Evidence and Practice

Clinical

How safe staffing can improve emergency nursing: time to cut the Gordian knot

How safe staffing can improve emergency nursing: time to cut the Gordian knot

Exploring the effects of fatigue, workplace bullying, moral distress and inadequate staffing

Decompression sickness: a guide for emergency nurses

Decompression sickness: a guide for emergency nurses

ENs have an essential role in recognising and initially treating patients experiencing DCS

Traffic lights

Screening for sepsis: SIRS or qSOFA? A literature review

Evidence from this article led to the creation of a screening tool developed by the author

Assessment and management of patients with tibial plateau fractures in emergency departments

Assessment and management of patients with tibial plateau fractures in EDs

Such fractures are a common presentation in EDs, yet diagnosis is not always obvious

Partner violence

Emergency healthcare for women who experience intimate partner violence: part 1

This integrative review is the first of a two-part series about intimate partner violence

Ankle sprain

A comparison of two interventions in the treatment of severe ankle sprains and lateral...

Aim Stable ankle injuries are highly prevalent in the UK. Prevention of complications and reoccurrence is essential. The literature shows that plaster of Paris and AirLoc brace are clinically effective treatments for such injuries. However, there is no research measuring patients’ satisfaction with these treatments. This study compared options in the treatment of severe ankle sprains and distal fibular avulsion fractures from patients’ perspectives. The aim was to determine patients’ preferred treatment between below knee plaster cast and AirLoc brace in the management of stable ankle injuries. Method A total of 39 patients who presented at an urban hospital with stable ankle injuries were recruited into a randomised controlled trial. Patient satisfaction levels were measured by questionnaire one week into treatment. The null hypothesis was ‘there is no significant difference in satisfaction levels between the two devices’. Findings There were statistically significant higher patient satisfaction levels in the AirLoc group compared to the plaster cast group. After analysis by the unrelated t-test, the null hypothesis was rejected. Comfort, daily activities, sleep, work and social life were the main contributing factors. Additionally, 67% of the AirLoc group compared to 46% of the plaster cast group were able to return to work. The number needed to treat for one additional AirLoc patient to return to work was 4.8 (five patients). Conclusion Patients’ preferred treatment is the AirLoc brace. The inquiry method could be used to provide patient-centred care in other fields.

CPD articles

Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology

Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology

Sepsis is a medical emergency that should always be considered in acutely unwell patients

Nursing patients with acute aortic dissection in emergency departments

Nursing patients with acute aortic dissection in emergency departments

This article aims to increase emergency nurses’ knowledge of acute aortic dissection

Asthma

Nursing management of paediatric asthma in emergency departments

Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines ( BTS/SIGN) (2016) .

Lyme disease: recognition and management for emergency nurses

Lyme disease: recognition and management for emergency nurses

Over the past ten years there has been a significant rise in the number of people who present to emergency departments with Lyme disease. Although some patients remain asymptomatic many present with a rash around a previous tick bite and others may present with a range of debilitating symptoms that can be problematic if left untreated. Due to the growing prevalence of Lyme disease in the UK and the US this article gives an overview of the vector-borne condition and provides emergency nurses with information about the pathophysiology, prevention, presenting signs and symptoms and management.

Burns

Emergency management of burns: part 2

Infrequent presentation of this patient group to emergency departments can cause stress and anxiety to front-line clinicians when they are faced with patients with a traumatic burn injury. Assessment relies on accurate evaluation of burn aetiology, size and depth, and initial management is directly responsible for patients’ outcomes and quality of life. This is the second article in a two-part series that gives an overview of the minimum standard of care in burns first aid, and highlights the likely challenges in assessment of burn depth and size. The aim of the two articles is to enhance emergency clinicians’ knowledge and confidence in burn management, and to build awareness of the life-changing implications of the initial clinical interventions in burn care.

Burns

Emergency management of burns: part 1

Caring for patients with burn injuries can be traumatic for staff. Non-specialist clinicians in emergency departments are often the first point of contact for patients with burn injuries and their families. Lack of burns education, exacerbated by infrequent presentations, can add to front-line clinicians’ stress and anxiety. Assessment relies on accurate evaluation of burn aetiology, and the size and depth of the injuries, and initial management is directly responsible for patients’ outcomes and quality of life. This is the first article in a two-part series that highlights the criteria and process of referral to a specialist burn service and gives an overview of the challenges posed by the burn mechanism and subsequent unique treatment considerations. The aim of the two articles is to enhance emergency clinicians’ knowledge and confidence in burn management, and to build awareness of the clinical guidance and support available via the specialist burn service providers.

How to

Reflective discussion

How to improve patient care by learning from mistakes

Mistakes made in healthcare settings and the challenges to staff that arise from them can harm service users, consume time and money, and often receive bad publicity. However, by learning from these mistakes and meeting these challenges, practitioners can improve the quality of the care they provide. This article explores what is meant by mistakes and challenges in the context of health care. It suggests that front line managers are best placed to prevent and learn from mistakes, and thereby improve care for patients.

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