Instrument Development: Knowledge, Attitudes, and Confidence in Palliative Care Concepts Held by Trauma and Neuroscience Intensive Care Nurses.

BACKGROUND AND PURPOSE: Unique pressures impact trauma intensive care unit (TICU) nurses in their provision of care for severely injured patients. When it becomes clinically obvious that these patients may not survive, TICU nurses must continue life-saving measures while at the same time consider a palliative care consultation. In order to facilitate this referral, TICU nurses need to have the appropriate knowledge, attitude, and confidence in doing so. The purpose of this study is to refine an instrument that aims to support this process. METHODS: A convenience sample of 42 respondents completed the Knowledge, Attitudinal, and Experiential Survey on Advance Directive (KAESAD). RESULTS: Domains with the highest Cronbach's alpha value were "professional attitudes" (α = .995) and "clinical experiences" (α = .999). CONCLUSIONS: Reliability assessments suggest that most domains of the instrument have strong internal consistency, and with a larger sample size, future studies may elucidate how nurse educators can use this instrument to target areas for continuing education.

Emergency management of dental injury; preparedness among school teachers in Bhubaneswar, India.

BACKGROUND: School is the place, identified with a noticeable risk of Traumatic Dental Injuries (TDI) in children which have functional, esthetic and psychological effects. OBJECTIVES: To assess the preparedness of concerning traumatic dental injuries and their management among school teachers and also to empower the clinician to frame a set of instructions for school teachers to handle the emergencies effectively at the site of the incident. MATERIAL AND METHODS: A cross-sectional study was conducted among 330 school teachers enrolled in government and private schools of 24 randomly selected schools in Bhubaneswar city. A self-administered questionnaire was distributed to collect information on participants demographic characteristics, knowledge, attitude and practice about emergency management of Traumatic Dental Injury. Chi-square test with level of significance set at 5% was used for statistical analysis. RESULTS: Statistically significant (p<0.05) correct responses were provided by 66.7% males and 35.6% females and 100% younger age teachers. Larger population perceived that their level of knowledge was not satisfactory as they responded for inadequate and don't know options which was significant in relation to gender and age (p<0.05) but not with respect to the type of school (p>0.05). All the respondents expressed the need for a training program. CONCLUSIONS: This study highlights the instantaneous need for tailor made dental health educational and preventive programs for school teachers in order to effectively manage the Traumatic Dental Injuries.

Multimodal Education Program to Improve Nurses' Knowledge and Confidence on Delirium Recognition in a Surgical-Trauma Intermediate-Care Setting.

BACKGROUND: High incidence of delirium in hospitalized patients has been reported in the United States and is significantly associated with increased morbidity and mortality. The lack of knowledge and confidence in performing delirium assessment (KCDA) has led to significant underrecognition of delirium by nurses regardless of evidence-based education intervention. OBJECTIVE: The purpose of this study was to determine the effectiveness of a multimodal educational program (MEP) to enhance nurses' KCDA. METHODS: A MEP including an online didactic with a video-simulation and 1:1 bedside coaching with delirium screening (DS) was conducted in the surgical intermediate-care unit of an academic medical center. A quasi-experimental pre- and post-test design was used. RESULTS: Of 23 nurses, the majority were <41 years old (73.9%) and had at least a bachelor of science in nursing degree (78.3%) with <6 years of experience (60.9%). The overall KCDA scores and the performance of DS improved significantly after the MEP (p < .001). A positive correlation was noted between the changes of the KCDA scores (p = .009). CONCLUSIONS: The MEP demonstrated improvement in nurses' KCDA. The MEP should focus on an individualized learning approach with a targeted patient population, using current delirium screening tools. IMPLICATIONS FOR NURSING: Educational programs are recommended in either an orientation or continuing education program on nursing units. This is also recommended for use in other academic centers that encompass similar clinical settings and could possibly be considered for use in other disease processes.

Trauma Nurses' Experience With Decontamination: Opportunities for Improvement.

Trauma patients are unique in their potential for exposure to dangerous chemicals or material, placing staff in the emergency department (ED) or trauma unit at risk for exposure themselves. The purpose of this study was to describe one centers' trauma nursing experience with decontamination and to identify opportunities for improvement. This was a cross-sectional descriptive study of decontamination practices using an anonymous online survey of trauma nurses at a single Midwestern verified Level I trauma center and burn center. A total of 82 nurses completed the survey with a 48% response rate. Overall, 57% reported having had some previous decontamination training, with ED and air transport nurse's training, knowledge, and comfort level reported as the highest and inpatient trauma nurses the lowest. A significant association was found between ED nurses and feeling the surest about their safety when caring for exposed patients (χ = 19.908, p = .018) and between hazardous materials training and receiving communication about the patient's decontamination procedures during care (χ = 8.879, p = .031). Our results show that trauma nurse decontamination training and communication, as well as confidence in knowledge and safety, vary by nursing unit. The relatively low-volume high-risk scenario of trauma decontaminations likely contributes to inpatient nurses reporting of inadequate preparedness. This requires administrative commitment to ensure that all trauma nurses receive decontamination training in orientation, as well as ongoing continuing education, skill competency checks, and simulation training. Decontaminate communication is an essential requirement of all ED trauma team handoffs and medical record documentation.

Rate of Nonsurgical Admissions at a Level 1 Trauma Center: Impact of a Trauma Nurse Practitioner Model.

The American College of Surgeons (ACS) mandates all trauma centers conduct individual case reviews of nonsurgical admissions when rates of allocation to this service exceed 10% of all inpatient traumas. Nonsurgical admission rates at the study institution, which is a Level I trauma center, historically exceeded this ACS criterion. In an effort to decrease nonsurgical admissions, the study institution recruited trauma nurse practitioners (TNPs) who began managing low acuity patients with oversight from trauma attending physicians. This study examines the impact of TNPs on the rate of nonsurgical admissions. A retrospective cohort study was conducted with 1,400 patients between January 2017 and October 2018. Two cohorts examined in this study included trauma patients whose care was managed by the TNPs versus those admitted under the care of hospitalists. The rate of admission to nonsurgical services (NSS) was 19.6% in 2017 and 13.9% in 2018, which yielded a significant decrease from previous years' percentages (p < .001). The average hospital length of stay was 1.17 days shorter in the TNP group, which translated into a savings of approximately $876,330 in hospital charges for the study period. Additional significant findings noted in favor of the TNP cohort were for discharge orders placed prior to noon, discharge location, and reduced time to the operating room. This TNP model proved to be successful in significantly reducing admissions to NSS and substantiated the quality of patient care provided by TNPs. Hospitals struggling to meet the ACS criterion for NSS admissions may consider implementing a similar TNP model.

The Association of Time to Palliative Medicine Consultation on Geriatric Trauma Outcomes.

The integration of specialized geriatric providers with trauma services has received increased attention with promising results. Palliative medicine consultation (PMC) has been shown to reduce length of stay, improve symptom management, and clarify advance directives in the geriatric trauma population. The aim of this study was to evaluate whether PMC reduced tracheostomies and percutaneous endoscopic gastrostomies (trach/PEG) and readmission rates in the geriatric trauma population. Retrospective cohort analysis of patients 65 years of age and older, admitted to a Level I trauma center surgical intensive care unit from 2013 to 2014. Patients who died within 1 day were excluded. Statistical analyses included descriptive statistics, independent-samples t test for continuous variables, χ test for categorical variables, and logistic regression analysis. A total of 202 patients were included. Palliative medicine consultation occurred in 48%. Average time from admission to PMC was 2.91 days. Thirty-day readmission rate was 19.3%. Patients with a PMC (69.1%) were less likely to undergo trach/PEG (30.9%; p < .001) but more likely if the consult was late (>72 hr posttrauma; 22.0% vs. 40.4%; p = .05). Patients without a trach/PEG were more likely to survive 1 year posttrauma (85.7% vs. 14.3%; p = .003). Thirty-day readmission rates were similar between groups. In a logistic regression analysis, PMC, age, and injury severity score demonstrated an independent association with trach/PEG (all p < .05). Early palliative consults (<72 hr posttrauma) for geriatric trauma patients may reduce tracheostomy and percutaneous endoscopic gastrostomy procedures and hospital stays.

Timely Venous Thromboembolism Prophylaxis in Trauma: A Team Approach to Process Improvement.

Venous thromboembolism is a significant complication in trauma. Multisystem injury, advancing age, surgery, and blood transfusion all contribute to the risk of venous thromboembolism in trauma patients. Our Level I trauma center was identified as an outlier with compliance in timely venous thromboembolism prophylaxis in the Michigan Trauma Quality Improvement Program, a statewide collaborative for improving trauma care. The purpose of this study was to provide an evaluation of a performance improvement project to increase the timely administration of venous thromboembolism prophylaxis in admitted trauma patients. Using a Plan-Do-Study-Act method of quality improvement, we initiated a focused, goal-directed team approach that emphasized education, tracking, and feedback. This approach resulted in improved and sustained compliance rates. Resolute focus, audit, and feedback moved our center from a low- to high-performing center for timely venous thromboembolism prophylaxis.

Thai trauma nurses' knowledge of neuroprotective nursing care of traumatic brain injury patients: A survey study.

Thai trauma nurses play a vital role in neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Nurses' knowledge of the evidence underpinning initial neuroprotective nursing care vital to safe and high-quality patient care. However, the current state of knowledge of Thai trauma nurses is poorly understood. In this study, we investigated Thai nurses' knowledge of neuroprotective nursing care of patients with moderate or severe traumatic brain injury. Data were collected by a survey, comprising a section on participant characteristics and series of multiple-choice questions. All registered nurses (n = 22) and nursing assistants (n = 13) from the trauma ward of a regional Thai hospital were invited to participate: the response rate was 100%. Participants had limited knowledge of carbon dioxide monitoring; causes and implications of hypercapnia; mean arterial pressure and cerebral perfusion pressure targets; management of sedatives and analgesics; and management of hyperthermia. Improving their knowledge focusing on knowledge deficits through educational training and implementation of evidence-based practice is essential to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury.