Stress and Coping in Emergency Nurses Following Trauma Patient Care: A Qualitative Grounded Theory Approach.

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses.

The Path Toward Fellow Designation in the Academy of Emergency Nursing: Understanding and Navigating the Process to Ensure Your Success.

The Academy of Emergency Nursing was established to honor emergency nurses who have made enduring and substantial contributions that have had significant impact and continue to advance the emergency nursing specialty. Nurses who have been recognized as having made enduring and substantial contributions to emergency nursing achieve fellow status in the Academy of Emergency Nursing and are conferred the credential, Fellow of the Academy of Emergency Nursing. Academy of Emergency Nursing Board Members want to dismantle any structural barriers, clarify any misunderstandings or mysteries, and support diverse candidates by providing clear and equitable resources about the path toward fellow designation and the application process. Therefore, the purpose of this article is to support interested persons in their path toward Academy of Emergency Nursing fellow designation and give explicit details of each section of the application to develop a shared understanding among potential applicants, sponsors, and Fellows of the Academy of Emergency Nursing.

Addressing a Key Leadership Challenge: Workplace Violence.

Workplace violence is a growing concern among health care workers, especially staff working in emergency departments. Emergency department leaders have oversight accountability that includes mitigation of workplace violence risks and staff education related to workplace violence prevention. Challenges associated with workplace violence events include disruption of safe patient care, decreased staff job satisfaction, and increased turnover. Improving safety for staff, patients, and visitors requires a culture focused on safety. A summary of current regulations, standards, and resources available to date is provided, including a list of mitigation strategies that can be easily translated into practice by emergency nurse leaders.

Does Suprapubic Stimulation in Infants Facilitate Collection of a Clean Catch Urine Specimen?

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Faster Clean Catch Urine Collection (Quick Wee Method) From Infants: Randomised Controlled Trial." This prospective study enrolled 344 infants between 1 and 12 months of age seeking care in an emergency department with a complaint that led to the ordering of a clean catch urine specimen. Use of the Quick Wee procedure yielded clean catch urine specimens without the use of an invasive procedure. Variables of interest were time to specimen collection and patient and provider satisfaction with procedure. Study subjects in the intervention group voided spontaneously within 5 min more often than subjects in the usual care group. This study highlights the important role of the APN in ordering clean catch urine specimen collection and avoidance of invasive procedures.

Is Subdissociative Ketamine As Safe and Effective As Morphine for Pain Management in the Emergency Department?

: Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Intravenous Subdissociative-Dose Ketamine Versus Morphine for Analgesia in the Emergency Department: A Randomized Controlled Trial." This prospective, randomized controlled inquiry enrolled 90 patients into 2 groups (ketamine vs. morphine) for patients seeking care in an emergency department with acute pain. Data regarding pain scores were collected at baseline, 15, 30, 60, 90, and 120 min. Study subjects reporting persistent pain could receive rescue analgesia with fentanyl. Initial pain scores for the subjects in each of the groups were comparable (ketamine: 8.6; morphine: 8.5). Pain management for the 2 groups revealed similar average doses (ketamine: 21.8 mg; morphine: 7.7 mg). Although subjects in both groups reported reduction in pain scores at 15 and 30 min, no clinical significance was found. Subjects experienced greater pain relief (pain score = 0) in the ketamine group at 15 min (percentage difference 31%; 95% confidence interval [13, 49]), yet this was not sustained at the 30-min interval. There were no serious or life-threatening adverse effects in either group. This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.

Does Persistent Pain Following a Motor Vehicle Crash Impact Functional Status in Older Adults?

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Persistent Pain Among Older Adults Discharged Home From the Emergency Department After Motor Vehicle Crash: A Prospective Cohort Study." This longitudinal inquiry enrolled 161 patients 65 years or older seeking care in an emergency department (ED) following a motor vehicle crash. Interviews were conducted at the initial ED visit and at 6 weeks, 6 months, and 1 year. Variables of interest were persistent pain, depressive symptoms, and interference with activities of daily living, with an end goal of impact on functionality. Study subjects with persistent pain at 6 months reported an overall decrease in their health status, and 23% needed additional assistance with their activities of daily living, resulting in a change in living arrangements compared with 8% of the subjects without persistent pain. Repeat ED visits in the 6 months following the crash were more likely to occur in those with persistent pain (30% vs. 15%). This study highlights the important role of the APN in providing quality care, communication about pain management, and related follow-up care.

Why Do Patients Return to the Emergency Department?

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Return Visits to the Emergency Department: The Patient Perspective." This qualitative inquiry performed 60 semistructured interviews of patients who returned to the emergency department within 9 days of their primary visit for the same complaint. Patients most often returned because of concerns that their initial visit did not adequately address their complaint, and they needed assurance from providers that their clinical condition was not a serious health concern. Patients also expressed a lack of contact with a provider between the 2 visits either to answer questions or to address ongoing concerns. This study highlights the important role of the APN in providing quality care, reassurance, and communication related to follow-up care.

Are Pediatric Pain Self-Report Scores Accurate?

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Clinically Significant Differences in Acute Pain Measured on Self-Report Pain Scales in Children." The study results showed that there were 314 pediatric patients with acute pain evaluated for minimum (MCSD) and ideal clinically significant differences (ICSD) using the Faces Pain Scale-Revised (FPS-R) and the Color Analog Scale (CAS). These data reveal stable MCSD estimates for the FPS-R and the CAS with generalizability for acute pediatric pain. The ICSD estimates did not prove to be stable for different groupings of acute pain. The implications and clinical relevance of these findings for APNs are discussed, highlighting best evidence.

Does the incidence of pulmonary embolism increase during pregnancy?

A review of recent evidence with translation to practice for the advanced practice nurse role is presented using a case study module for "Systematic Review and Meta-Analysis of Pregnant Patients Investigated for Suspected Pulmonary Embolism in the Emergency Department." The study results showed that there were 25,339 patients evaluated for pulmonary embolism in an emergency department included in the 17 study articles, 2,636 had venous thromboembolism (VTE; 13%; 95% CI [10, 17]), and 506 were pregnant and underwent diagnostic chest imaging (2%; 95% CI [1.5, 2.6]). These data suggest that pregnancy does not appear to increase the incidence of a VTE-positive diagnosis. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.

Does emergency department observation impact the rate of computed tomography in children with minor blunt head trauma?

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "The Effect of the Duration of Emergency Department Observation on Computed Tomography Use in Children With Minor Blunt Head Trauma." The study results showed that 49% of the patients were "observed" in the emergency department (ED). Of those "observed" (N = 676) in the ED, the authors found that 20% had a computed tomographic (CT) scan performed. However, "observed" patients did experience a lower rate of CT scan (5%) than "nonobserved" patients. The implications and clinical relevance of these findings for APNs are discussed, highlighting best practice evidence.

Pain, perceptions, and perceived conflicts: improving the patient's experience.

Pain is the number 1 reason patients seek care in an emergency department (ED). A limiting factor for effective pain management may be clinical staff attitudes about pain and pain management. Analysis of data from an investigation into pain, perceptions, and perceived conflicts of ED staff pain management revealed a need for change. Operation Pain and ED pain champions created an environment that promoted enhanced pain management resulting in measurable outcomes. Emergency nurses participating in Operation Pain placed a higher priority on pain management for their patients.

Complications associated with oral anticoagulation therapy.

Review of recent evidence with translation to practice for the advanced practice nurse (APN) role is presented using a case study module for "Complications Associated With Oral Anticoagulation Therapy." The study results showed that bleeding complications were most often due to gastrointestinal bleeding associated with anticoagulants (dabigatran 80% and warfarin 48%). The implications and clinical relevance of these findings for APNs are discussed highlighting best evidence.

What is known about outcomes of patients with low back pain?

Review of recent evidence with translation to practice for the role of advanced practice registered nurses is presented using a case study module for the following: "What is known about Outcomes of Patients with Low Back Pain? The study results showed that patients with low back pain may have substantial continuing pain and functional limitations. The implications and clinical relevance of these findings for advanced practice nurses are discussed highlighting best evidence.