Elements of an Advanced Trauma Education Program for Emergency Nurses: A Modified Delphi Approach.

BACKGROUND: Basic trauma education for emergency department (ED) staff is available, but there are currently no advanced trauma nursing practice standards for ED nurses. OBJECTIVE: The purpose of this study was to identify consensus-based elements of an advanced trauma nursing program for ED nurses. METHODS: We used a modified Delphi process with three rounds of online survey data collection to ensure a large group of geographically diverse experts. Data were collected from February 2023 to May 2023. The sample for Round 1 was recruited from members of the Emergency Nurses Association reporting job titles, including trauma coordinator, trauma nursing core course instructor, and vice president of trauma services (n = 829). Participants in subsequent rounds were drawn from respondents to the initial invitation to participate (n = 131). Members of an emergency nursing research council with clinical and research expertise reviewed the results and provided expert input. RESULTS: An initial sample of 131 experts identified 17 elements that were assigned a median score equivalent to "agree/strongly agree" (i.e., median 4/5 or 5/5) in Round 2 (n = 69). These elements were presented in Round 3 (n = 43) to determine a rank order. Critical thinking/clinical judgment was the overall priority, followed by assessment/reassessment and early recognition of trauma. CONCLUSIONS: Emergency department trauma care experts identified priority content for advanced trauma education. Heterogeneity in the final ranking of components for this advanced trauma course, specifically differences by facility, regional, or demographic characteristics, suggests that training and education may not conform to a one-size-fits-all model.

Impact of Bedside Laparotomy Simulation and Microlearning on Trauma Nurse Role Clarity, Knowledge, and Confidence.

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.

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.

Perceived trauma nursing core competency, interprofessional collaborative competency, and associated barriers among regional trauma center nurses.

INTRODUCTION: As key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency. PURPOSE: This study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses. METHODS: This cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression (Enter method) analyses. RESULTS: The perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance. CONCLUSIONS: Training programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated.

The Game Is On and We're in the Ninth! Evolution of the Trauma Nursing Core Course, Ninth Edition.

Trauma is a global phenomenon resulting in the death of millions of people every year and affecting countless others. Foundational to excellence in trauma nursing, which contributes to optimal patient outcomes, is evidence-based education driven by best practices accompanied by a systematic approach to the assessment and care of the injured patient. The Trauma Nursing Core Course has provided nurses with the knowledge necessary for the assessment and management of injured patients since the first course was held in 1986. The 9th Edition, launched in July of 2023, continues to provide nurses worldwide with knowledge necessary based on current evidence-based literature and resources. A revision is an arduous process necessitating a concerted team approach involving Emergency Nurses Association member volunteers, internal and external experts, and a lot of dedication!

Development and Evaluation of a Web-Based Application for Trauma Nursing Documentation in Thailand: A Feasibility Study.

BACKGROUND: Electronic nursing documentation has advantages for monitoring and improving the quality of trauma nursing documentation. However, electronic nursing documentation has rarely been implemented in Thailand. OBJECTIVES: This study aimed to assess the feasibility and nursing satisfaction of a web-based trauma nursing documentation application. METHODS: A descriptive cross-sectional survey design was used to assess the feasibility and nursing satisfaction with a web-based trauma nursing documentation application. The application was based on literature review, Advanced Trauma Life Support principles, and the North American Nursing Diagnosis Association. The survey was administered to trauma and emergency department registered nurses in a hospital in Thailand from November 2021 to January 2022. Patient data were also extracted from the web application system for analysis. RESULTS: A total of 59 nurses piloted the web-based application on 79 trauma patients. Of 59 nurses, 45 (76.3%) were female, 44 (74.6%) had worked in the emergency department for more than 5 years, and 49 (83.1%) had no prior experience with using web-based applications. The nurses were satisfied with the application (M = 3.51, SD = 0.62), and they suggested that it was feasible to apply in practice (M = 3.46, SD = 0.79). CONCLUSION: These preliminary data demonstrate that implementing a web-based application for trauma nursing documentation in the emergency department is feasible and satisfactory to nurses.

Tertiary survey by trauma nurse specialist at a paediatric trauma centre.

INTRODUCTION: Tertiary surveys aim to detect injuries missed in the initial assessment of trauma. We introduced a process by which the trauma nurse specialist performed a number of the tertiary surveys (NTSs) at our paediatric trauma centre. METHODS: Data from the first six months following introduction of the NTS were compared to retrospective data from the six months prior to NTS implementation (pre-NTS), when trauma surveys were completed by medical staff. RESULTS: Over the 12-month period, 130 children met the criteria for a tertiary survey. Pre-NTS, 57/62 eligible patients received a tertiary survey, compared to 61/68 during NTS (p=0.77). There were significantly more road traffic crash patients in the NTS group (p=0.008) but no significant differences by demographics, injury pattern, injury severity score or outcomes. New injuries were found in three patients pre-NTS compared to five patients during NTS (odds ratio 1.3 (95%CI 1.3-2.0, p=0.73)). CONCLUSION: This study conservatively supports the hypothesis that, with training and support, a trauma nurse specialist can perform tertiary surveys as effectively as doctors. A larger study is required to confirm these findings.

Prioritizing Injury Prevention: Cause of Injury Text Analysis.

BACKGROUND: Motor vehicle (MVCs) and motorcycle crashes (MCCs) continue to be among the most prevalent mechanisms of trauma injury and mortality. We sought to identify specific populations and factors associated with MVCs and MCCs for local injury prevention efforts. A novel, yet easily performed, research method was utilized-a qualitative content analysis of text narratives describing each patient's cause of injury. OBJECTIVE: To determine target populations for local MVC and MCC injury prevention. METHODS: A retrospective descriptive analysis was performed using registry data from a Level I trauma center. The registry was queried for all trauma patients presenting with MVC or MCC injuries between June 8, 2014, and June 7, 2019. Cases were then reviewed via their respective text narratives of injury causation. Common themes were identified, coded by independent raters, and assessed for interrater reliability using Cohen's κ. Frequencies and proportions are reported for each preventable factor and patient characteristic. RESULTS: There were a total of 2,861 cases studied, of which 2,330 (81.4%) were MVC and 531 (18.6%) were MCC. Demographics varied by mechanism of injury. Driver drug or alcohol use was involved in 97 (3.4%), protective devices were not used in 776 (27.1%), distracted driving was involved in 30 (1%), excessive speeding was involved in 152 (5.3%), and driver sleeping/syncope/medical condition was present in 113 (3.9%) cases. CONCLUSIONS: Content analysis of cause of injury text narratives can detect target populations and preventable factors to direct injury prevention efforts specific to the local population.

Health-Related Quality of Life After Polytrauma: A Systematic Review.

BACKGROUND: Following hospital discharge after traumatic injuries, many patients' rehabilitation is inhibited by poor health-related quality of life (HRQoL). OBJECTIVE: The purpose of this review is to identify factors that influence the HRQoL of polytrauma patients after hospital discharge. METHODS: A systematic literature search was performed in CINAHL and PubMed databases for English-language articles published between January 2015 and January 2020. Articles that dealt with pediatric or narrow adult populations, exclusively considered brain and spinal cord injuries, burn injuries, or isolated fractures were excluded. In total, 22 nonexperimental cohort studies were eligible for inclusion. RESULTS: Based on these studies, with minor disagreements explainable by deficient sampling, variables that impacted HRQoL fell into 11 categories: demographics, preinjury HRQoL, preexisting conditions, mental health status, injury type and location, injury severity, course of hospitalization, time after injury, financial and employment status, functional capacity, and pain. CONCLUSION: The finding with the greatest implications was that mental health, positive coping, self-efficacy, and perception of physical state significantly influence HRQoL after injury and, along with other modifiable variables, can be optimized by directed treatment. Additionally, targeted assessments and interventions can be utilized to improve quality of life for patients with nonmodifiable risk factors.

Improving a Mature Palliative Care Program at a Level I Trauma Center.

BACKGROUND: Similar to the significant rise in the geriatric population in the United States, trauma centers have seen an increase in geriatric trauma patients. These patients present with additional challenges such as a higher likelihood of undertriage, mortality, and frailty. In addition, the varying presence of advanced directive documentation increases the importance of early palliative care consultations for geriatric trauma patients. OBJECTIVE: In 2018, a Level I trauma center in the Midwest reviewed the American College of Surgeons Trauma Quality Improvement Program's Palliative Care Best Practice Guideline to identify opportunities for improvement to strengthen the collaboration between the palliative care consult service and trauma program. METHODS: The guideline drove improvements, which included documentation changes (i.e., expansion of palliative care consultation triggers, frailty assessment, advanced directives questions, depression screening, and addition of palliative care consultation section on the performance improvement program form) and training (1-hr lecture on palliative care and 5-hr palliative care simulation training) opportunities. RESULTS: A 3-month manual chart review (March 2019 through May 2019) revealed that by May 2019, 87.2% of admitted geriatric trauma patients received frailty assessments, which surpassed the benchmark (≥85%). In addition, advanced care planning questions (i.e., health care power of attorney, do not resuscitate order, or living will) exceeded the benchmarks set forth by the guideline (≥90%), with all of the questions being asked and documented in 95.7% of those same patient charts by May 2019. CONCLUSION: This quality improvement project has applicability for trauma centers that treat geriatric trauma patients; using the guidelines can drive changes to meet individual institution needs.

The Building Blocks to a Highly Effective Trauma Program.

BACKGROUND: Well-developed trauma programs take years of planning, dedication, and commitment to the trauma population to achieve the desired outcomes and, even more, resilience and persistence to maintain a high-quality standard of care. Despite widespread trauma care systems across the nation and their link to improved outcomes for the trauma patient, there is a paucity of literature outlining the foundational elements required to evolve and grow a successful trauma program. OBJECTIVE: The purpose of this article is to outline the key elements for developing and maintaining a successful trauma program that yields high-quality patient outcomes. METHODS: Developing a program requires intense focus and continued efforts. Multiple foundational building blocks can facilitate program success and foster program growth. RESULTS: Foundational elements include leadership structure and support, building the right team, clinical expertise, trauma registry, program data, research, outreach and education, injury prevention, and ensuring adequate survey readiness. Building on these foundational elements, engagement of stakeholders at all levels throughout the program and organization can help drive program growth. Using these strategies, a program has been able to grow from 7.6 full-time equivalents to 24.4 in just a few short years while achieving, exceeding, and sustaining top metrics across state and national benchmarks. CONCLUSION: A program can achieve sustainable, high-quality outcomes for the trauma patient by following a structured team approach to program development. Using the outlined building blocks for program development and sustainability, a successful trauma program can lead to improved patient and program outcomes.

Mass Casualty Mini Drills on Trauma Surgery Department Staff Knowledge: An Educational Improvement Study.

BACKGROUND: Over the last decade, the United States has witnessed an increase in mass casualty incidents (MCIs). The outcome of an MCI depends upon hospital preparedness, yet many hospitals are unfamiliar with their facility MCI procedure. Educational training drills may be one method to improve staff knowledge of policy and procedure. OBJECTIVE: This study aimed to improve knowledge gained through educational MCI mini drills of institutional mass casualty policy and procedure in surgery department staff at a level II trauma center. METHODS: A pre-/posttest design was utilized. The hospital implemented MCI mini training drills as a quality improvement project using Plan-Do-Study-Act iterative cycles with prospective data collection. Knowledge scores were measured using a 12-item surgery department MCI policy and procedure questionnaire that was developed by the author and leadership. RESULTS: A one-way analysis of covariance analysis in participants that mini drilled more than once indicated significant effect on mean cycle score differences among three cycles F(2,21) = 12.96, p = .00. Multiple comparison using Games-Howell indicated the mean score for Cycle 4 (M = 96.15, SD = 6.54) was significantly different from Cycle 3 (M = 59.71, SD = 25.15). Gender, shift, and credentials of participants influenced knowledge improvement. CONCLUSION: Implementation of hospital MCI mini drills improved staff knowledge of institutional mass casualty policy and procedure in the surgery department and may be applied to surgery departments with similar policy, procedure, and participant characteristics. Hospital mass casualty response education and preparation is essential to saving lives.

Using Weather, Lunar Cycles, and Time of Year to Predict Trauma Incidents in an Urban, Level I Pediatric Trauma Center.

BACKGROUND: Trauma patterns in adults are influenced by weather conditions, lunar phases, and time of year. The extent to which these factors contribute to pediatric trauma is unclear. OBJECTIVE: The present study aimed to review patients from a single Level I pediatric trauma center to determine the influence of weather, the lunar cycle, and time of year on trauma activity. METHODS: A retrospective review of trauma activations (n = 1,932) was conducted from 2015 to 2017. Injury type and general demographics were collected. Weather data and lunar cycles were derived from historical databases. RESULTS: Days with no precipitation increased the total number of injuries of all types compared with those with precipitation (p < .001). Blunt and penetrating injuries were more likely to occur during full moons, whereas burn injuries were significantly higher during new moons (p < .001). Blunt trauma was significantly higher in September than all other months, F(11, 1,921) = 4.25, p < .001, whereas January had a significantly higher number of burns than all other months (p < .001). CONCLUSIONS: Pediatric trauma trends associated with external factors such as weather, lunar cycles, and time of year can inform hospital staffing decisions in anticipation of likely injuries and help direct injury prevention efforts.

Instrument Development: Knowledge, Attitudes, and Confidence in Palliative Care Concepts Held by Trauma and Neuroscience Intensive Care Nurses.

BACKGROUND AND PURPOSE: Unique pressures impact trauma intensive care unit (TICU) nurses in their provision of care for severely injured patients. When it becomes clinically obvious that these patients may not survive, TICU nurses must continue life-saving measures while at the same time consider a palliative care consultation. In order to facilitate this referral, TICU nurses need to have the appropriate knowledge, attitude, and confidence in doing so. The purpose of this study is to refine an instrument that aims to support this process. METHODS: A convenience sample of 42 respondents completed the Knowledge, Attitudinal, and Experiential Survey on Advance Directive (KAESAD). RESULTS: Domains with the highest Cronbach's alpha value were "professional attitudes" (α = .995) and "clinical experiences" (α = .999). CONCLUSIONS: Reliability assessments suggest that most domains of the instrument have strong internal consistency, and with a larger sample size, future studies may elucidate how nurse educators can use this instrument to target areas for continuing education.

Burnout and Anxiety Among Trauma Nursing Specialties in a Rural Level I Trauma Center.

BACKGROUND: Burnout and anxiety compromise physical and mental well-being of nurses and jeopardize patient safety. Personal, professional, and workplace characteristics have been associated with burnout and anxiety across diverse practice settings, yet none in rural, community trauma centers. We sought to identify the severity and predictors of burnout and anxiety in the trauma nursing staff of a rural Level I trauma center. METHODS: A convenience sample of trauma nurses from the emergency department (ED), intensive care unit (ICU), and trauma ward was voluntarily surveyed using a demographic questionnaire, the Maslach Burnout Inventory (MBI) subscales: depersonalization (DP), emotional exhaustion (EE), and reduced personal accomplishment, as well as the Generalized Anxiety Disorder seven-item (GAD-7) scale. Multivariable linear regression identified the significant predictors of burnout and anxiety. RESULTS: Ninety-six nurses completed surveys (response rate: 83.5%). Married or divorced status, and ICU or trauma ward job assignments were associated with significantly lower adjusted DP scores. Thus, the model-predicted score for a single ED nurse was 15 versus a predicted score of 7 for a divorced ICU or trauma ward nurse, p < .001 for each group. The GAD-7 model demonstrated that race/ethnicity (Asian compared with White, coefficient: -5.06, p = .03), number of children (2 compared with 0, coefficient: -2.54, p = .02), and job tenure (5-10 years vs. <2, coefficient: -3.18, p = .01) were each associated with fewer GAD-7 points. CONCLUSION: Depersonalization and anxiety vary across the trauma nursing workforce based on identifiable personal and work-related risk factors. Group-specific, targeted interventions are needed to effectively reduce burnout and anxiety in trauma nursing staff.