Canadian Journal of Emergency Nursing (CJEN)
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Flipping the virtual classroom: A novel approach to critical care education in undergraduate nursing
Full text linkDéclaration de position nationale de l’ANIIU sur l’autogestion de la santé chez le personnel infirmier d’urgence
Full text linkExploring delay points at the emergency department
Full text linkBackground
The increasing time spent in the emergency department is becoming a global problem contributing to overcrowding. The increased length of stay in the emergency department can negatively affect patients\u27 perception of care, contributes to high morbidity and mortality rates, and increased aggression towards staff. Therefore, understanding the delay points will help administrators and policy makers channel resources to the areas that require improvement.
Methods
This is a cross-sectional descriptive study to evaluate the delay points in the emergency department. The study was conducted at level IV community hospital in British Columbia. One hundred sixty-seven participants were recruited using a consecutive convenience sampling.
Results
The total sample size of this study was 167 and the age of the respondents ranged from 18-101 years. There were more females (50.9%) than males (47.9%) or queer individuals. The care point with the longest wait time was tests to physician reassessment (median time 65 minutes), followed by physician to Imaging (median time 52 minutes) and finally nurse to physician assessment (median time 45 minutes). Despite the prolonged length of stay in emergency department, most participants enjoyed the courtesy of staff (74.7%, good-very good) and 59.9% indicated that they would recommend this emergency department to others.
Conclusion
Tests and waiting for physician reassessments are important points in the patient journey in the emergency department that can prolong length of stay. Future studies are needed to determine whether various interventions such as point of care testing, utilizing the Lean Model and improving physician services can help reduce lengths of stay in the emergency department
La gestion des hémorragies du post-partum dans la pratique des soins infirmiers d’urgence au Canada
Full text linkBackground: Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality globally, claiming approximately 70,000 lives annually. Despite preventive efforts, high-income countries, including Canada, have reported increasing rates of PPH. The rising incidence and associated complications indicate improved emergency nursing practices in managing PPH are needed. Methods: PPH guidelines from the Society of Obstetricians and Gynecologists of Canada, Federation of International Gynecologists and Obstetricians, and the Canadian Association of Perinatal, and Women’s Health Nurses were compared to National Emergency Nurses Association guidelines. The competencies, medications, and obstetric maneuvers for PPH that may be relevant to emergency nurses were extracted and categorized for the emergency nursing HIRAID (History & Red flags, Assessment, Interventions, & Diagnosis) framework. Findings/Results: We found 13 discrete skills across the PPH guideline recommendations that are applicable to emergency nurses. There is near perfect overlap in medical recommendations, but gaps exist between FIGO and SOGC guidelines and NENA and CAPWHN guidelines. There are SOGC and FIGO guidelines that apply to emergency nurses that are not addressed in NENA guidelines, Discussion: There was significant overlap on treatment recommendations from maternal health bodies such as uterotonic drugs, hemorrhage control, and hemostatic resuscitation. There were significant gaps in NENA recommendations. Conclusion: The comparison of PPH guidelines highlights where NENA guidelines need further detail. These skills are particularly significant for providing nursing care in rural and remote areas. Standardized protocols for PPH management, interprofessional collaboration, and regular competency assessments are included in most guidelines but are conspicuously absent for emergency nurses. To address the gap, NENA could integrate national emergency nursing PPH competencies standards or develop recommendations for the care of maternal emergencies.Contexte : L’hémorragie post-partum (HPP) demeure l’une des principales causes de mortalité maternelle dans le monde, avec quelque 70 000 décès par an. Malgré les efforts de prévention, les pays à revenu élevé, y compris le Canada, ont signalé des taux croissants d’HPP. L’incidence croissante et les complications qui y sont associées témoignent de la nécessité d’améliorer les pratiques infirmières d’urgence dans la prise en charge de l’HPP.
Méthodes : Les directives relatives à l’HPP de la Société des obstétriciens et gynécologues du Canada (SOGC), de la Fédération internationale de gynécologie et d’obstétrique (FIGO) et de l’Association canadienne des infirmières et infirmiers en périnatalité et en santé des femmes (CAPWHN) ont été comparées aux directives de l’Association nationale des infirmières et infirmiers d’urgence (ANIIU). Les compétences, les médicaments et les manœuvres obstétricales pour l’HPP qui pourraient être pertinents pour le personnel infirmier d’urgence ont été extraits et catégorisés pour le cadre « Antécédents et signaux d’alerte, évaluation, interventions et diagnostic » (HIRAID).
Constatations et résultats : Nous avons trouvé 13 compétences distinctes dans les recommandations des lignes directrices sur l’HPP qui correspondent au personnel infirmier des urgences. Les recommandations médicales se chevauchent presque parfaitement, mais il existe des écarts entre les lignes directrices de la FIGO et de la SOGC et les lignes directrices de l’ANIIU et du CAPWHN. Certaines directives émanant de la SOGC et de la FIGO qui s’appliquent au personnel infirmier d’urgence ne sont pas prises en compte dans les directives de l’ANIIU.
Discussion : Les recommandations des organismes de santé maternelle en matière de traitement se chevauchent nettement, par exemple en ce qui concerne les médicaments utéro-tonique, le contrôle des hémorragies et la réanimation hémostatique. Les recommandations de l’ANIIU font état d’importantes lacunes.
Conclusion : La comparaison des lignes directrices de l’HPP met en évidence les aspects des lignes directrices de l’ANIIU qui méritent d’être précisés. Ces compétences sont particulièrement importantes pour la prestation de soins infirmiers dans les zones rurales et éloignées. Des protocoles normalisés pour la prise en charge de l’HPP, la collaboration interprofessionnelle et l’évaluation continue des compétences sont inclus dans la plupart des lignes directrices, mais sont manifestement absents en ce qui concerne le personnel infirmier des urgences. Pour combler cette lacune, l’ANIIU pourrait incorporer des normes nationales de compétences en soins infirmiers d’urgence pour l’HPP ou élaborer des recommandations pour la prise en charge des urgences maternelles
Use of Social Media and Free Open Access Medicine (FOAM) for Continuing Education in Emergency Nursing: A Scoping Review
Full text linkObjective: Emergency nurses are responsible for ensuring that they have up-to-date knowledge and skills to deal with any situation that may present in clinical practice. As an emerging trend for learners to obtain and discuss evidence-based medical education, social media, Free Open Access Medical education (FOAM) and Free Open Access Nursing education (FOAN) could be used for continuing education in emergency nursing. This scoping review aims to discover what is known about social media and FOAM in continuous emergency nursing education.
Methods: This scoping review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses – Extension for Scoping Reviews (PRISMA-ScR). The review searched three databases (Medline, CINAHL, and Web of Science) for any paper that discussed social media or FOAM in the context of continuing education in either general or emergency nursing published in any year. Of the 346 records screened, 12 studies were reviewed for their description of social media for continuing education use and any reported challenges or outcomes.
Results: The current state of literature is limited in describing the use of social media with continuing education specifically in emergency nursing. Rather than as a primary educational intervention, social media has been used to enhance other educational strategies or as in-the-moment forms of learning. Studies that utilized social media showed favorability to its use, but there were often challenges to the methodology of these studies. Despite papers describing the elements of FOAM, papers within the nursing literature did not use this term.
Conclusion: Although the literature on social media in emergency and general nursing literature is growing, it is superficial and broad. More studies are needed to see the overall effects of social media in continuing education in emergency nursing.
Keywords: continuing education, emergency nursing, nursing education, social media
The Impact of Nurse Practitioner Role in Emergency Departments: A Mixed Studies Systematic Review Protocol
No full textBackground
Overcrowding and long wait times in the emergency department (ED) have resulted in decreased patient satisfaction and quality of care. One of the solutions proposed to address wait times is the introduction of the nurse practitioner (NP) role in the ED. We present a systematic mixed studies review protocol that aims to gather and analyze available knowledge on the impact of the NP role in the ED on patients, other healthcare providers, and organizations.
Methods
The review will employ a mixed studies analysis approach. Data will be gathered from peer-reviewed and grey literature in English with no time limit. All international publications on the impact of NP role implementation that meets the inclusion criteria in the ED setting will be included. Each study will be appraised for quality using the mixed methods appraisal tool and data extracted by two independent authors. In the presence of conflict, a third author will provide a resolution. Study characteristics and findings will be synthesized using descriptive analysis, meta-analysis, and a three-stage thematic analysis approach. The review results will be presented using the PRISMA checklist for systematic reviews.
Conclusions
The systematic review will present current evidence on the impact of NP role implementation in the ED setting. The results are anticipated to support decisions and policymakers in their quest to decrease ED wait times and improve the quality of patient care in healthcare settings.
Keywords: Nursing, Nurse Practitioner, Emergency Department, Patient Care, Systematic Revie
Combler les lacunes dans les soins d’urgence: le rôle vital du personnel infirmier de pratique avancée au service des populations vulnérables
Full text linkAbstract: Current socio, political, and economic events may disproportionately affect those who are identified as vulnerable, as well as their presentation to Canadian emergency departments. The housing crisis, food instability, and concurrent issues with mental health and addictions are a harsh reality for many of these individuals. The emergency department may not be suited to complex health and social issues, but it provides an essential safety net for the vulnerable who cannot access care through traditional primary care routes. Alternative, patient-centered solutions to the problem are necessary, and advanced practice nurses can be the key to appropriately organizing and delivering integrated care innovative models. Raising awareness and influencing public policy to drive meaningful social change and address alarming health inequities is an important consideration for nurses working in emergency departments.Résumé: Les événements sociopolitiques et économiques actuels peuvent avoir des conséquences disproportionnées sur les personnes vulnérables et sur leur présentation dans les services d’urgence canadiens. La crise du logement, l’instabilité alimentaire et les problèmes parallèles de santé mentale et de toxicomanie sont une dure réalité pour grand nombre de ces personnes. Le service des urgences ne convient peut-être pas aux enjeux de santé et sociaux complexes, mais il assure un filet de sécurité essentiel pour les personnes vulnérables qui ne peuvent pas accéder aux soins par les voies habituelles des soins de santé primaires. Il est nécessaire de trouver d’autres solutions au problème, centrées sur le patient, et le personnel infirmier de pratique avancée peut jouer un rôle fondamental dans l’organisation et la mise en œuvre de modèles novateurs de soins intégrés. La sensibilisation et l’influence sur les politiques gouvernementales afin de conduire un changement social significatif et de remédier aux inégalités alarmantes en matière de santé sont des considérations importantes pour le personnel infirmier des services d’urgence
English: English
No full textBackground: For patients sustaining major trauma, decreasing time to definitive care remains a primary goal. Specialized trauma team involvement is essential for coordinating the emergency department care of complex major trauma patients. The aim of this study was to evaluate if the timing of trauma team involvement impacts length of stay and time to definitive care in the emergency department.
Methods: This is a single-centre retrospective medical record review, including patients meeting Quebec pre-hospital triage criteria for major trauma from May 15, 2018 to December 31, 2020. We assessed time from patient arrival until departure from the resuscitation room, time to CT scan, time to disposition, and overall length of emergency department stay. Patients were grouped according to the timing of trauma team activation (TTA) as (1) pre-hospital notification, (2) on arrival in the emergency department, (3) receiving a trauma consult only, or (4) no trauma team involvement. Mean times and standard deviations were calculated, and group differences were assessed using the Kruskal-Wallis test and the independent sample Mann-Whitney U test.
Results: We identified 371 patients meeting our inclusion criteria; there were no differences between groups in mean time spent in the resuscitation room based on the timing of trauma team involvement (45-51 minutes, p=0.422). A trauma team activation with pre-hospital notification was associated with a statistically significant shorter time to CT scan (62-81 minutes, p=0.010), time to disposition (6:37-13:41, p<0.001), and total emergency department length of stay (9:22-23:16 hours: minutes, p<0.001).
Conclusion: Appropriate trauma team activation improves performance indicators used to evaluate the quality of care in the emergency department. This research suggests that pre-hospital trauma team activation should be considered the standard of care for all patients meeting pre-hospital field triage criteria for major trauma.
Keywords: trauma, triage, pre-hospital, trauma team activation, trauma quality indicator
Intégration des apprenants paramédicaux et infirmiers d’urgence dans une simulation d’équipe de traumatologie sur place
Full text linkThe COVID-19 and its associated restrictions and closures provided challenges to health professions education programs in creating suitable clinical experiences to allow consolidation and application of the concepts learned from the classroom. While in situ simulation has been well-established for continuing education with active clinical teams, there is a paucity in literature describing the integration of health professions learners in an in situ simulation. This created an opportunity to integrate learners from paramedic and postgraduate emergency nursing programs to participate in an in situ simulation with active clinical team members of an Canadian academic tertiary trauma center. A series of high fidelity simulations were designed and implemented with paramedic learners performing the initial assessment and management in the prehospital phase and subsequently handing over to a receiving team inside a trauma center. Preliminary feedback solicited from participants indicated that this was a valuable learning experience and provided an opportunity to practice technical and nontechnical skills.La COVID-19 et les restrictions et fermetures qui y sont associées ont posé des défis aux programmes de formation des professions de santé pour créer des expériences cliniques adaptées permettant de consolider et d\u27appliquer les concepts appris en classe. Bien que la simulation in situ soit bien établie pour la formation continue des équipes cliniques actives, il y a une rareté dans la littérature décrivant l\u27intégration des apprenants des professions de santé dans une simulation in situ. Cela a créé une opportunité d\u27intégrer des apprenants des programmes de soins paramédicaux et des programmes de formation en soins infirmiers d\u27urgence de troisième cycle pour participer à une simulation in situ avec des membres actifs d\u27une équipe clinique d\u27un centre de traumatologie universitaire canadien. Une série de simulations haute fidélité ont été conçues et mises en œuvre, avec des apprenants paramédicaux effectuant l\u27évaluation initiale et la gestion en phase préhospitalière, puis transférant le relais à une équipe de réception à l\u27intérieur d\u27un centre de traumatologie. Les retours préliminaires recueillis auprès des participants ont indiqué que cela représentait une expérience d\u27apprentissage précieuse et offrait une opportunité de pratiquer des compétences techniques et non techniques
