Causes and effects of emergency departments overcrowding, as perceived by health care providers and consumers

Emergency departments [EDs] are responsible for dealing with a large number of patients who pass through them, and they do not restrict themselves to the treatment of specific medical specialties. This creates significant problems related to overcrowding, associated with extended waiting period, increasing acuity and delay in the initiation of needed emergency care. As a result, patient suffers from undue prolonged pain, inconvenience, frustration, and poor outcomes. Overcrowding is considered a situation in which demand for service exceeds the ability to provide care within a reasonable time, causing physicians and nurses to feel too rushed to provide quality care. The phenomenon of emergency departments EDs overcrowding cannot be attributed to any single factor, but instead appears to be a product of complex causal relations, encompassing multifactor, as direct consequence of these causes or factors EDs overcrowding has numerous negative effects on the quality of patient care, health care providers and ED environment

Objectives: this study was carried out to determine the causes, and effects of EDs overcrowding as perceived by the health care providers and consumers, and to propose potential solutions to overcome the negative effects of EDs overcrowding

Methods: This study was conducted in the EDs at Alexandria University Hospitals namely Main University Hospital, El Chatby Maternity, and El Chatby Pediatrics University Hospital

Subjects: the study sample included the EDs medical staff who are involved in providing direct patients care in the selected settings [N=13], all head nurses of EDs [N=3], representative sample of nursing staff [N= 55] and representative sample of EDs conscious patients who are able to communicate from the selected setting [N=l0]. ED Overcrowding questionnaire was used to collect the study data

Results: the result of the current study reveals that the causes of ED Overcrowding are related to four main categories namely: Manpower, resources and facilities, patients, and work system. Poor clinical patient outcomes, increase level of stress and dissatisfaction among ED medical and nursing staff, outbreaks of infectious diseases, increasing violence and interpersonal miscommunication were indicated by highest percentage of the subjects as negative effects of ED overcrowding. Numerous solutions have been proposed to improve quality, efficiency of EDs and alleviate overcrowding negative effects. A statistical significant relation was observed between the causes, and effects of ED overcrowding, and between the effects and the proposed potential solutions of ED Overcrowding

Measures to prevent suctioning related Hypoxemi

Using of the mechanical ventilators to support external respiration is wide spread in critical care. Patent airway is essential for successful ventilatory support. Suctioning of the airways is often required for removal of secretions in critically ill patients with artificial air- ways, since the normal coughing mechanism is disrupted. But one of the most serious complications of tracheal suctioning is hypox- emia. Increased inspired tidal volume [hyperinflation] and in- creased inspired oxygen concentration to the highest possible percentage [hyper-oxygenation with 100% 02] have been recommended to protect against suctioning-associated hypoxemia. Although, hyperinflation has a very important role in minimizing suction-related hypoxemia, some studies have shown that it may cause some hemodynamic changes. Moreover, hyper-oxygenation with 100% 02, may be undesirable in-patients with chronic obstructive pulmonary disease [COPD], particularly during weaning from mechanical ventilator

Objective: this study was conducted to test the effectiveness of mechanical breaths and an 02 con- centration of 20% above maintenance level on prevention of suctioning-associated hypoxemia.

Design: a quasi-experimental research design

Methods: twenty-five adult mechanically ventilated patients were studied. Tracheal suctioning was performed only when needed. Three suctioning passes were performed during each suctioning intervention. Three mechanical breaths were applied be- fore and after each suctioning pass. In addition, an elevation of the 02 concentration 20% above the maintenance level was applied one minute before suctioning and lasted with the end of the suctioning procedure for another two minutes. Mean arterial blood pressure [MAP], arterial blood gases, and peak inspiratory pressure [PIP] were monitored immediately before, immediately after, and five minutes after suctioning intervention

Results: heart rate and MAP increased significantly immediately after suctioning and had returned to the baseline, or slightly above or below, 5 minutes after suctioning [Z=3.55 at p=0.000, and 2=2.38 at P=0.017, respectively]. Furthermore, there were significant increases in the mean values of Pa02 [Z=3.51 at p=0.000], and SaO2 [Z=2.50 at p=0.012] immediately after suctioning. The Pa02 mean values also were significantly higher than the baseline values 5 minutes after suctioning [Z=3.47 at p=0.001]. Regarding PIP change, it in- creased significantly immediately after suctioning [Z=4.17 at p=0.000] and had returned to the baseline 5 minutes after

Conclusion: mechanical breaths and 02 concentration of 20% above I maintenance level prevented suctioning-associated hypoxemia

Nurses' identification and interventions of anxiety indicators among critically III patients

Anxiety is the most common psychological problem experienced by critically ill patients; it is estimated to occur in as many as 70% to 87% of critically ill patients. Anxiety produces complex changes in neuroendocrine and immune functions that interact with current and prior health status and health behaviors to alter behavioral responses, physiological functioning, and ultimately expected patients' outcomes. Critical care nurses must be able to assess anxiety accurately and quickly, because of the high prevalence and potentially serious effects of anxiety on critically ill patients. The aims of this study are to identify the clinical indicators that critical care nurses perceive as defining attributes of anxiety in critically ill patients; and delineate the nursing interventions used by critical care nurses to alleviate anxiety among critically ill patients. The sample of this study comprised 140 critical care nurses, involved in direct patient care working in the intensive care units of Alexandria Main University hospital, The "Critical Care Nurse Anxiety Identification and Management Sheet" is the tool used to collect the data. Result of this study re veal that critical care nurses depend on the physical/physiological indicators to assess anxiety more than other clinical indicators as behavioral, affective and cognitive indicators. As regard to the management of anxiety, Critical care nurses in this study also stated some strategies to manage anxiety. The most commonly used strategies were pharmacological pain relief, reassurance about status or progress, giving information, control environmental stressors, and empathetic touch

Effect of the utilization of nursing practice guidelines on occurrence of aspiration for critically ill intubated patients

Abstract: Patients with artificial airways are considered at high risk for aspiration. An endotracheal tube [ETT] is the most commonly used artificial airway. Despite its benefit for providing airway management for critically ill patients, it may be associated with problems and complications that may be life threatening

Objective: This study was conducted to determine the effect of utilization of nursing practice guidelines on occurrence of aspiration for critically ill intubated patients. Design: A quasi-experimental design. Sample: Forty critically ill intubated adult patients

Method: An assessment of the nurses' knowledge and skills to prevent occurrence of aspiration was initially performed. Observation was done first for nurses involved in providing direct patient care for the control group after 24 hours of intubation. Then implementation of the developed guidelines on the study group after instruction of these guidelines in the second day of intubation and followed up for seven consequent days. Assessment of the occurrence of aspiration among the control and study groups was done. Patients were followed up from the second day of intubation up to seven consequent days to detect aspiration's manifestations and chest X-ray changes. Comparison between the control and study groups was done to determine the effect of the use of the nursing practice guidelines on occurrence of aspiration

Results: Marked improvement in the nursing practices was found after instructions for the nursing guidelines. The results of the study revealed decrease in the percent of aspiration manifestations. Moreover, it was observed that there were some possible contributing factors for pulmonary aspiration such as age, Glasco coma scale, and the mode of ventilator

Conclusion: The results of the present study highlighted the importance of the nursing role in prevention of aspiration. The intubated patient requires meticulous care to ensure airways maintenance and prevent complications until he can maintain independent ventilation