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Shirzad F, Shariat SV, Masjedi N, Ghadirivasfi M, Ghalichi L, Fakhrian A, Hadi F. Workshop-based training of pre-hospital emergency technicians for acute psychiatric patients: benefits and drawbacks. BMC MEDICAL EDUCATION 2024; 24:996. [PMID: 39267028 PMCID: PMC11396583 DOI: 10.1186/s12909-024-05856-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 08/01/2024] [Indexed: 09/14/2024]
Abstract
BACKGROUND Pre-hospital emergency technicians are crucial in managing patients with acute psychiatric symptoms. They must quickly assess the condition, make a primary diagnosis, and refer the patient to the appropriate treatment center. Insufficient skills in these situations can cause serious harm. Educating technicians on dealing with these patients may enhance their knowledge and skills; however, we do not know the extent and longevity of this improvement and which areas are affected. This study investigates the impact of training on pre-hospital emergency technicians' knowledge and skills. METHODS This quasi-experimental study involved pre-hospital emergency technicians in Robat Karim and Nasim Shahr counties from December 2022 to January 2022. The technicians received workshops on interacting with psychiatric patients. The training topics included the basic principles of coping with a psychiatric patient. They also covered a step-by-step approach to dealing with an aggressive patient, dealing with a patient threatening suicide, managing agitation, managing a patient suffering from panic attacks, and finally dealing with a delirious patient. A pre-test assessed their baseline knowledge and skills, followed by a post-test after training and another test three months later. The test results were analyzed. RESULTS This study involved forty male participants ranging in age from 25 to 44 and with work experience ranging from five to twenty years. As a result of training in dealing with acute psychiatric patients, technicians developed significant skills and knowledge immediately after training, and these improvements remained significant three months after training. Nevertheless, the correct answers decreased during the three-month follow-up compared to the pre-test. Education was less effective at managing panic, delirium, and agitation. CONCLUSION In conclusion, technicians' knowledge and skills can be effectively enhanced through training; however, the impact diminishes with time. Theories and practical methods, periodic repetition, and real-world internships are the best ways to maximize training effectiveness.
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Grants
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
- 98-3-8-4868 Vice President of Health, Iran University of Medical Sciences,Tehran,Iran.
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Affiliation(s)
- Fatemeh Shirzad
- Spiritual Health Research Center, Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Vahid Shariat
- Mental Health Research Center, School of Behavioral Sciences and Mental Health, Department of Psychiatry, School of Medicine, Tehran Institute of Psychiatry), Tehran, Iran
| | - Neda Masjedi
- Department of psychiatry, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghadirivasfi
- Medical faculty, Research Center for Addiction and Risky Behaviors (ReCARB), Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghalichi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Arghavan Fakhrian
- Fellowship of Psychosexual Medicine, Department of Psychosexual Medicine, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadi
- Department of Psychiatry, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Song J, Kim S, Chung HS, Park I, Kwon SS, Myung J. Predictive indicators for determining red blood cell transfusion strategies in the emergency department. Eur J Emerg Med 2023; 30:260-266. [PMID: 37115971 DOI: 10.1097/mej.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND AND IMPORTANCE Appropriate decision-making is critical for transfusions to prevent unnecessary adverse outcomes; however, transfusion in the emergency department (ED) can only be decided based on sparse evidence in a limited time window. OBJECTIVES This study aimed to identify factors associated with appropriate red blood cell (RBC) transfusion in the ED by analyzing retrospective data of patients who received transfusions at a single center. OUTCOME MEASURES AND ANALYSIS This study analyzed associations between transfusion appropriateness and sex, age, initial vital signs, an ED triage score [the Korean Triage and Acuity Scale (KTAS)], the length of stay, and the hemoglobin (Hb) concentration. MAIN RESULTS Of 10 490 transfusions, 10 109 were deemed appropriate, and 381 were considered inappropriate. A younger age ( P < 0.001) and a KTAS level of 3-5 ( P = 0.028) were associated with inappropriate transfusions, after adjusting for O 2 saturation and the Hb level. CONCLUSIONS In this single-center retrospective study, younger age and higher ED triage scores were associated with the appropriateness of RBC transfusions.
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Affiliation(s)
| | | | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | | | - Jinwoo Myung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Reliability and Validity of a New Computer-Based Triage Decision Support Tool: ANKUTRIAGE. Disaster Med Public Health Prep 2022; 17:e162. [PMID: 35765149 DOI: 10.1017/dmp.2022.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Triage is a tool used to determine patients' severity of illness or injury within minutes of arrival. This study aims to assess the reliability and validity of a new computer-based triage decision support tool, ANKUTRIAGE, prospectively. METHODS ANKUTRIAGE, a 5-level triage tool was established considering 2 major factors, patient's vital signs and characteristics of the admission complaint. Adult patients admitted to the ED between July and October, 2019 were consecutively and independently double triaged by 2 assessors using ANKUTRIAGE system. To measure inter-rater reliability, quadratic-weighted kappa coefficients (Kw) were calculated. For the validity, associations among urgency levels, resource use, and clinical outcomes were evaluated. RESULTS The inter-rater reliability between users of ANKUTRIAGE was excellent with an agreement coefficient (Kw) greater than 0.8 in all compared groups. In the validity phase, hospitalization rate, intensive care unit admission and mortality rate decreased from level 1 to 5. Likewise, according to the urgency levels, resource use decreased significantly as the triage level decreased (P < 0.05). CONCLUSIONS ANKUTRIAGE proved to be a valid and reliable tool in the emergency department. The results showed that displaying the key discriminator for each complaint to assist decision leads to a high inter-rater agreement with good correlation between urgency levels and clinical outcomes, as well as between urgency levels and resource consumptions.
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Schinkel M, Bergsma L, Veldhuis LI, Ridderikhof ML, Holleman F. Comparing complaint-based triage scales and early warning scores for emergency department triage. Emerg Med J 2022; 39:691-696. [PMID: 35418407 PMCID: PMC9411919 DOI: 10.1136/emermed-2021-211544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 03/25/2022] [Indexed: 12/28/2022]
Abstract
Background Emergency triage systems are used globally to prioritise care based on patients’ needs. These systems are commonly based on patient complaints, while the need for timely interventions on regular hospital wards is usually assessed with early warning scores (EWS). We aim to directly compare the ability of currently used triage scales and EWS scores to recognise patients in need of urgent care in the ED. Methods We performed a retrospective, single-centre study on all patients who presented to the ED of a Dutch Level 1 trauma centre, between 1 September 2018 and 24 June 2020 and for whom a Netherlands Triage System (NTS) score as well as a Modified Early Warning Score (MEWS) was recorded. The performance of these scores was assessed using surrogate markers for true urgency and presented using bar charts, cross tables and a paired area under the curve (AUC). Results We identified 12 317 unique patient visits where NTS and MEWS scores were documented during triage. A paired comparison of the AUC of these scores showed that the MEWS score had a significantly better AUC than the NTS for predicting the need for hospital admission (0.65 vs 0.60; p<0.001) or 30-day all-cause mortality (0.70 vs 0.60; p<0.001). Furthermore, when non-urgent MEWS scores co-occur with urgent NTS scores, the MEWS score seems to more accurately capture the urgency level that is warranted. Conclusions The results of this study suggest that EWSs could potentially be used to replace the current emergency triage systems.
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Affiliation(s)
- Michiel Schinkel
- Center for Experimental and Molecular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
| | - Lyfke Bergsma
- Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | | | | | - Frits Holleman
- Internal Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
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Vergara P, Forero D, Bastidas A, Garcia JC, Blanco J, Azocar J, Bustos RH, Liebisch H. Validation of the National Early Warning Score (NEWS)-2 for adults in the emergency department in a tertiary-level clinic in Colombia: Cohort study. Medicine (Baltimore) 2021; 100:e27325. [PMID: 34622831 PMCID: PMC8500632 DOI: 10.1097/md.0000000000027325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/07/2021] [Indexed: 01/05/2023] Open
Abstract
The National Early Warning Score (NEWS)-2 is an early warning scale that is used in emergency departments to identify patients at risk of clinical deterioration and to help establish rapid and timely management. The objective of this study was to determine the validity and prediction of mortality using the NEWS2 scale for adults in the emergency department of a tertiary clinic in Colombia.A prospective observational study was conducted between August 2018 and June 2019 at the Universidad de La Sabana Clinic.The nursing staff in the triage classified the patients admitted to the emergency room according to Emergency Severity Index and NEWS2. Demographic data, physiological variables, admission diagnosis, mortality outcome, and comorbidities were extracted.Three thousand nine hundred eighty-six patients were included in the study. Ninety-two (2%) patients required intensive care unit management, with a mean NEWS2 score of 7. A total of 158 patients died in hospital, of which 63 were women (40%). Of these 65 patients required intensive care unit management. The receiver operating characteristic curve for NEWS2 had an area of 0.90 (CI 95%: 0.87-0.92). A classification and score equivalency analysis was performed between triage and the NEWS2 scale in terms of mortality. Of the patients classified as triage I, 32.3% died, and those who obtained a NEWS2 score greater than or equal to 10 had a mortality of 38.6%.Among our population, NEWS2 was not inferior in its area under the receiver operating characteristic curve when predicting mortality than triage, and the cutoff point for NEWS2 to predict in-hospital mortality was higher.
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Affiliation(s)
- Peter Vergara
- Evidence-based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Clínica Universidad de La Sabana, Chía, Colombia
- Clinical Pharmacology Service, Clínica Universidad de La Sabana, Colombia
| | - Daniela Forero
- Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Alirio Bastidas
- Research Department, Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Julio-Cesar Garcia
- Evidence-based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Clínica Universidad de La Sabana, Chía, Colombia
- Clinical Pharmacology Service, Clínica Universidad de La Sabana, Colombia
| | - Jhosep Blanco
- Evidence-based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Clínica Universidad de La Sabana, Chía, Colombia
| | - Jorge Azocar
- Faculty of Medicine, Universidad de La Sabana, Chía, Colombia
| | - Rosa-Helena Bustos
- Evidence-based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Clínica Universidad de La Sabana, Chía, Colombia
| | - Hans Liebisch
- Evidence-based Therapeutics Group, Clinical Pharmacology, Universidad de La Sabana, Clínica Universidad de La Sabana, Chía, Colombia
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Moudi A, Iravani M, Najafian M, Zareiyan A, Forouzan A, Mirghafourvand M. Exploring the concept and structure of obstetric triage: a qualitative content analysis. BMC Emerg Med 2020; 20:74. [PMID: 32933481 PMCID: PMC7493847 DOI: 10.1186/s12873-020-00369-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Obstetric triage is a new idea, so the design and implementation of it requires identification of its concept and structure. The aim of this qualitative study was to explore the concept and structure of the obstetric triage in Iran. METHODS The purposive sampling was done and it continued until reaching the theoretical saturation. Thirty-seven semi-structured interviews were conducted individually and face-to-face. Interviews were audio recorded, transcribed, and analyzed using conventional content analysis. RESULTS Two themes, 8 main categories, and 16 subcategories emerged from the content analysis of the interviews and observations. The themes were the concept and structure of obstetric triage. The concept of obstetric triage consisted of three categories of nature, process, and philosophy of obstetric triage. The structure of obstetric triage included five categories of assessment criteria, emergency grading, determining the appropriate location for patient guidance, initiation of diagnostic and therapeutic measures, and timeframe for initial assessment and reassessment. CONCLUSION Findings highlighted that obstetric triage is a process with a dual and dynamic nature. This process involves clinical decision making to prioritize the pregnant mother and her fetus based on the severity and acuity of the disease in order to allocate medical resources and care for providing appropriate treatment at the right time and place to the right patient. The results of this study could be used for the design and implementation of the obstetric triage system.
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Affiliation(s)
- Asieh Moudi
- Midwifery Department, Birjand University of Medical Sciences, Birjand, Iran
| | - Mina Iravani
- Midwifery Department, Reproductive Health Promotion Research Center, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Mahin Najafian
- Department of Obstetrics and Gynecology, School of Medicine, Fertility Infertility and Perinatology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Armin Zareiyan
- Public Health Nursing Department, Nursing Faculty Aja University of Medical Sciences, Tehran, Iran
| | - Arash Forouzan
- Department of Emergency Medicine, Imam Khomeini General Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mojgan Mirghafourvand
- Midwifery Department, Social Determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran
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Phiri M, Heyns T, Coetzee I. Patients' experiences of triage in an emergency department: A phenomenographic study. Appl Nurs Res 2020; 54:151271. [PMID: 32650888 DOI: 10.1016/j.apnr.2020.151271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/10/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Triage, predominantly done by nurses in the emergency department, is globally accepted as essential to prioritise the acuity of patient care. Patients with low acuity illness often express frustration and disgruntlement with the triage process and long waiting times. Consequently, some patients leave the emergency department unseen, which may negatively affect their health outcomes. In order to change practice efficiently, triage nurses should provide patients an opportunity to share their experiences. OBJECTIVE This paper deals with exploring the understanding patients' emergency department triage experiences. DESIGN A phenomenographic approach was used to explore and understand patients' triage-related experiences in an emergency department. METHODS AND CONTEXT Semi-structured individual interviews were conducted with 10 purposively selected participants who were triaged as yellow or green in an emergency department in a public hospital in Botswana. Collaborative creative hermeneutic data analysis by 11 nurses working in the same context identified categories of description. RESULTS Three categories of description emerged from patient experiences, namely triage environment, triage nurse and waiting times. Following data analysis, the nurses reflected that they were not aware of the consequences in the way triage was currently conducted. Consensus was reached that they should move away from focusing on a biomedical model towards person-centred triage, which then underpinned the outcome space for triage in the emergency department. CONCLUSION The reality in the emergency department is that patients' needs, wishes and expectations are neglected, leaving them dissatisfied and disgruntled. Moving towards person- centred triage may improve their overall experience of triage. What is already known about this topic? WHAT THIS PAPER ADDS
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Affiliation(s)
- Moitshepi Phiri
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
| | - Tanya Heyns
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa.
| | - Isabel Coetzee
- University of Pretoria, Department of Nursing Science, Pretoria, South Africa
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Moon SH, Shim JL, Park KS, Park CS. Triage accuracy and causes of mistriage using the Korean Triage and Acuity Scale. PLoS One 2019; 14:e0216972. [PMID: 31490937 PMCID: PMC6730846 DOI: 10.1371/journal.pone.0216972] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 08/12/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To identify emergency department triage accuracy using the Korean Triage and Acuity Scale (KTAS) and evaluate the causes of mistriage. Methods This cross-sectional retrospective study was based on 1267 systematically selected records of adult patients admitted to two emergency departments between October 2016 and September 2017. Twenty-four variables were assessed, including chief complaints, vital signs according to the initial nursing records, and clinical outcomes. Three triage experts, a certified emergency nurse, a KTAS provider and instructor, and a nurse recommended based on excellent emergency department experience and competence determined the true KTAS. Triage accuracy was evaluated by inter-rater agreement between the expert and emergency nurse KTAS scores. The comments of the experts were analyzed to evaluate the cause of triage error. An independent sample t-test was conducted to compare the number of patient visits per hour in terms of the accuracy and inaccuracy of triage. Results Inter-rater reliability between the emergency nurse and the true KTAS score was weighted kappa = .83 and Pearson’s r = .88 (p < .001). Of 1267 records, 186 (14.7%) showed some disagreement (under triage = 131, over triage = 55). Causes of mistriage included: error applying the numerical rating scale (n = 64) and misjudgment of the physical symptoms associated with the chief complaint (n = 47). There was no statistically significant difference in the number of patient visits per hour for accurate and inaccurate triage (t = -0.77, p = .442). Conclusion There was highly agreement between the KTAS scores determined by emergency nurses and those determined by experts. The main cause of mistriage was misapplication of the pain scale to the KTAS algorithm.
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Affiliation(s)
- Sun-Hee Moon
- Department of Nursing, Changwon National University, Changwon, South Korea
| | - Jae Lan Shim
- Department of Nursing, Dongguk University, Gyeongju, South Korea
- * E-mail:
| | - Keun-Sook Park
- Department of Nursing, Chonnam National University Hospital, Gwangju, South Korea
| | - Chon-Suk Park
- Department of Nursing, Boramae Medical Center, Seoul, South Korea
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Ambulance Nurses' Competence and Perception of Competence in Prehospital Trauma Care. Emerg Med Int 2018; 2018:5910342. [PMID: 29850251 PMCID: PMC5937596 DOI: 10.1155/2018/5910342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 03/14/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction We focus on trauma care conducted in the context of a simulated traumatic event. This is in this study defined as a four-meter fall onto a hard surface, resulting in severe injuries to extremities in the form of bilateral open femur fractures, an open tibia fracture, and a closed pelvic fracture, all fractures bleeding extensively. Methods The simulated trauma care competence of 63 ambulance nurses in prehospital emergency care was quantitatively evaluated along with their perception of their sufficiency. Data was collected by means of simulated trauma care and a questionnaire. Results Life-saving interventions were not consistently performed. Time to perform interventions could be considered long due to the life-threatening situation. In comparison, the ambulance nurses' perception of the sufficiency of their theoretical and practical knowledge and skills for trauma care scored high. In contrast, the perception of having sufficient ethical training for trauma care scored low. Discussion This study suggests there is no guarantee that the ambulance nurses' perception of theoretical and practical knowledge and skill level corresponds with their performed knowledge and skill. The ambulance nurses rated themselves having sufficient theoretical and practical knowledge and skills while the score of trauma care can be considered quite low.
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Abelsson A, Rystedt I, Suserud BO, Lindwall L. Learning High-Energy Trauma Care Through Simulation. Clin Simul Nurs 2018. [DOI: 10.1016/j.ecns.2017.11.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions. Int Emerg Nurs 2011; 19:113-9. [DOI: 10.1016/j.ienj.2010.07.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/30/2010] [Accepted: 07/18/2010] [Indexed: 11/18/2022]
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Emergency Department triage: what data are nurses collecting? J Emerg Nurs 2011; 37:417-22. [PMID: 21474170 DOI: 10.1016/j.jen.2011.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Revised: 12/30/2010] [Accepted: 01/17/2011] [Indexed: 11/20/2022]
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