Canadian Journal of Emergency Nursing (CJEN)
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Patient caregiver preferences on discharge instructions from the Alberta Children’s Hospital Emergency Department
Full text linkBackground: Greater than 90% of children who visit a pediatric emergency department (ED) are discharged home. Effective discharge teaching is an opportunity to provide caregivers with the information that they need to provide care for their child at home, ensure appropriate follow-up, and achieve the best outcomes for the child. Discharge instructions should be in a format that families will find accessible and useful, and not result in unnecessary healthcare system costs. As a new electronic health record is being adopted in our ED, this is an opportune time to optimize and standardize discharge instructions.
Methods:
The study design was an anonymous, self-reported, 10-item cross-sectional survey in the ACH ED. Caregivers of patients aged 0-17 years were eligible to complete the survey and approached consecutively during shifts selected by availability of the project lead. Families who required an interpreter to communicate in English were not approached to complete the survey; instead, this was recorded to reflect those who would require translated resources. A sample size of 100 caregivers was chosen to provide a 95% confidence interval of +/- 10%. Survey questions covered preference of discharge instruction modality (verbal, print, electronic, or combination) and likelihood of using instructions if given in print or electronic format. We asked the caregiver’s primary language spoken at home and whether they would be able to use English-language resources. Finally, we tested the caregiver’s ability to use QR codes with a question that could only be answered after successfully accessing a QR code. The project was exempted from research ethics board review due to its classification as quality improvement.
Descriptive analysis was performed, including calculations of proportions and confidence intervals. Results were analyzed using IBM SPSS software.
Results: Of the 117 caregivers approached, 104 completed the survey (89%). Caregivers had a strong preference for written discharge instructions, with 98% supporting either electronic or printed resources in addition to verbal instructions, as opposed to verbal only. There was similar interest for both printed and electronic resources with the likelihood of utilizing that modality being reported as 75% and 79%, respectively.
Three percent of families were unable to complete the survey due to a language barrier. Of the 104 completed surveys, 19% noted that their primary spoken language at home was not English. Nonetheless, 100% of participants who did not primarily speak English but were able to complete the survey reported that they would use English-written discharge resources.
Eighty percent of the participants were able to successfully use the QR code and provide a correct answer to the test question. Of those who could not access the QR code, several reported that their inability was due to devices needing to be charged.
Advice and Lessons Learned
Caregivers of patients in our ED have a strong preference to receive discharge instructions in writing, whether printed or electronic.
There was not a significant difference in preference for electronic versus paper written instructions.
Some families will require translated resources, though many who do not speak English at home would still be able to use English resources. This does not diminish the importance of providing discharge instructions in a family’s preferred language.
QR codes could be an effective tool for distributing electronic resources for most families, but there is still a sizeable proportion of families who are unable to use a QR code
Dog Therapy for Staff in a Pediatric Emergency Department: A Quality Improvement Project
Full text linkAbstractBackground: Recent surveys of our pediatric emergency department staff showed a decrease in staff morale related to increased stress, indicating the need for intervention. Animal-assisted therapy has been shown to have multiple other positive effects in various populations including decreased stress and anxiety reduction. Our existing dog therapy program was unpredictable and inconsistent, resulting in limited staff involvement. Objectives: The purposes of this project were to determine whether a consistently offered dog therapy program in our pediatric emergency department would be utilized by staff and to elicit staff feedback on the program.Methods: A therapy dog was scheduled for one hour twice weekly for staff to visit when they were available. All staff in the ED were encouraged to attend these sessions.Results: Staff responses were collected via pre- and post-intervention questionnaires. The percentage of staff who were not able to visit the dogs pre-intervention was 33%, decreasing to 15% post-intervention. Prior to project initiation, 60% of staff indicated that dog therapy was not offered enough, compared to only 37% after project completion. Staff reported the program was a morale booster and added positivity to the unit. Barriers to participation and suggested improvements were identified.Conclusions: Staff were able to participate in dog therapy more often during the project than prior to project implementation, meeting the overall goal of providing more accessible dog therapy to staff. The program was well-received and has now become a standard offering for our emergency department staff.Keywords: animal assisted therapy, professional burnout, emergency departments, job-related stress, complementary therapy, compassion fatigu
Attitudes et acceptabilité de l’enregistrement des dons d’organes et de tissus dans les services d’urgence : Une enquête nationale auprès du personnel infirmier d’urgence
Full text linkWorldwide, there is a shortage of organs for transplantation. The number of people listed on organ donation registries can possibly be increased by promoting organ donation registration in emergency departments. We administered a national survey to assess emergency nurses’ attitudes and feelings on offering patients’ information on registering to become an organ donor in the emergency department, as well as an immediate opportunity to register. We had 130 (10.2%) responses. Of these, 61.5% of nurses feel that the emergency department is an acceptable location to promote organ donation registration. Additionally, 58.4% feel that the emergency department is an appropriate setting to offer patients and visitors an immediate opportunity to register as an organ and tissue donor while they await medical care. We identified several facilitators and barriers to a potential intervention to promote organ donation registration in the emergency department, such as public importance of increasing donation rates, the recognition of patients’ willingness to help others, and strong institutional donation culture. Some barriers were also identified, such as time constraints and departmental efficiency and flow. We also found that 80% of nurses report to be personally registered as organ donors. This study reveals that Canadian emergency nurses are very engaged and supportive of organ donation and the majority feel that the ED is an appropriate venue to promote organ donation. However, the specific mechanism by which patients are approached by emergency department staff regarding organ donation registration remains unclear.Introduction : À travers le monde, il y a une pénurie d’organes disponible à des fins de transplantations. Il est possible d’augmenter le nombre de personnes inscrites sur les registres de dons d’organes en promouvant l’inscription dans les services d’urgence
Méthodologie : Nous avons mené une enquête nationale pour déterminer les attitudes et les sentiments des infirmières des services d’urgence quant à la possibilité d’offrir aux patients des renseignements sur l’inscription au registre des donneurs d’organes dans les services d’urgence, ainsi qu’une occasion immédiate de s’inscrire.
Résultats : Nous avons obtenu 130 réponses (10,2 %). Parmi celles-ci, 61,5 % des infirmières estiment que le service des urgences est un endroit acceptable pour favoriser l’enregistrement des dons d’organes. De plus, 58,4 % considèrent que le service des urgences est un endroit convenable pour offrir aux patients et aux visiteurs la possibilité de s’inscrire immédiatement comme donneur d’organes et de tissus pendant qu’ils attendent des soins médicaux. Nous avons identifié plusieurs facteurs, facilitant et entravant une intervention potentielle visant à promouvoir l’enregistrement des dons d’organes dans les services d’urgence, tels que la conscientisation du public sur l’importance d’augmenter les taux de dons, la reconnaissance de la volonté des patients d’aider les autres et une solide culture institutionnelle du don. Certains obstacles ont également été identifiés, comme les contraintes de temps, le taux d’efficacité et le flux du département. Nous avons également constaté que 80 % des infirmières déclarent être inscrites comme donneurs d’organes.
Conclusions : Cette étude révèle que les infirmières d’urgence canadiennes sont très engagées et appuient le don d’organes. La majorité d’entre elles estiment que l’urgence est un lieu approprié pour promouvoir le don d’organes. Cependant, le mécanisme spécifique par lequel les patients se verront proposer par le personnel des services d’urgence des informations concernant l’inscription au registre des dons d’organes reste imprécis
Emergency Transport Crew: Post-Traumatic Stress Disorder Prevention Program
Full text linkBackground: The incidences of post-traumatic stress disorder (PTSD) among critical care nurses, emergency room nurses, and paramedics range from 20 to 33%. PTSD is associated with a lower quality of life (QOL), occupational impairments, physical health decline, and increases the risk of premature death. Research supports prevention and surveillance measures for post-traumatic stress disorder in emergency medical service providers, but the practice is not routinely done.
Methods: A multi-purpose quality improvement project focused on educating transport crew members about PTSD. Other interventions emphasized anti-stigma lessons, resiliency assistance, and coping skills training. The pilot provided surveillance efforts, employed an early organizational PTSD recognition, and immediate debriefing for at-risk personnel at three Air Evac Lifeteam bases.
Results: After the QI interventions, most crew members’ overall post-test PCL-5 scores were lowered by 12.5%. Another measure of the QI success was the Professional Quality of Life score improvement. Specially, the compassion satisfaction average level increased by 14% and the average burnout level decreased by of 15%.
Conclusions: The QI project demonstrated the transport crew members’ well-being can be positively influenced by a PTSD prevention and surveillance program. These interventions offer a promising reduction in the prevalence of stress and PTSD. A nationwide practice change with these project interventions could improve the mental health of helicopter emergency medical personnel
Occupational Disappointment and Emergency Nurses: A Qualitative Descriptive Study
Full text linkBackground: Occupational disappointment is a novel concept in emergency nursing. It is a feeling of disheartenment with career choice. It results from prevalent, unaddressed verbal abuse in the emergency department directed towards nurses from patients and/or their visitors. Occupational disappointment is conceptually different from burnout and compassion fatigue. In the context of the COVID-19 pandemic, it is important to acknowledge this phenomenon and understand its implications while considering strategies to mitigate it.
Method: A qualitative descriptive methodology was used in this study. Nurses were interviewed to explore the question: How do emergency department nurses experience occupational disappointment as a result of verbal abuse?
Results: Three major themes with several subthemes were identified: (1) nurses’ experiences of occupational disappointment with sub-themes of powerlessness and normalizing; (2) nurses’ responses to occupational disappointment with sub-themes of changes in nursing practice, retention, and nurses’ mental health; (3) nurses’ concerns regarding occupational disappointment with sub-themes of nursing and organizational leadership.
Discussion: Policies addressing verbal abuse would help guide nurses when managing this violence. Failure of nurse leaders to implement such measures contributes to nurses’ occupational disappointment, consequently affecting nurses’ practice, mental health, and retention. While these implications are not new, the COVID-19 pandemic has exacerbated this phenomenon. The magnitude of verbal abuse that emergency nurses currently face has increased exponentially; a renewed urgency for strategic action is necessary.
Conclusion: Occupational disappointment is a direct result of verbal abuse and an indirect result of organizational failures to support nurses and empower them to mitigate this abuse
The Alberta Health Services Emergency Strategic Clinical Network™ Quality Improvement and Innovation Forum presented on February 22, 2022.
Full text linkEvidence-based research and quality improvement work are pivotal to health systems meeting their goals. Translating findings and disseminating innovative practices to new settings occurs in part through knowledge translation events, such as conferences and workshops.
The Emergency Strategic Clinical Network™ (ESCN) Quality Improvement and Innovation Forum fills a gap between local and national events. It is devoted to sharing methods and results of emergency department projects in Alberta among those working in emergency care. Despite the challenges presented by the COVID-19 pandemic, 2022 was the fourth consecutive year the ESCN has held this event.
The event provides an opportunity for those working on quality improvement in emergency medicine to network with one another, share innovative projects, share know how and translate promising works to new settings. In addition, the event provides an opportunity to identify projects for potential development through local, provincial, or national funding opportunities. This year’s forum was, again, held virtually due to the ongoing pandemic. 18 teams provided oral presentations including the ESCN patient advisors who shared details of how to engage patients in quality improvement work.. Not all abstracts are published in this collection, as some abstracts will have been previously published elsewhere.
Strong attendance shows the value practitioners see in the forum. In 2022, approximately 121 educators, managers, nurses, physicians and researchers from across Alberta and British Columbia, attended the forum. Post-event evaluation survey feedback suggests that the online format was greatly appreciated and many of the initiatives presented would be pursued further by participants.
The findings presented in the abstracts are solely the work of the submitting authors. The ESCN does not guarantee the accuracy of any reported information. The views expressed in the abstracts are solely the views of the authors and do not represent the ESCN or Alberta Health Services
Identifying and managing latent safety threats though a zone-wide emergency department in-situ multidiscipline simulation program: A quality improvement project
Full text linkABSTRACT
Background
Latent safety threats (LSTs) have been defined as system based issues that threaten patient safety that can materialize at any time and were previously unrecognized by healthcare providers, unit directors, or hospital administration. While LSTs such as system deficiencies, equipment failures, training, or conditions predisposing medical errors are frequently reported in the literature, a paucity was noted in the management and mitigation of these threats. The purpose of the translational simulation quality improvement project study was to utilize translational simulations to identify, manage, and mitigate future latent safety threats in our EDs.
METHODS
In 2017, 18 in-situ inter-professional simulation sessions were conducted at 11 EDs. Following each session, a survey assessment tool, created by the research team, was completed by participants to identify latent safety threats. Findings were shared with site clinical nurse educators and managers to help facilitate institutional follow up. For reporting, latent safety threats were categorized thematically and coded as either (i) resolved, (ii) ongoing, or (iii) not managed. Follow-up with sites was completed 1 year following the simulation.
RESULTS
A total n=158 LSTs were identified. The number and percentage by theme was: staff 48 (30.4%), equipment 41 (25.9%), medications 33 (20.9%), resuscitation resources 24 (15.2%), and information technology (IT) issues 12 (7.6%).Site follow-up identified that 149 LSTs were resolved and ten required ongoing work to manage. No occurrences of a LST ‘not managed’ were identified.
CONCLUSIONS
Translation simulation effectively identified latent safety threats and assisted interdisciplinary teams in the creation of a structured plan and systematic follow-up to enhance the health system and patient care. Through use of a threat mitigation strategy all identified threats were addressed while some require ongoing management. 
Le coin du clinicien : La Règle canadienne concernant la radiographie de la colonne cervicale (Canadian C-Spine Rule)
Full text linkA 44-year-old driver of a small sedan self-presents to your emergency department (ED) triage area indicating they developed a stiff neck 30 minutes after they were rear-ended by a small van when they were stopped at a traffic light. The rear bumper of the patient’s vehicle is slightly dented, and there is scuffing to the front bumper of the van. No airbags were deployed and the driver of the sedan did not hit their head. The van was estimated to be travelling between 10-20 km/h at the time of impact. The patient self-extricated from their vehicle and was ambulatory at the scene. Currently, the patient is alert, oriented, and in no distress. The patient denies paresthesia, has no midline cervical spine (c-spine) tenderness, and is able to actively rotate their neck 45° left and right.Un conducteur âgé de 44 ans au volant d’une petite berline se présente spontanément au triage de votre service d’urgence déclarant qu’il a développé un torticolis 30 minutes après avoir été embouti par une camionnette en attendant à un feu rouge. Le pare-chocs arrière de sa voiture est légèrement cabossé, et le pare-chocs avant de la camionnette est égratigné. Aucun coussin gonflable ne s’est déployé et le conducteur de la berline ne s’est pas cogné la tête. D’après le patient, la camionnette roulait entre 10 et 20 km/h au moment de l’impact. Le patient s’est extrait lui-même de son véhicule et était mobile sur les lieux. Actuellement, le patient est alerte, orienté et ne présente aucune détresse. Le patient n’a pas de paresthésie, ne présente pas de sensibilité le long de la ligne médiane de la colonne vertébrale et est capable de tourner activement sa tête de 45° à gauche et à droite