[A Project to Improve the Ability of Hemodialysis Staff to Respond to Fire Emergencies]

BACKGROUND & PROBLEMS

In case of fire in the hemodialysis room, it is necessary to help patients get away from dialysis machines smoothly and safely and evacuate the room rapidly. Our unit is located on a higher floor. An investigation showed that the accuracy rate for fire response awareness among the staffs in our unit was only 57.9%, while the accuracy rate of fire response skill operations was only 57.4%. Moreover, 62.0% of the staffs were not clear about the task grouping and task content of fire response. Confusion in our unit regarding the definition of patient mobility led to staffs classifying patients based on subjective perceptions and standards. Moreover, the unit also lacked an audit system for fire emergency operations and fire-response-related learning materials.

PURPOSE

To improve staff knowledge and skills related to fire emergency response in the hemodialysis room to 100%.

RESOLUTION

The project team worked out solutions such as adding a self-defense fire-fighting group to the dialysis information system, producing fire emergency response learning materials, establishing a seed personnel system, organizing on-the-job education, organizing fire response simulation drills, and implementing an audit system.

RESULTS

The awareness of fire emergency response and the accuracy of skill operation among the staff were both improved to 100%, and there were statistically significant differences between the pre-test and post-test paired t-test results. Furthermore, consistent implementation of these resolution measures maintained the staff`s fire emergency response skills at 100% between June 2019 and May 2020.

CONCLUSIONS

Tabletop simulation, practice drills, and skill operation audits are effective tools for improving the ability of staff in the hemodialysis room to respond to fire emergencies. It is recommended that institutions produce tabletop simulation props and combine regular on-site drills to improve the readiness of their staffs to respond to fire emergencies, which will shorten the response time during incidents.

School Nurses on the Front Lines of Medicine: Emergencies Associated With Sport and Physical Activities: Part 1

Illness and injury associated with sport and physical activities may occur in the school setting. Although most sport-related illness and injury in students are considered minor emergencies, life- and limb-threatening illnesses or injuries may occur, such as sudden cardiac arrest, heat stroke, status asthmaticus, catastrophic brain or cervical spine injuries, hypoglycemia, blunt chest/abdominal injuries, or extremity fractures requiring surgery. It is important for the school nurse to recognize potential life- and limb-threatening emergencies associated with sport and physical activity, to initiate stabilization of the student with life- and limb-threatening symptoms, and to triage these students to an appropriate level of care (back to the classroom, home with their guardian with follow up at their primary healthcare provider's office, or directly to the closest emergency department via emergency medical services). This article describes the initial assessment and management of three common emergencies associated with sport and physical activities.

[Carbon monoxide poisoning, treatment and orientation]

Colourless and odourless, each year carbon monoxide is responsible for several thousand cases of poisoning. Often collective, their symptoms are non specific and can result in serious neurological sequelae or even death, if they are not detected in time. The (pre-) hospital emergency nurse plays an important role in the management of these patients, in terms of assessment, treatment and monitoring as well as the organisation of the admittance of victims, categorisation and medical triage. As part of a team, the nurse ensures that the patient enters an adapted, regulated pathway, with the most serious cases being directed towards a hospital equipped with a hyperbaric medicine facility.

[A senate report in favour of an emergency nursing speciality]

In July 2017, an information report written by three senators highlighted the difficulties encountered by emergency departments in France and attempted to pinpoint the causes. In addition, the recommendations of this report suggest reinforcing the nursing contribution within the multi-disciplinary emergency department team, by creating an emergency nurse speciality.

Redefining Perioperative Advanced Practice the Nurse Specialist in Anaesthesia and Emergency Surgery

The development of the specialist nursing role was born out of an honest and clinically-driven review of the system that emergency patients experienced. The approaches taken during this review consistently returned facts that this pathway was less than optimal, and a great many improvements could be made. It is important to identify at this stage that simply adding more resources, i.e.: theatre space and beds, would not have improved the patient's experience. The pathway needed greater continuity and better co-ordination. This required a great deal of cooperation between clinical and managerial staff, including some fundamental re-examination of traditionally held beliefs about the role that perioperative nursing could have in managing this patient group. Part Two of the paper (Radford et al 2003) will present the details of how the development of this post challenged the care delivery system for emergency surgical patients. Particular reference will be made to the scope of practice, clinical and organisational impacts and future directions.

An exploration of emergency nurses' perceptions, attitudes and experience of teamwork in the emergency department

BACKGROUND

Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process.

METHOD

A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis.

RESULTS

Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix.

DISCUSSION

Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED.

Pregnant Women in the Workplace

The Bureau of Labor Statistics reported in 2001 that 51% of married women return to the work force before their children are 1 year old (Rojjanasrirat, 2004). Women's roles in the United States are rapidly changing, and the workplace environment is also changing to meet the added demands of women in the work force. Many women assimilate the multiple roles of wife, mother, and working professional into a cohesive unit; however, this is often difficult. Occupational health nurses play a vital role advocating for women in the work force. A critical area of advocacy (and education) focuses on providing necessary support to pregnant employees.

Public Health Emergencies

During a public health emergency such as an influenza pandemic or a bioterrorism attack, nurses may be at risk for exposure to lethal infectious diseases when caring for victims. The aim of this study was to identify interventions nurses believe will support their ability to cope during public health emergencies. A qualitative research design was used with 33 nurses from designated bioterrorism-receiving hospitals. Nurses recommended adequate protective equipment, education, drills, accessible information and available content experts, and available administrators. Other recommendations included increased security to protect nurses, emotional and physical support, communication with nurses' families, and commitment from institutions to care for ill or injured nurses. Preparations for emergencies should include assessments of nurses' and other stakeholders' concerns. These nurses proposed specific measures to improve safety, reduce anxiety, increase trust in hospitals, and provide physical and emotional support.

Learning to deal with crisis in the home: Part 1--developing community simulation scenarios

Contemporary health care is increasingly being located in the community. From the evident changes in demographics and general health, it can be derived that the people whom student nurses care for are likely to have multiple comorbidities and be vulnerable to clinical deterioration. These nurses are required to develop a range of transferrable skills to meet the demands of the population. The challenge for educators of preregistration student nurses is to develop educational strategies to prepare them with the skills, knowledge, and confidence necessary to recognise and manage deterioration appropriately in any context. This article is the first of two papers discussing the stimulus, design, and delivery of an educational innovation that focuses on the recognition and management of the deteriorating patient. The article explores current literature about community-focused simulation highlighting the potential learning opportunities resulting from contextualising simulation scenarios specific to the community setting.

[The nurse consultation in a Swiss university paediatric emergency department]

In Switzerland, overcrowding in tertiary emergency departments is a frequent problem, resulting in lengthy waiting times, lower satisfaction on the part of families and a risk for patient's safety. The setting up of a nurse consultation in a university paediatric emergency centre has helped to improve the quality of care in this context.

A cost-effective approach to simulation-based team training in obstetrics

Many larger facilities regularly stage obstetric drills in modern simulation departments equipped with expensive simulators. Despite lacking these resources, we wanted to provide effective simulation training at our rural hospital. A team of clinicians and educators developed a cost-effective and time-efficient simulation drill for nurses, which included both a didactic review and a simulation day. The drill included obstetric providers and incorporated scenarios for shoulder dystocia, neonatal resuscitation and postpartum hemorrhage. This was a successful multidisciplinary learning experience that was high in creativity and teamwork, but low in cost.

Developing protocols for obstetric emergencies

There is potential for important steps to be missed in emergency situations, even in the presence of many health care team members. Developing a clear plan of response for common emergencies can ensure that no tasks are redundant or omitted, and can create a more controlled environment that promotes positive health outcomes. A multidisciplinary team was assembled in a large community hospital to create protocols that would help ensure optimum care and continuity of practice in cases of postpartum hemorrhage, shoulder dystocia, emergency cesarean surgical birth, eclamptic seizure and maternal code. Assignment of team roles and responsibilities led to the evolution of standardized protocols for each emergency situation.

Developing a process to support perinatal nurses after a critical event

The work of perinatal nurses sometimes includes emergencies involving death, or near death, which can leave health care providers with feelings of stress and grief. After experiencing a particularly stressful period, nurses at our organization identified processes to help themselves recover and to support each other. The result of this work is a written plan to facilitate the support of perinatal nurses after critical events. This article describes the development and implementation of this plan.

Planning a collaborative conference to provide interdisciplinary education with a focus on patient safety in obstetrics

Collaboration is an important component of evidence-based practice in modern health care. A number of publications have touted the benefits of "team training" to improve obstetric outcomes during emergent situations. In August 2011, the Ohio sections of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and the American Congress of Obstetricians and Gynecologists (ACOG) held a joint conference that focused on interdisciplinary education to promote patient safety. This joint venture drew more than 120 attendees, 12 exhibitors and 17 poster displays. Evaluations were positive and attendees cited planned practice changes for themselves as well as for their respective institutions.

[Optimization of nursing care in emergency cases in elderly patients residing in nursing homes]

The study analyzes data on the frequency of emergencies in elderly patients residing in nursing homes. We propose to introduce into the nursing care the screening phase of emergency conditions in elderly patients residing in nursing homes based on the selection of the leading symptom. This improves the quality of the nursing process in pre-hospital geriatric care in emergencies.

Ground zero: holistic care for the first responders of 9/11

Holistic nurses bring a dynamic tool box to the front lines of caring. We offer specialized clinical knowledge that embodies holistic values, principles and therapies. These skills and competencies prepare us to provide the best possible holistic care, even in the most unfavorable circumstances.

Behavioral health emergencies managed by school nurses working with adolescents

BACKGROUND

As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health emergencies managed by school nurses.

METHODS

We used data from a New Mexico public school nurse workforce survey to describe the involvement of school nurses in managing adolescent behavioral health emergencies. We included all respondents who self-identified as working in a secondary school (N = 186). We conducted descriptive analyses.

RESULTS

Two thirds of survey respondents had provided emergency management in the prior school year for child abuse or neglect, depression, and violence at school. Over 40% had provided emergency management for a suicidal student in the prior school year. Although almost 80% of respondents identified "violence at school" as a very important continuing education topic, 40% reported having received continuing education on this topic in the prior 5 years.

CONCLUSIONS

In New Mexico, public school nurses provide substantial amounts of emergency management for adolescent behavioral health problems. Continuing education received by school nurses on behavioral health emergencies may not be commensurate with their clinical responsibilities.

[Pre-hospital management of adults with life-threatening emergencies]

In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas, fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities.

Emergencies during home births

This article reflects on how community midwifery skills days have assisted community midwives to develop confidence in managing unexpected emergencies at home births, and how team work, communication and working in partnership have supported women in their choices for birth.

The effectiveness of high fidelity simulation on medical-surgical registered nurses' ability to recognise and respond to clinical emergencies

BACKGROUND

There is a paucity of evidence regarding the efficacy in preparing medical-surgical nurses to respond to patients with acutely deteriorating conditions.

STUDY AIM

The aim of this study was to evaluate registered nurses' ability to respond to the deteriorating patient in clinical practise following training using immersive simulation and use of a high fidelity simulator.

METHODS

This study was a follow-up survey of medical-surgical graduate nurses following immersive high fidelity simulation training. Thirty eight registered nurses practising in medical-surgical areas completed the simulation as part of university graduate study. A follow-up survey of the graduate medical-surgical registered nurses conducted three months following completion of a high fidelity simulation-based learning experience. Outcomes consisted of the number of times skills were used in practise and the usefulness of simulation in preparing for actual emergency events.

RESULTS

Participants reported a total of 164 clinical patient emergencies in the follow-up time period including: 46% cardiac, 32% respiratory, 10% neurological, 7% cardiac arrest and 5% related to electrolyte disturbances. The ability to respond in a systematic way, handover to the emergency team and airway management were identified as the skills most improved during patient emergencies following simulation. The most useful aspects of the simulation experience identified were scenario debriefing and assertiveness training. Participants with less years of clinical experience were more likely to report practising the team leader role and debriefing as the most useful aspects of simulation.

CONCLUSIONS

The skills practised in simulation were highly relevant to participants practise in medical-surgical areas. Non-technical skills, including assertiveness skills should be considered in future emergency training courses for nurses.

Protection for 'have-a-go' nurses

Stopping to help at an accident or giving first aid to someone in an emergency can be a daunting task for a nurse. Doctors have, for many years, been reluctant to volunteer in such situations for fear of being sued. Professional health regulators appear to encourage nurses to stop and help victims, as long as he/she works within his/her competencies. In practice, the situation has been difficult and there have been attempts by the compensation culture to ‘have a go’ at those who try their best to help people in difficulty. For example, there was one case of a child who drowned because when the police arrived at the scene they could not enter the water because they had no water rescue training. Much of the red tape surrounding these events relates to this country’s over-zealous health and safety laws. In fact, David Cameron has said that the ‘fear of transgressing’ UK and EU rules sometimes meant people ‘stand aside when others need help’

Nursing recognition and response to signs of clinical deterioration

The suboptimal assessment of patients for signs of clinical deterioration and the subsequent response has led to the development of national guidelines and tools for tracking and responding to these situations. Such tools can provide guidance but ultimately the clinical skill, decision making and collaboration of professional practitioners determine optimal care. The use of track-and-trigger tools is insufficient to provide optimal care due to the many factors that affect patient journeys. The clinical knowledge and skill of nurses are important to this process and in achieving safe patient care. This article focuses on the clinical implications of the knowledge and experience of nurses, as well as their role in team working when recognising and responding to clinical deterioration.

Immersive virtual reality simulations in nursing education

This article explores immersive virtual reality as a potential educational strategy for nursing education and describes an immersive learning experience now being developed for nurses. This pioneering project is a virtual reality application targeting speed and accuracy of nurse response in emergency situations requiring cardiopulmonary resuscitation. Other potential uses and implications for the development of virtual reality learning programs are discussed.

Assessment of acutely ill patients in the criminal justice system

This article, the third in a five-part series, explores the difficulties that nurses experience when dealing with an offender who becomes acutely ill within the prison setting. The authors compare and apply the recommendations from the National Institute for Health and Clinical Excellence, the National Patient Safety Agency and the Department of Health to offender health care. The article also explores how education and simulation can be used to equip nurses to deal with any difficulties they experience.

A survey of nurses' beliefs about the medical emergency team system in a canadian tertiary hospital

BACKGROUND

Nurses are the primary activators of the medical emergency team (MET). Although the MET system can empower nurses to seek help in managing acutely ill patients, few data on nurses' beliefs about the system are available.

OBJECTIVE

To evaluate nurses' beliefs and behaviors about the MET system.

METHODS

Nurses from a large academic hospital in Canada were surveyed (2 demography-related questions and 17 Likert-scale questions).

RESULTS

Of 614 nurses employed on units participating in the MET system, 293 (47.7%) were approached and 275 completed the survey (response rate, 93.9%). Most respondents (84.2%) believed that the MET could prevent cardiopulmonary arrest in acutely ill patients, and 94% believed that the MET allowed them to seek help for patients they were worried about. Most nurses (75.9%) would call the responsible physician before activating the MET. Fifteen percent indicated reluctance to activate the MET because of fear of criticism, but only 2.2% considered the MET overused. Most (81.3%) believed that the MET did not increase their workload, and 91.3% did not believe that the MET reduced their skills. Forty-eight percent of nurses indicated that they would activate the MET for a patient they were worried about, even if the patient had normal vital signs.

CONCLUSION

Nurses value the MET system. Nurses believe that the MET can help them care for acutely ill patients and improve outcomes. However, barriers to MET activation exist, including a fear of criticism and an adherence to a more traditional model of first contacting the responsible physician before activating the MET.