Understanding the issues experienced by older people undergoing emergency surgery.

The number of older people undergoing surgery in the UK is increasing, partly due to an ageing population and advances in surgical techniques. However, outcomes for older patients who have undergone surgery are suboptimal when compared with younger people, especially following emergency surgery. To minimise the risk of adverse events affecting older people following surgery, it is essential that nurses understand how to manage common challenges for this patient group such as delirium, pain, reduced mobility and inadequate hydration.

Disaster Nursing: Taking Your Faith to the Field.

National and global disasters require immense resources, including nurses. Personal, professional, and spiritual preparation is strongly recommended for healthcare workers who desire to serve in disaster settings. Most nurses are underprepared for this role; options for preparation are described along with the ministry of nursing and spiritual care that expresses God's heart of mercy and care for hurting and desperate people.

Práctica avanzada de la enfermera en urgencias extrahospitalarias y comparación con la casuística atendida por equipos con médicos / Advanced practice of the nurse in out-of-hospital emergencies and comparison with the casuistry attended by teams with doctors

OBJETIVO: Explorar la práctica enfermera en urgencias extrahospitalarias y comparar su casuística con la de equipos con médico presencial. METODOLOGÍA: Estudio transversal, con pacientes del Distrito Málaga atendidos por una enfermera (2012-2016) y por 6 equipos con médico presencial (2012). VARIABLES: prioridad, motivo de asistencia, diag-nósticos enfermeros, medicamentos y derivación. Estadística descriptiva e inferencial multivariante. RESULTADOS: La enfermera atendió 2253 pacientes. Los equipos con méicos atendieron 21226, presentando patologías similares el 34,8%. Motivos de asistencia: cérvico-dorso-lumbo-ciatalgia (12,6%), mareos/vértigo (9.6%), sin patología urgente (9,2%), etc. El 63,9% de pacientes precisó medicación: diazepam (19,3%), metoclopramida (13,6%), metamizol (12,5%), etc. El manejo del tratamiento y de dispositivos sanitarios, junto al afrontamiento de problemas se asociaron a los motivos de asistencia. El 92% de avisos fueron resueltos in situ. CONCLUSIÓN: La enfermera es una opción muy eficiente para la atención compartida de la demanda, aún con la legalización de la prescripción de medicamentos pendiente

OBJECTIVE: To explore prehospital emergency nursing and to compare the case-mix attended with prehospital medical teams. METHODS: Cross-sectional study, including patients from Málaga District attended by a prehospital nurse (2012 - 2016), and by prehospital medical teams (2012). MAIN VARIABLES: priority, cause of the demand, nursing diagnosis, medication and referral. Descriptive and multiple inferencial analyses. RESULTS: The nurse attended 2253 patients. Medical teams attended 21226 patients, and 34.8% presented similar pathologies. Case-mix: Cervical-back-sciatica pain (12.6%), dizziness/vertigo (9.6%), no urgent pathology (9.2%), etc. 63.9% of patients needed medication: Diazepam (19.3%), metoclopramida (13.6%), metamizol (12.5%), etc. Management of medication or healthcare devices, and problem coping were usually associated to assistance demands. 92% of demands were resolved in situ. CONCLUSIONS: The emergency nurse turns out to be an efficient choice for sharing prehospital demands, even with nursing prescription not yet legalized

Implantación de un protocolo de triaje avanzado de enfermería en el manejo del dolor moderado en urgencias / Implementation of an advanced nursing triage protocol for managing moderate pain in the emergency department

No disponible

Primary Health Care Nurses' Self-Perception of Theoretical Knowledges and Practical Skills in Life-Threatening Emergencies: A Cross-Sectional Study.

BACKGROUND: Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as "a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation." OBJECTIVES: The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work. DESIGN: Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain. METHODS: A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero ("Minimum") to ten ("Maximum"). RESULTS: There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work. CONCLUSIONS: All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.

Nurses' practices in the preparation and administration of intramuscular injections in mental health: A cross-sectional study.

BACKGROUND: Intramuscular injections (IMIs) remain a frequent practice in mental health. Few studies have examined the issue of nurses' practices concerning IMI in this domain, and none considered specifically hygiene. Finally, no study appears to have looked at emergency situations and their possible influence on practices. The principal objective of our study was to assess the practices associated with IMI in mental health, especially the hygiene-related practices. The secondary objectives were as follows: 1) to assess the practices for the preparation and administration of IMI in mental health for criteria other than hygiene and 2) to determine whether professional experience and emergency situations influence these practices. DESIGN: Single-centre cross-sectional study in a psychiatric Hospital and adherence to the STROBE guidelines. METHODS: The participating nurses all worked with inpatients, and all volunteered for the study. A self-administered questionnaire was sent to all participants. The questionnaire included questions about knowledge and practices associated with IMI, some considered in two different situations: emergencies and planned injections. The distribution of the responses was tested by the chi-squared test or Fisher's exact test, as appropriate, or by McNemar's chi-squared test or Friedman's nonparametric chi-squared test for matched data. RESULTS: Response rate was 48.6%. Overall, 81% of nurses reported correct handwashing before preparation, 87.5% responded that the dorsogluteal site is currently recommended for IMI, and 74.6% that they did not know the "Z track" technique. In planned injections, 58.7% reported that the choice of needle was determined, at least in part, by the patient's body mass index. In emergency situations, adherence to guidelines was less frequent for all types of practices. CONCLUSIONS: This study shows the need to improve practices for the frequently used procedure of IMI among mental health nurses. RELEVANCE TO CLINICAL PRACTICE: Better professional education appears necessary to develop optimal practices, especially in emergency situations.

Evaluación de las cargas de enfermería en la atención del intoxicado en un servicio de urgencias / Assessment of the nursing burden in the care of intoxicated patients in the emergency department

Objetivos: Medir la intensidad de los cuidados enfermeros que precisan los intoxicados que acuden a Urgencias. Método: Durante cuatro meses se registraron los intoxicados remitidos a Urgencias y se seleccionó un subgrupo en el que se midieron los tiempos consumidos por enfermería en cada una de las actividades asistenciales. Resultados: Se registraron 155 intoxicados. La intoxicación medicamentosa fue más frecuente en días laborables (p < 0.05) y la alcohólica en los no laborables (p < 0.05). Al 72 % se les realizó una extracción de sangre y al 55 % de orina para identificar la presencia de tóxicos. Al 79 % se le administró alguna medicación y al 25% carbón activado. El consumo de tiempo en la comunicación verbal fue mayor en el grupo intoxicado con fármacos (p < 0.001). Conclusiones: La ingesta de fármacos ha sido la intoxicación atendida con mayor frecuencia, en particular en días laborables. El intoxicado por medicamentos es el que requiere más tiempo de comunicación verbal

Objectives: To describe and measure the intensity of nursing care in intoxicated patients attended by different levels of emergency care, depending on the day of admission and type of poison involved. Methods: Observational, cross-sectional, descriptive study. For four months, patients referred to the emergency department for acute poisoning were recorded. Of the total patients, a subgroup in which the nursing time used in each activity of the care process were measured was selected. Epidemiological variables (sex, age, date and time of admission to the emergency room), toxicology (type of poison), level of triage, nursing activities and patient outcomes were recorded. Results: 155 cases of poisoning were recorded. Drug poisoning was more common in working days (p < 0.05) and alcoholic in nonworking (p < 0.05). 72 % of patients underwent a blood test and 55 % a urine test to detect the presence of toxic substances. 79 % was administered any medication and 25 % activated carbon. The use of time in verbal communication was greater in patients consuming medicaments (p < 0.001) compared with patients consuming alcohol or illicit drugs. Conclusions: The intake of drugs has been the most frequently attended poisoning, particularly on working days. The intoxicated by drugs is the most time-consuming verbal communication

Evaluación de la satisfacción profesional de Enfermería en unidades de urgencias en Brasil / Evaluation of professional satisfaction among Emergency Unit Nurses in Brazil

OBJETIVO: describir la satisfacción en el trabajo, así como de sus componentes incluidos en el Index of Work Satisfaction (IWS), en el equipo de Enfermería de los servicios de urgencias en una ciudad del interior del estado de São Paulo en Brasil. MÉTODO: estudio descriptivo transversal, desarrollado en cinco unidades de urgencias de una ciudad del interior de São Paulo (Brasil), sobre 208 trabajadores del equipo de Enfermería. Se utilizó el instrumento IWS, que recorre seis componentes: autonomía, interacción, estatus profesional, requisitos del trabajo, normas organizacionales y remuneración, y oscila entre 0,9 (menos satisfacción) y 37,1(más satisfacción). RESULTADOS: los componentes con más y menos satisfacción profesional son, respectivamente, remuneración y estatus profesional, tanto para enfermeros/as como para auxiliares de Enfermería. La puntuación de satisfacción global evaluada por el IWS fue de 9,5 para enfermeros/as y 10,1 en auxiliares. En el caso de los profesionales de Enfermería, y en relación al apartado "importancia asignada", el componente autonomía obtuvo la mayor puntuación. CONCLUSIONES: ante los resultados obtenidos, mediante el análisis de los componentes del IWS, el personal de Enfermería de los servicios de urgencias, de una ciudad del interior de São Paulo (Brasil), presentaron bajo índice de satisfacción profesional. Es importante la concienciación de los gestores relativo a la mejora de las condiciones laborales y la profundización en la investigación de las variables que corroboraron a una puntuación por debajo del mínimo

OBJECTIVE: to describe the satisfaction in work, as well as in the components included in the Index of Work Satisfaction (IWS), among the Nursing Team of the Emergency Units in a city from inner São Paulo, Brazil. METHOD: a descriptive cross-sectional study, conducted in five Emergency Units from a city in inner São Paulo (Brazil), with 208 workers from the Nursing Team. The IWS instrument was used, which covers six components: autonomy, interaction, professional status, work requirements, organization rules and remuneration; it ranges from 0.9 (lower satisfaction) to 37.1 (higher satisfaction). RESULTS: the components with the highest and lowest professional satisfaction were, respectively, remuneration and professional status, both for nurses and for nursing assistants. The overall satisfaction score assessed by the IWS was 9.5 for nurses and 10.1 for assistants. In the case of Nursing professionals, the Autonomy component obtained the highest score in the section "Importance assigned". CONCLUSIONS: according to the results obtained through the analysis of the IWS components, the Nursing staff from the Emergency Units of a city in inner São Paulo (Brazil) presented a low rate of professional satisfaction. It is important to create awareness in managers regarding the improvement in working conditions, and to conduct a deeper research into the variables that led to a score below the minimum level

Análisis de la vía intraósea: Una alternativa para enfermería ante casos urgentes / Analysis of the intraosseous route. an alternative for nursing in emergency cases

Introducción: La vía intraósea es la segunda vía de elección ante la imposibilidad de canalizar una vía intravenosa en situaciones de extrema urgencia. Se consigue de forma rápida y sencilla y requiere pocos segundos para su inserción. Objetivos: Conocer la bibliografía escrita sobre la técnica de inserción intraósea, así como conocer cómo se lleva a cabo y sus ventajas. Compararla con la vía intravenosa. También indagar sobre los conocimientos de los enfermeros de diferentes lugares sobre esta vía. Metodología: Se realiza una revisión bibliográfica sobre la vía intraósea utilizando las bases de datos PubMed, Medline y Buscador Gerión. Los artículos considerados para la inclusión en el estudio se publicaron en los últimos seis años, tanto en inglés como en castellano. Resultados: La vía intraósea se inserta en zona tibial proximal en niños menores de seis años y tibial distal en adultos. Requiere un mínimo de entrenamiento para su inserción y una vigilancia constante para evitar la aparición de complicaciones. Dependiendo de las enfermeras estudiadas se obtienen diferentes resultados según el área en la que trabajan. No existe ninguna diferencia de absorción entre la vía intravenosa e intraósea. Discusión y conslusiones: Los profesionales de emergencias extrahospitalarias son los que obtienen mejores conocimientos y más utilizan esta técnica. El resto debe recibir formación para aumentar su habilidad y considerar la vía intraósea como alternativa a la intravenosa en cualquier situación que pueda presentarse

Introduction: The intraosseous (IO) route is the second route of choice in emergency cases, when inserting a venous catheter is extremely difficult. Venous access through the IO route is achieved easily and quickly, requiring few seconds for insertion. Objectives: To review the available literature on intraosseous insertion technique, to determine how it is best performed, its advantages and to compare it with the use of the intravenous route. Furthermore, to inquire on the knowledge that nurses from different geographical locations and services have on the IO route. Methodology: A bibliographic review on articles discussing the IO route was performed using the following search engines: Pubmed, Medline and Buscador Gerion. Articles published in English and Spanish over the last six years were considered for inclusion. Results: The IO route is inserted in the proximal tibial zone in children younger than six years and in the distal tibial zone in adults. Its insertion requires minimum training and a constant vigilance to avoid complications. Depending on the nurses analyzed, different results were obtained based on their area of work. No absorption difference was found between the intravenous and intraosseous route. Discussion and conclusions: Outpatient emergency professionals are those who have enhanced knowledge and are most skilled in the use of IO technique. The remaining staff should receive training to increase their skills in order to consider the intraosseous route as an alternative to the intravenous route in situations where it might be required

Proceso asistencial en el accidente cerebrovascular agudo: Activación del código ictus. Caso clínico / Acute stroke care process. activating the code stroke. Clinical case

El accidente cerebrovascular se ha convertido en uno de los motivos de asistencia más frecuentes y de extrema gravedad en los servicios de Urgencias. Requiere una atención inmediata y coordinada para tratar de restablecer la perfusión cerebral con la mayor rapidez posible y permitir así que el paciente recupere sus funciones reduciendo el tiempo de isquemia cerebral. El Código Ictus (CI) es un protocolo que permite la coordinación intra e interhospitalaria en la que sus profesionales se coordinan y actúan de manera rápida para realizar un diagnóstico adecuado y proporcionar un tratamiento precoz que permita conseguir mayores beneficios para el paciente. En este artículo se expone un caso clínico para verificar cual es el proceso asistencial que sigue el paciente con ictus isquémico desde que se atiende en el domicilio hasta que recibe el tratamiento definitivo

Cerebrovascular accidents, more commonly known as strokes, have become one of the most frequent and extremely serious reasons for attending emergency services. Strokes require immediate and coordinated attention, aimed at restoring cerebral perfusion as quickly as possible, and allowing the patient to regain his functions by reducing the time of cerebral ischemia. The Code Stroke (CS) is a protocol that enables intra and interhospital coordination, facilitating health professionals to coordinate and act quickly, in order to reach an adequate diagnosis and provide early treatment that will result in greater benefits for the patient. The present article presents a clinical case with the aim of monitoring the care process that a patient suffering from acute ischemic stroke undergoes, from the time he/she is seen at home until he/she receives definitive treatment

Incidents and adverse events in enteral feeding tube users: warnings based on a cohort study / Incidentes y eventos adversos en usuarios de sonda enteral: alerta a partir de una cohorte

Introduction: few studies clearly describe incidents or adverse events that occur during the enteral nutrition process, which hinders the identification of critical points. Objective: to describe breaches of protocol, incidents and adverse events, during the period beginning with indications until the use of enteral feeding tube in an Emergency Department. Method: trained nurses prospectively monitored a cohort of adults in a Brazilian Emergency Department where use of enteral feeding tube was indicated and up to their use. The study sought to identify breaches of protocol, such as verbal orders to insert feeding tubes, or authorization of their use without X-rays to confirm the position of the feeding tubes. Incidents were characterized as events that could have caused harm to patients, while adverse events were those that did actually cause harm. The study was approved by the institution's Research Ethics Committee. Results: in 150 feeding tube insertions, there were 169 breaches of protocol: verbal orders for feeding tube insertion (n = 59); no X-rays taken (n = 11); and no examination of the X-rays by physicians (n = 12). There were 30 incidents: unintentional removal of the feeding tube (n = 23); and administration of enteral nutrition after breach of preventive barriers. There was one adverse event: aspiration of enteral nutrition. Conclusion: there was a high frequency of breaches of safety protocols; many developed into incidents, and one resulted in an adverse

Introducción: pocos estudios describen claramente los incidentes o eventos adversos que suceden durante el proceso de nutrición enteral, dificultando la identificación de puntos críticos. Objetivo: describir las rupturas de protocolo, los incidentes y los eventos adversos de la indicación para uso de sondas nasogástricas en un Servicio de Urgencias. Método: enfermeras capacitadas siguieron prospectivamente a una cohorte de adultos de un Servicio de Urgencias brasileño, con indicación de uso de sonda enteral. Se buscó identificar las rupturas de protocolo, descritas como: «orden verbal» para inserción de la sonda o para aprobar su uso; y no realización de radiografía confirmatoria del posicionamiento de la sonda. Los incidentes fueron considerados eventos que podrían haber provocado daños al paciente, mientras que los eventos adversos, como incidentes que efectivamente los provocaron. Este proyecto fue aprobado por el Comité de Ética en Investigación de la institución. Resultados: en 150 inserciones de sonda hubo 169 rupturas de protocolo: orden verbal para inserción de sonda (n = 59), no realización de radiografía (n = 11) y radiografía no evaluada por médico (n = 12). Ocurrieron 30 incidentes: retiro inadvertido de sonda (n = 23) y administración de dieta en vigencia de ruptura de barreras (n = 7). Hubo un evento adverso grave (aspiración de dieta). Conclusión: hubo elevada frecuencia de ruptura de protocolo de seguridad; muchas evolucionaron a incidentes y uno de ellos resultó evento adverso

Evaluación del ambiente de trabajo entre profesionales de enfermería en una unidad de urgencia y emergencia / Avaliação do ambiente de trabalho entre profissionais de enfermagem em uma unidade de urgência e emergencia / Evaluation of the working environment between nursing professionals in an urgent and emergency unit

Investigación cuantitativa, descriptiva y exploratoria, llevada a cabo en una unidad de emergencia de la ciudad de Curitiba, Estado de Paraná - Brasil, que tuvo como objetivo identificar la percepción del personal de enfermería acerca de su entorno de trabajo y comparar la percepción del entorno de trabajo de las enfermeras y técnicos de enfermería. Para la recolección de datos se utilizó el instrumento Nursing Work Index - revisado y adaptado al contexto brasileño (B- NWIR), compuesto por 57 elementos que se dividen en cuatro subescalas: autonomía, control sobre el medio ambiente, relación entre los médicos y las enfermeras y apoyo organizativo. Los puntajes inferiores a 2,5 se consideran positivos y por encima de este valor, negativo. Los datos se introdujeron en la hoja de cálculo Excel y se analizaron mediante el software SPSS v.20. La investigación mostró opinión ética favorable conforme a la legislación nacional existente para los estudios en humanos. Los participantes fueron 17 enfermeras y 46 técnicos de enfermería. Hubo un predominio de mujeres jóvenes; sólo la subescala "autonomía" tuvo un promedio de menos de 2,5 y evaluada positivamente por el personal de enfermería. Entre los ítems que componen el instrumento 11 obtuvieron resultados satisfactorios en cuanto a la percepción del ambiente de trabajo, pero no hubo acuerdo entre los grupos estudiados para las medias por ítem. El ambiente de trabajo se evaluó negativamente para la práctica profesional del personal de enfermería y los resultados pueden ayudar a las acciones futuras de los profesionales de enfermería y gestores de servicios con el fin de proporcionar un entorno adecuado para la atención en la unidad de emergencia y de emergencia

Pesquisa quantitativa, descritiva e exploratória, realizada em uma Unidade de Pronto Atendimento do Município de Curitiba, Paraná - Brasil, que objetivou identificar a percepção da equipe de enfermagem quanto ao seu ambiente de trabalho e comparar a percepção do ambiente de trabalho entre enfermeiros e técnicos de enfermagem. Para a coleta de dados foi utilizado o instrumento Nursing Work Index - versão revisada e adaptada ao contexto brasileiro (B- NWIR), composto por 57 itens o qual é subdividido em quatro subescalas: autonomia, controle sobre o ambiente, relação entre médicos e enfermeiros e suporte organizacional. Escores abaixo de 2.5 são considerados positivos e acima deste valor, negativos. Os dados obtidos foram inseridos em planilha Excel(R) e analisados pelo software SPSS Statistics v.20. A pesquisa apresentou parecer ético favorável, conforme a legislação nacional vigente para estudos com seres humanos. Participaram 17 enfermeiros e 46 técnicos de enfermagem. Houve o predomínio de mulheres jovens; apenas a subescala "Autonomia" obteve média inferior a 2,5 e avaliada positivamente por técnicos de enfermagem. Entre os itens que compõem o instrumento, 11 obtiveram resultados satisfatórios quanto à percepção do ambiente de trabalho, contudo não houve concordância entre os grupos estudados para as médias por item. O ambiente de trabalho foi avaliado de forma negativa para a prática profissional da equipe de enfermagem e os resultados podem subsidiar futuras ações dos profissionais de enfermagem e gestores do serviço com vistas a proporcionar um ambiente adequado ao atendimento em unidade de urgência e emergencia

A quantitative, descriptive and exploratory study was carried out in an Emergency Care Unit of the Municipality of Curitiba, Paraná, Brazil, which aimed to identify the perception of the nursing team regarding their work environment and to compare the perception of the working environment among nurses And nursing technicians. For data collection, the Nursing Work Index - a revised version adapted to the Brazilian context (B-NWIR) was used, composed of 57 items, which is subdivided into four subscales: autonomy, control over the environment, relationship between doctors and nurses And organizational support. Scores below 2.5 are considered positive and above this negative value. The data obtained inserted in an Excel(R) worksheet and analyzed by SPSS Statistics software v.20. The research presented a favorable ethical opinion, according to the national legislation in force for studies with human beings. Participants were 17 nurses and 46 nursing technicians. There was a predominance of young women, only the subscale "Autonomy" obtained an average of less than 2.5 and evaluated positively by nursing technicians. Among the items that make up the instrument, 11 obtained satisfactory results regarding the perception of the work environment, however there was no agreement among the groups studied for the averages per item. The work environment evaluated in a negative way for the professional practice of the nursing team and the results can subsidize future actions of the nursing professionals and managers of the service with a view to providing an adequate environment to the attendance in an emergency and emergency unit

Enfermería de práctica avanzada en la atención urgente, una propuesta de cambio: Revisión sistemática / Advanced Practice Nursing in emergency care, a proposal for the change: Systematic review

Fundamentos: La Enfermería de Práctica Avanzada es un rol desconocido en nuestro país. El objetivo principal de esta revisión fue mostrar los resultados de este modelo en los servicios de urgencias para alcanzar su futura implementación dentro del ámbito sanitario español. Métodos: Revisión sistemática de las bases de datos de The Cochrane Controlled, Web Of Science, Cinahl, Cuiden, LILACS, Guía Salud y Cochrane Database of Systematic Reviews. Se utilizaron escalas validadas para la selección de 14 artículos finales, siguiendo el formato PRISMA. Resultados: Se apreciaron resultados favorables, con tiempos de espera máximos de 53 minutos y tiempo medio de estancia de 45 minutos, y menos de un 8% de casos de reingresos inesperados; así como en materia seguridad y satisfacción del paciente. Conclusiones: La implantación de esta figura ofrecería ventajas muy importantes para la mejora del sistema sanitario público, incrementando la calidad asistencial en términos de eficiencia

Background: Advanced Practice Nursing is an unknown role in our country. The aim of the study is to show the results of this model in emergency services for its future implementation in the Spanish health system. Methods: Systematic review with the Cochrane Controlled, Web Of Science, Cinahl, Cuiden, LILACS, Guía Salud and Cochrane Database of Systematic Reviews databases. Different validated scales were used for the selection of 14 final articles, following the PRISMA Statement. Results: Favourable results were observed, with maximum waiting times of 53 minutes and average time of stay of 45 minutes. There were less than 8% of cases of unexpected readmissions. Favourable results were also found regarding safety and patient satisfaction. Conclusions: The implementation of this figure could be beneficial for the improvement of the public health system, increasing the quality of care in terms of efficiency

Impact of specific training in anaphylaxis for triage nursing staff in the Pediatric Emergency Department of a Tertiary Hospital

Background: After a diagnosis of anaphylaxis, patients receive action management plans to prevent and treat new episodes, including attending the emergency department for follow-up or further treatment. In a previous study, we observed that more than half of the children with anaphylaxis were incorrectly prioritized in our Pediatric Emergency Unit (PEU), thus delaying their treatment. In conjunction with our PEU staff, we designed a basic educational intervention (BEI) to try to solve this problem. We analyzed the effect of the intervention on triage of children subsequently diagnosed with anaphylaxis. Methods: Our BEI consisted of a training lecture given to the PEU triage nurses and the design of a reference card highlighting symptoms and risk factors of anaphylaxis. We included 138 children with a medical diagnosis of anaphylaxis and assessed modifications in their triage priority level and waiting times (WT) before seeing a physician after our intervention. According to the BEI implementation date, 69 children were diagnosed before the intervention (G1) and 69 after (G2). Clinical data were compared to assess the severity of the episodes. Results: There were no differences between the groups. WT decreased (from 8 to 1 minute; P=.03), and the number of correctly identified patients increased after the BEI (36.2% [G1] and 72.2% [G2]; P=.0001). Conclusions: Our BEI was effective, improving the identification and prioritization of children with anaphylaxis and reducing their WT. We need to pay attention to the functioning of our patients' reference emergency department and establish interdisciplinary measures that enable optimal management of anaphylaxis

Introducción: Tras un diagnóstico de anafilaxia los pacientes reciben planes de tratamiento para prevenir y tratar nuevos episodios, que incluyen acudir a Urgencias para control o tratamiento subsiguientes. Previamente, nuestro grupo había observado que más de la mitad de los niños con anafilaxia eran priorizados incorrectamente en nuestra Unidad de Urgencias de Pediatría (UP). Elaboramos, en colaboración con el personal de UP, una intervención educativa básica (IEB) para resolver el problema. Analizamos el efecto de dicha intervención en el triaje de los niños atendidos posteriormente por anafilaxia. Métodos: Nuestra IEB consistió en una sesión clínica para el personal de enfermería responsable del triaje y diseñamos una Reference Card destacando síntomas y factores de riesgo de anafilaxia.Incluimos 138 niños con diagnóstico de anafilaxia, analizando los cambios en el nivel de prioridad, tiempos de espera para valoración médica (TEM) tras nuestra IEB. Según la fecha de implementación, 69 niños fueron atendidos antes (G1) y el resto después (69). Se compararon además los datos clínicos de los episodios. Resultados: No hubo diferencias en los datos clínicos entre grupos. Los TEM disminuyeron (de 8 a 1 minutos [p: 0,03]), incrementándose las cifras de pacientes priorizados correctamente (36,2% [G1] y 72,2% [G2][p=0,0001]) tras nuestra intervención. Conclusiones: Nuestra EIB ha sido eficaz, mejorando la identificación, priorización de los niños con anafilaxia y reduciendo los TEM. Debemos conocer el funcionamiento de los Servicios de Urgencias de referencia para nuestros pacientes y establecer medidas multidisciplinarias que optimicen el manejo de la anafilaxia

Collaboration Between Academia and Practice: Interprofessional Crises Leadership and Disaster Management.

An innovative interprofessional disaster preparedness program was designed and implemented through an academic-practice partnership between a large midwestern children's hospital and a community-based state university. This course was part of a constellation of courses developed in response to Presidential Directive (HSPD) 8, a mandate to standardize disaster response training that was issued after the inefficiencies following Hurricane Katrina. A hybrid immersive and didactic approach was used to train senior leadership and frontline clinicians. Included were simulated experiences at the National Center for Medical Readiness, a workshop, and online modules. The program that focused on crisis leadership and disaster management was developed and implemented to serve patient-centered organizations.

Current practices related to family presence during acute deterioration in adult emergency department patients.

AIMS AND OBJECTIVES: To explore the characteristics of and interactions between clinicians, patients and family members during management of the deteriorating adult patient in the emergency department. BACKGROUND: Previous research into family presence during resuscitation has identified many positive outcomes when families are included. However, over the last three decades the epidemiology of acute clinical deterioration has changed, with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite the decrease in cardiac arrests, research related to family presence continues to focus on care during resuscitation rather than care during acute deterioration. DESIGN: Descriptive exploratory study using nonparticipatory observation. METHODS: Five clinical deterioration episodes were observed within a 50-bed, urban, Australian emergency department. Field notes were taken using a semistructured tool to allow for thematic analysis. RESULTS: Presence, roles and engagement describe the interactions between clinicians, family members and patients while family are present during a patient's episode of deterioration. Presence was classified as no presence, physical presence and therapeutic presence. Clinicians and family members moved through primary, secondary and tertiary roles during patients' deterioration episode. Engagement was observed to be superficial or deep. There was a complex interplay between presence, roles and engagement with each influencing which form the other could take. CONCLUSIONS: Current practices of managing family during episodes of acute deterioration are complex and multifaceted. There is fluid interplay between presence, roles and engagement during a patient's episode of deterioration. RELEVANCE TO CLINICAL PRACTICE: This study will contribute to best practice, provide a strong foundation for clinician education and present opportunities for future research.

Psychometric properties of the Management of Aggression and Violence Attitude Scale in Hong Kong's emergency care setting.

BACKGROUND: Emergency unit is one of the most high-risk areas for patient violence. However, in Hong Kong, little research has been test psychometric properties of assessment tool of Emergency unit nurses' attitude toward violence. METHODS: The Management of Aggression and Violence Attitude Scale's (MAVASs) Scale- and Item-Content Validity Index were established by 5-experts panel. A convenience sample of 123 nurses working in 4 public Emergency Department in Hong Kong was recruited. The construct validity was tested using exploratory factor analysis and the reliability was assessed by Cronbach's alpha and test-retest reliability. RESULTS: The Scale-Content Validity Index was 97.0% and the Item-Content Validity Indexes ranged from 80.0% to 100.0%. Exploratory factor analysis indicated 4-factors solution (i.e., "importance of communication with patients", "perceived effectiveness of interventions", "pitfalls of interventions" and "perceived need for intervention"). Its' internal consistency was satisfactory (Cronbach's alphas=0.40-0.77) across the 4 subscales and test-retest reliability over 4-week interval was satisfactory (Pearson's coefficient=0.85). CONCLUSION: MAVAS was found to be a valid and reliable tool to examine nurses' attitudes towards patients' violence in emergency care setting, and provides useful information to those developing training and intervention programmes for management of aggression.

Knowledge and Skills of Healthcare Providers in Sub-Saharan Africa and Asia before and after Competency-Based Training in Emergency Obstetric and Early Newborn Care.

BACKGROUND: Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this. METHODS: We evaluated knowledge and skills among 5,939 healthcare providers before and after 3-5 days 'skills and drills' training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR. RESULTS: 99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49-70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6-15%). CONCLUSIONS: Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working in maternity wards in both sub-Saharan Africa and Asia. Additional support and training is needed for use of the partograph as a tool to monitor progress in labour. Further research is needed to assess if this is translated into improved service delivery.

[Emergency, the nurse and the patient]. / L'urgence, l'infirmier et le patient.

At the heart of an emergency, nurses work closely with the patient and centralise the focus of the team work. They provide technical assistance through procedures carried out in an optimal safety framework.

All the Resources was Gone: The Environmental Context of Disaster Nursing.

US nurses are not prepared for the altered conditions of the disaster environment, nor has the context of providing disaster nursing care been a focus of disaster research. Using an existential phenomenologic approach, US nurses described the "not normal" conditions of the disaster environment they experienced as physically and emotionally challenging, because of the reduced infrastructural capabilities, unfamiliar patient populations, and reliance on low-technology nursing with insufficient staff and supplies. Preparation for the reduced resources of the disaster environment should be integrated into current nursing education, clinical practice, and disaster preparedness policy.