public health. DISCUSSION: Multimodal discharge education that addresses various learning styles and levels of health literacy improved patient education, self-management, and clinical outcomes. Additional support and reminders improved patient adherence. Identified gaps included limited kinesthetic interventions and culturally tailored education. Translational science for advancing sustainable interventions in clinical practice is needed to enhance the emergency department discharge process and patient, system, and public health outcomes.

Polish Perspective: The Influence of National Emergency Severity Index Training on Triage Practitioners' Knowledge.

INTRODUCTION: The aim of this study was to assess the impact of the national government initiative Emergency Severity Index version 4.0 validated triage training on triage practitioners' knowledge and accuracy. METHODS: This pre/post intervention study evaluated the knowledge of triage practitioners, who constituted 30% of employees trained by the national program, in 74 emergency departments across Poland in 2020. Statistical analysis was used to evaluate the impact of the triage training. RESULTS: No significant differences in triage knowledge were found based on experience, length of ED service, or previous training. Training resulted in increased accuracy (61.3% vs 81.1%) and decreased overtriage and undertriage. Participants significantly reduced errors and improved Emergency Severity Index guideline-based case evaluations, especially for Emergency Severity Index 1-3 cases, with the most notable improvements observed among those without prior triage experience. The training significantly improved interrater reliability. DISCUSSION: The Emergency Severity Index pilot training demonstrated a significant improvement in the accuracy of triage practitioners. Emergency Severity Index level 4 has been identified as a challenging area to learn, as well as yielding promising results in the acquisition of knowledge across levels 1 and 2, among less experienced practitioners.

Enhancing triage accuracy in emergency nurses: The impact of a game-based triage educational app.

INTRODUCTION: Digital technology has enabled gamification methods to enhance triage education, reflecting an evolving healthcare landscape. OBJECTIVE: To evaluate the effectiveness of a Gamification Triage Education App (GTEA) as a learning tool for emergency nurses, with a focus on creating an engaging and educationally effective platform for triage training. METHOD: The GTEA was developed using no-code based software and expanded upon previous iterations, with added features such as points, rankings, instant feedback, and quest-based stories. From December 2021 to March 2022, 27 emergency room nurses from three hospitals in Korea were instructed to use GTEA for 100 min over the course of a week. The effects were measured before and after the intervention. RESULTS: The results demonstrated a significant increase in triage accuracy from 4.3 ± 2.00 to 5.33 ± 1.47 (t = -2.18, p = 0.039), along with a substantial reduction in overtriage (t = 3.11, p = 0.004). Additionally, increases in critical thinking disposition, triage competency, and triage knowledge were observed (t = -3.11, p = 0.004; t = -2.72, p = 0.011; t = -3.14, p = 0.004, respectively). CONCLUSIONS: The findings provide robust evidence for the effectiveness of gamification in triage training within emergency nursing.

Development of a Competency-Based Triage Education Application and Usability Testing for Triage Training Based on the Korean Triage and Acuity Scale.

BACKGROUND: Improving the quality of emergency nursing care requires enhancing triage competency through education programs that integrate the content of the Korean Triage and Acuity Scale, a triage system specifically developed for the Korean context. Thus, this study developed a competency-based triage education application (CTEA), based on the Korean Triage and Acuity Scale, and evaluated its effectiveness through usability testing. METHOD: The CTEA used various teaching methods and game mechanisms, including lectures, case studies, and video-based scenarios, to improve triage competency. RESULTS: In the usability testing phase, the CTEA was refined through expert heuristic evaluation and user interviews conducted with the think-aloud method. Six themes were derived from the interviews, highlighting the need for a well-structured program with realistic scenarios, easy accessibility, gamification, functional improvements, and future triage educational applications. CONCLUSION: These findings suggest that the CTEA is effective and satisfactory for users and can contribute to improving the triage competency of emergency nurses. [J Contin Educ Nurs. 2024;55(1):33-41.].

GridlockED as an Intervention for Nurses (GAAIN) Study.

BACKGROUND: GridlockED (The Game Crafter, LLC) is a serious game that was developed to teach challenges that face nursing and medical professionals in the emergency department (ED). However, few studies have explored nurses' perceptions of the utility, fidelity, acceptability, and applicability of the serious game modality. This study examined how ED nurses view GridlockED as a continuing education platform. METHOD: This single-center observational study explored how nurses engage with and respond to Grid-lockED. The convenience sample included participants recruited from a local continuing nursing education day. Participants completed a presurvey, engaged in a full game play session with the GridlockED game for approximately 45 minutes, and immediately completed a post-game play survey. RESULTS: Of the 48 participants (11 male, 37 female; 44 of 48 were RNs), most (91%) agreed that the workflow reflected in the game was equivalent to the flow in a typical ED. Almost all (96%) found the cases in the game reflective of real ED patients, and most (92%) found the game a useful educational tool to prepare new nurses to transition into the ED environment. CONCLUSION: The GridlockED game shows potential as a serious game to support nursing education, particularly for new ED nurse orientation and transition to ED practice. [J Contin Educ Nurs. 2024;55(5):231-238.].

Construção e validação de cartilha educativa sobre suporte básico de vida para estudantes do ensino médio / Construction and validation of an educational booklet on basic life support for high school students / Construcción y validación de carpeta educativa sobre soporte vital básico para estudiantes de secundaria

O objetivo deste estudo é construir e validar uma cartilha educativa para estudantes do ensino médio sobre Suporte Básico de Vida nas escolas. Trata-se de uma pesquisa metodológica, realizada em três etapas. Na primeira etapa foi realizada revisão bibliográfica, na segunda etapa procedeu-se a elaboração da cartilha educativa e por fim, a validação do material por especialistas. Entre os resultados destaca-se que a cartilha aborda as principais recomendações acerca da segurança do socorrista e suporte básico de vida no adulto e possui 14 páginas. Conclui-se que todos os itens da cartilha educativa obtiveram índice de validade de conteúdo maior que 0,82 conseguindo a validação.

The objective of this study is to build and validate an educational booklet for high school students about Basic Life Support in schools. This is a methodological research, carried out in three stages. In the first stage, a bibliographic review was carried out, in the second stage, the educational booklet was elaborated and, finally, the material was validated by specialists in the subject. Among the results, it is highlighted that the booklet addresses the main recommendations regarding rescuer safety and basic adult life support and has 14 pages. It was concluded that all items in the educational booklet had a content validity index greater than 0.82, achieving validation.

El objetivo de este estudio es construir y validar una cartilla educativa para estudiantes de secundaria sobre Soporte Vital Básico en las escuelas. Se trata de una investigación metodológica, realizada en tres etapas. En la primera etapa se realizó una revisión bibliográfica, en la segunda etapa se elaboró la cartilla educativa y, finalmente, el material fue validado por especialistas en el tema. Entre los resultados, se destaca que la cartilla aborda las principales recomendaciones sobre seguridad del reanimador y soporte vital básico del adulto y tiene 14 páginas. Se concluyó que todos los ítems de la cartilla educativa tuvieron un índice de validez de contenido superior a 0,82, lográndose la validación.

Factors affecting the triage decision-making ability of emergency nurses in Northern China: A multi-center descriptive survey.

INTRODUCTION: The quality of triage decision-making is a prerequisite for priority treatment of critically ill patients and effective utilization of medical resources. Figuring out how to improve triage decision-making is still a topic around the global emergency department. Hence, this study aims to promote an understanding of triage priority care and clarify the elements influencing triage decision-making ability, offering reference for the future to improve the quality of triage decision-making. METHOD: A total of 404 emergency nurses from 11 tertiary hospitals in northern China were surveyed by questionnaire, of which 371 valid questionnaires were submitted (effective rate = 91.83 %). One hospital distributed the questionnaire face-to-face, and the other ten used online form. RESULT: Prior to occupying triage jobs, only a quarter of participants(25.30 %)were qualified. Less than half of emergency nurses (46.60 %) reported taking part in the triage training program. The emergency nurses' triage decision-making ability score was 166.50 ± 26.90(95 %CI 163.75,169.24) in northern China. Gender(P = 0.003), case discussion(P = 0.024), secondary assessment(P = 0.020)and knowledge of triage consensus(P = 0.027) are independent factors influencing triage decision-making ability. CONCLUSION: Emergency triage practices are less implemented in northern China. The triage decision-making ability of emergency nurses in northern China is at a low level. Providing emergency nurses with diverse opportunities to develop their triage skills, finding effective triage training content, form, and frequency, strengthening implement triage consensus, and wisely managing triage nurse resources would improve triage decision-making.

Evaluation of the factors affecting triage decision-making among emergency department nurses and emergency medical technicians in Iran: a study based on Benner's theory.

INTRODUCTION: Emergency department (ED) nurses and emergency medical technicians (EMTs) find themselves performing triage under time pressure and with limited information. Identifying an effective triage decision-making process can play a significant role in promoting patient safety. Experts are able to make faster and more effective decisions in emergencies than novices. OBJECTIVE: The current study aimed to identify the level of triage decision-making (TDM) and its' predictors in ED nurses and EMTs based on self-reported levels of nursing proficiency in Benner's theory from novice to expert. MATERIALS AND METHODS: Out of 821 ED nurses and EMTs who met the inclusion criteria, 320 ED nurses and 152 EMTs were included in this descriptive-analytical research. Data were collected by a demographic information form and triage decision-making inventory (TDMI) and analyzed by SPSSv.22 software using descriptive statistics, Pearson correlation test, t-test, ANOVA, and multiple linear regression. RESULTS: The total score of TDMI in the ED nurses and EMTs was higher in the expert nurses than in the proficient, competent, advanced beginner and novices. Multiple linear regression analysis showed that self-reported levels of nursing proficiency, age, work experience, marital status and triage training course were predictors of TDM in ED nurses (P < .05), and self-reported levels of nursing proficiency, service location, work experience, and triage training course were predictors of TDM in EMTs (P < .05). CONCLUSION: Understanding the predictors influencing TDM health professionals may facilitate the understanding of their training needs. The training needs of a novice and inexperienced person may be different from those of an expert person, it is recommended that the training methods be based on the experiences and professional levels of nurses so that the training provided is effective and quality. Moreover, to increase the TDM power and reduce TDM errors due to lack of experience, a system is suggested to be established to allow novice nurses in the first year to work with experienced nurses. Also it is suggested that the determining educational and training focus with regards to triage before entering the bedside be done based on predictors.

Forensic professional's thoughts on New Zealand emergency nurse's forensic science knowledge and practice.

INTRODUCTION: The clinical forensic nursing role in emergency departments is a recognised nursing speciality globally but there is no designated clinical forensic role in New Zealand nor is their adequate tertiary education despite New Zealand emergency nurses being expected to be able to complete these duties if required. The study sought to find out the perceptions of forensic professionals about 1) how well if at all forensic protocols and practices are adhered to by emergency nurses in New Zealand, 2) what areas of forensic practice if any do ED nurses need tertiary training in to effectively care for patients with health conditions related to violence, and, 3) what relationship exists between emergency nurses and forensic professionals. METHODS: Health professionals in forensic nursing roles were invited to complete an anonymous, online survey consisting of Likert scale questions and free text commentary. A descriptive, content analysis of the data was undertaken. RESULTS: Content analysis described, incorrect evidence collection, erroneous chain of custody errors, limited relationship between emergency nurses and forensic professionals and clear support for a postgraduate clinical forensic nursing programme. DISCUSSION: This study identified that forensic science knowledge and practices by emergency nurses are inadequate for the work they are required to undertake, suggesting that additional professional development is warranted in order to maintain best practice standards for forensic emergency care.

Delivering an online course in emergency nursing education during the pandemic: What are the effects on students' learning?

BACKGROUND: Online learning emerged as an auxiliary approach in 2013 when MOOCs were imported and popularized in Chinese universities, particularly in the duration of pandemic outbreaks worldwide. World health organization (WHO) had recommended online education to keep social distance which still needs further evaluation. This study aimed to examine whether an open online course is superior to conventional education in emergency nursing during the COVID-19 pandemic. METHODS: Two groups of conventional education students (CG) and two groups of students participating in an online course that utilized an application (called SuperStar) as the SuperStar Group (SSG) were studied to compare their abilities in the process of new knowledge acquisition. The SSG was divided into a blended group (S1) and an online group (S2). The emergency nursing course was scheduled in 16 independent classes, which contained stochastic tests at least eight times. RESULTS: The CG group showed better performance on the final exam than the SSG group, but there was no statistically significant difference. The CG group obtained better scores on the memory capacity tests while the SSG had better scores on the application capacity tests. The SSG group scored higher on the later tests during the process of education compared to the CG group. CONCLUSIONS: Comprehension of an emergency nursing course was stronger in the SSG group than in the CG group. Horizontal comparison of subentry tests discriminated between the groups, with a better trend for the SSG group in application ability. There are potential effects on chronological learning through the use of the online course for emergency nursing education, not only during COVID-19 but also in the post-pandemic era.

Development and Implementation of a Pediatric Telesimulation Intervention for Nurses in Community Emergency Departments.

The need for virtual education for nursing staff has dramatically increased because of social distancing measures after the coronavirus disease pandemic. Emergency departments in particular need to educate staff on caring for patients with coronavirus disease while concurrently continuing to ensure education related to core topic areas such as pediatric assessment and stabilization. Unfortunately, many nurse educators are currently unable to provide traditional in-person education and training to their nursing staff. Our inter-professional team aimed to address this through the rapid development and implementation of an emergency nursing telesimulation curriculum. This curriculum focused on the nursing assessment and initial stabilization of a child presenting to the emergency department in status epilepticus. This article describes the rapid development and implementation of a pediatric emergency nursing telesimulation. Our objectives in this article are (1) to describe the rapid creation of this curriculum using Kern's framework, (2) to describe the implementation of a fully online simulation-based pediatric emergency training intervention for nurse learners, and (3) to report learners' satisfaction with and feedback on this intervention.

Evaluating a new trauma and critical care management course for nurses.

A new practical-based course for nurses on the management of major trauma has been developed using high-level simulation and moulage to deliver education based on established trauma competencies. The Nurse Trauma and Critical Care course was developed by nurses with input from the Anaesthesia Trauma and Critical Care group and has been accredited by the Royal College of Surgeons. This article describes the development of the course and discusses the findings of a course evaluation that aimed to measure candidates' confidence and knowledge after completion.

Importance Ranking of Electrocardiogram Rhythms: A Primer for Curriculum Development.

INTRODUCTION: Electrocardiogram interpretation is an essential skill for emergency and critical care nurses and physicians. There remains a gap in standardized curricula and evaluation strategies used to achieve and assess competence in electrocardiogram interpretation. The purpose of this study was to develop an importance ranking of the 120 American Heart Association electrocardiogram diagnostic labels with interdisciplinary perspectives to inform curriculum development. METHODS: Data for this mixed methods study were collected through focus groups and individual semi-structured interviews. A card sort was used to assign relative importance scores to all 120 American Heart Association electrocardiogram diagnostic labels. Thematic analysis was used for qualitative data on participants' rationale for the rankings. RESULTS: The 18 participants included 6 emergency and critical care registered nurses, 5 cardiologists, and 7 emergency medicine physicians. The 5 diagnoses chosen as the most important by all disciplines were ventricular tachycardia, ventricular fibrillation, atrial fibrillation, complete heart block, and normal electrocardiogram. The "top 20" diagnoses by each discipline were also reported. Qualitative thematic content analysis revealed that participants from all 3 disciplines identified skill in electrocardiogram interpretation as clinically imperative and acknowledged the importance of recognizing normal, life threatening, and time-sensitive electrocardiogram rhythms. Additional qualitative themes, identified by individual disciplines, were reported. DISCUSSION: This mixed-methods approach provided valuable interdisciplinary perspectives concerning electrocardiogram curriculum case selection and prioritization. Study findings can provide a foundation for emergency and critical care educators to create local ECG educational programs. Further work is recommended to validate the list amongst a larger population of emergency and critical care frontline nurses and physicians.

Cost Savings of Frequent, Concise Skills Competency Training in the Emergency Department.

Nurse educators are confronted with ensuring skills competency and staff compliance to support the provision of safe and quality care. The ED setting presents additional challenges when conducting skills competency training. One military hospital's emergency department implemented a method of frequent, concise skills training sessions to overcome barriers unique to the ED setting; the same method was then implemented at a second military organization owing to the effectiveness of the training approach to increase staff compliance. This article outlines the methods for the implementation of frequent, concise skills training sessions, and it displays the cost savings and increased compliance experienced by the 2 health care organizations after the implementation of this frequent, concise skills training method.

Reversible causes of cardiac arrest: Nursing competency acquisition and clinical simulation satisfaction in undergraduate nursing students.

BACKGROUND: It is essential to determine and treat the reversible causes of cardiac arrest, so emergency nurses must acquire the competencies needed for its adequate management. METHOD: 106 undergraduate nursing students participated in a cross-sectional study, using a mixed-method. Simulated scenarios recreated critically ill patients with diagnoses of potentially reversible causes of cardiac arrest in an emergency room. An internally validated questionnaire was used to analyse students' satisfaction and perceptions about clinical simulation sessions. Nursing competencies were assessed using a verification list. Data were analysed using the IBM SPSS Statistics version 24.0 (quantitative data) and ATLAS-ti version 8.0 (qualitative data) software. RESULTS: Nursing students expressed a high level of satisfaction (most of the scores obtained were higher than 90%) and positive perceptions about clinical simulation sessions. Most of the students (85.6%) acquired the necessary nursing competencies for adequate management of the reversible causes of cardiac arrest. CONCLUSION: Clinical simulation methodology is a useful tool for the learning process and acquisition of nursing competencies related to emergency situations management. This methodology prepares nursing students for their clinical placements and future careers in emergency care. Therefore, it is recommended to extend clinical simulation training to emergency qualified nursing staff and advanced practitioners.

External Female Urinary Catheter: Implementation in the Emergency Department.

The emergency department is a care environment in which indwelling urinary catheters are placed frequently; however, the significance of the role of the emergency department in catheter-associated urinary tract infection prevention has been overlooked. The use of an external female urinary catheter is an alternative to placing an indwelling urinary catheter for female patients in the emergency department who are incontinent of urine or are immobile. The purpose was to describe the implementation of an initiative to decrease the number of indwelling urinary catheters and increase the use of external urinary female catheters in non-critically ill women who visited the emergency department at a 451-bed Magnet-designated community hospital in the Southeast. For this clinical implementation project, the Plan, Do, Check, Act framework was used to develop the initiative, and outcome data were collected retrospectively and included an indirect calculation of the number of indwelling urinary catheters placed in the emergency department. A total of 187 external catheters were used in place of indwelling catheters in female patients over a 3-month period. No skin irritation or breakdown was observed. This project demonstrated the initial staff acceptability and feasibility of external female urinary catheter use in the ED setting.