ABSTRACT
BACKGROUND: The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. OBJECTIVES: This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. METHODS: The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days. RESULTS: From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p< .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01). CONCLUSIONS: We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL.
Subject(s)
Clinical Competence , Laparotomy , Trauma Nursing , Humans , Laparotomy/nursing , Female , Male , Prospective Studies , Adult , Trauma Nursing/education , Nurse's Role , Simulation Training/methods , Middle Aged , Trauma Centers , Critical Care Nursing/educationABSTRACT
A 21-year-old male trauma patient presented after a motor vehicle crash, witnessed massive aspiration and sustained traumatic brain injury. On postinjury day 3, the patient progressed to adult respiratory distress syndrome (ARDS) refractory to all conventional therapies, prompting the use of extracorporeal membrane oxygenation (ECMO). After 5 days of ECMO support and 3 thrombosed oxygenators, systemic anticoagulation was initiated. After 20 days of ECMO, 15 of which required systemic anticoagulation, the patient was decannulated and transferred to a rehabilitation facility. The patient is currently home without any neurological deficits. Although controversial, ECMO may serve a role as a rescue therapy in ARDS when conventional therapies fail in the brain-injured patient.
Subject(s)
Brain Injuries/therapy , Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome/therapy , Accidents, Traffic , Anticoagulants/therapeutic use , Brain Injuries/complications , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Male , Respiratory Distress Syndrome/etiology , Thrombosis/drug therapy , Thrombosis/etiology , Young AdultABSTRACT
A review on the role of open reduction and internal fixation of flail chest injuries is presented. A 37-year-old woman involved in a motorcycle crash sustained comminuted rib fractures on her right 3rd through 12th ribs. On postinjury day 2, the patient's fifth through ninth ribs were surgically reduced and plated. Later that same day, the patient was successfully weaned from mechanical ventilation and experienced a rapid improvement in incentive spirometry volumes. Further studies are needed to definitively determine the benefits of rib plating versus conventional treatment. Through our case, we are able to demonstrate successful management of pain and chest wall instability associated with flail chest through the use of rib plating.
Subject(s)
Early Medical Intervention/methods , Flail Chest/surgery , Fracture Fixation/methods , Rib Fractures/surgery , Accidents, Traffic , Adult , Bone Plates , Female , Flail Chest/diagnostic imaging , Follow-Up Studies , Fracture Fixation/instrumentation , Glasgow Coma Scale , Humans , Injury Severity Score , Multiple Trauma/diagnosis , Multiple Trauma/therapy , Radiography , Respiration, Artificial/methods , Rib Fractures/diagnostic imaging , Trauma Centers , Treatment OutcomeABSTRACT
UNLABELLED: Older adults with progressively worsening aortic valve stenosis are limited in their treatment options. Conventional treatment replaces the aortic valve via open-heart surgery, introducing numerous risks and increased mortality in older populations with comorbidities. In recent years, however, transcatheter aortic valve implantation (tAVI) has become a viable option for symptomatic, nonsurgical candidates. Although tAVI is available only to a select population, early randomized and nonrandomized clinical trials are offering insight into the new therapy, with promising results as this treatment continues to evolve. PURPOSE: This article examined the progression of tAVI therapies, from first-generation to third-generation devices and through 4 studies that address the utility of tAVI in symptomatic, nonsurgical candidates, in an effort to prepare nurses in the management of this newly emerging patient population. METHODS: A literature search was conducted of studies within the past 5 years that address transfemoral tAVI in adult populations. Transapical approaches were excluded. RESULTS: Early outcomes demonstrate that successful implantation can improve valvular function and patient functional status. Nurses play a critical role in patient education and monitoring both before and after tAVI. CONCLUSIONS: With increasing life expectancies and a prediction that many aging adults with aortic valve stenosis will be limited to tAVI, nurses need to gain familiarity with this novel therapy and its role in patient outcomes.
