Nurse, Provider, and Emergency Department Technician: Perceptions and Experiences of Violence and Aggression in the Emergency Department.

INTRODUCTION: Patient/visitor violence and aggression (V&A) in the emergency department occurs daily. Few interventions exist to decrease V&A. Research describing prevalence, severity, and perceived safety among ED clinicians is limited. METHODS: A descriptive survey explored V&A against ED clinicians in one urban emergency department. A sample of nurses, ED technicians, physicians and advanced practice providers participated. Participants completed a demographic survey, Personal Workplace Safety Instrument for Emergency Nurses (PWSI-EN), and ENA V&A frequency checklist. Analysis of Variance (ANOVA) for unadjusted and Analysis of Covariance (ANCOVA) for adjusted associations were used to assess differences in the PWSI-EN survey composite score and "feeling safe in the ED" among ED roles. ANCOVA was adjusted for potential confounders: sex, race, years working in emergency department, and shift worked. RESULTS: Sixty-five (46.4%) of the 140 ED clinicians returned surveys, which were almost evenly distributed between ED clinician roles and sex. Mean age was 37.2 (range: 21-64) years. All (100%) nurses and providers reported being verbally abused. More nurses reported physical violence (n = 21, 87.5%) than providers (n = 7, 36.8%) and ED technicians (n = 11, 55%). Nurses and ED technicians reported experiencing greater prevalence of physical violence than providers (P < .05). Nurses (mean 3.29, range 2.95 to 3.63) were more fearful for their personal safety than ED technicians (mean 3.88, range 3.48 to 4.28) (P < .03). DISCUSSION: V&A are common creating a fearful environment. However, little research regarding clinician perceptions exists. Our study aids in identifying areas for clinician-targeted strategies to prevent ED V&A.

Systematic Debriefing for Critical Events Facilitates Team Dynamics, Education, and Process Improvement.

BACKGROUND: Debriefing is used in clinical settings to support interprofessional staff, improve processes, and identify educational needs. Nurses who lead debriefing sessions are empowered to improve processes. PROBLEM: Nurse leaders identified the need for debriefing outside the critical care areas due to the rising acuity levels. APPROACH: Two nurse leaders developed a debriefing initiative in one urban teaching hospital following rapid responses, codes, and stressful situations. Nurses developed a Debriefing Facilitation Guide to collect qualitative aspects of clinical emergencies to improve processes, education, and team dynamics. OUTCOMES: Following each debriefing session, we deductively purposively coded the qualitative data into 3 a priori themes: the American Heart Association's team dynamics, process improvement, and educational opportunities. We identified opportunities for improvement for these themes during our first 54 debriefing sessions. CONCLUSIONS: Following each debriefing session, the debriefing nurse leader intervened on all educational and process improvement opportunities identified and facilitated positive team dynamics.

Teaching Evidence-Based Sepsis Care: A Sepsis Escape Room.

BACKGROUND: Using evidence-based sepsis guidelines, nurse educators identified the nursing skills required to recognize and treat sepsis. METHOD: Nurse educators created an innovative, interactive sepsis escape room to provide sepsis education. The escape room included a manikin, puzzles, distractors, riddles, and props. Participants were given 20 minutes to solve four puzzles/riddles to treat the sepsis patient and escape the room. RESULTS: All but two (N = 16) groups solved the clues and riddles to prioritize treatment in the allotted time. Evaluations were excellent. Mean score (1 = poor to 5 = outstanding) for overall escape room experience was 4.92. Adherence data improved on the Surviving Sepsis Campaign sepsis performance measure intervention bundles (SEP 1-3 care bundles) 2 months following the escape room. Bundles are a group of interventions that improve care. CONCLUSION: The escape room engaged nurses in educational gaming, stimulating critical thinking and problem solving contributing to improved clinical outcomes. [J Contin Educ Nurs. 2021;52(5):217-225.].

Utility of the neurologic intensive care evaluation (NICE) in detecting neurologic deficit after cardiac operations--a pilot study.

BACKGROUND: Neurocognitive changes are common after cardiac operations. The acute post-operative period is a critical time when significant neurologic changes may be detected and appropriate therapy initiated promptly. Formal neuropsychologic testing in this situation however is impractical so other means of early detection are required. The goal of this preliminary study was to determine whether simple, standardized, serial nursing neurologic evaluations using the Neurologic Intensive Care Evaluation (NICE) could be helpful in screening patients for neurologic injury in the immediate post-operative period. MATERIAL/METHODS: Details of the intra-operative and post-operative anesthetic management were obtained during report and nurses subsequently scored acute post-operative patients in the CTSICU using the NICE every half hour for the first five hours. Finally, a chart review was performed to determine the neurologic outcome of the patients. RESULTS: The time to achieve the lower NICE scores which reflect mainly brainstem function was the same whereas the time to achieve NICE scores>4 was prolonged in patients with neurocognitive dysfunction. The effect of intra-operative factors on the times to achieve NICE scores was different for the higher and lower scores. The times to reach NICE scores correlated with outcome variables including the time in ICU and time of intubation. CONCLUSIONS: Standardized, serial nursing neurologic assessments of post-operative cardiac patients may be a useful tool for early identification of patients with neurologic injury. They may also provide useful information complementing the data obtained from detailed neuropsychologic testing on the neurologic effects of cardiac operations.