The new emergency department "Tuscan triage System". Validation study.

INTRODUCTION: A new organizational framework was recently implemented in Tuscan Emergency Departments (EDs), including specific low-priority streaming. A new ED triage system, named "Tuscan Triage System" (TTS), was devised with the purpose of applying this reorganization. METHODS: A validation study was designed with the primary aims of assessing the content, face, and criterion validities, and the inter-rater reliability of the TTS. The secondary aim was to estimate the differences in triage level assignation between the previous "Regional Triage System" (RTS) and the TTS. Twenty-four nurses trained for the TTS were enrolled to assign TTS priority levels to 100 triage clinical case vignettes drawn up by the developers of the TTS (reference standard). RESULTS: The Content Validity Index - Scale/Average (S-CVI/Ave) of TTS was 0.98. Concerning to face validity, the S-CVI/Ave was 1. The highest adherence of triage level assignation to the reference standard was for levels 1 and 2. The Krippendorff α value was 0.808. Undertriage and overtriage were 10.45% and 14.29%, respectively. Overall, the comparation between RTS and TTS showed a marked shift of level assignation towards TTS low priority levels. CONCLUSIONS: The TTS seems to be safe. These results should be confirmed through studies in the real clinical settings.

[Not Available]. / Violenza orizzontale e bullismo nella professione infermieristica.

INTRODUCTION: Bullying and horizontal violence are particular features of workplace violence, currently under the attention of professional organizations in the nursing world. OBJECTIVE: To highlight the spread of the phenomenon, the characteristics, consequences and possible solutions. METHODS: Literature review through Medline and CINAHL databases using the following keywords: "lateral", "horizontal", "hostility", "bullying", "workplace bullying," "violence" "nursing". RESULTS: 30 original studies were selected and included in the review. The prevalence of bullying variesfrom 5.7% to 94% of surveyed nurses. The horizontal violence percentages are, instead, 1.3% and 65%. Theforms of abuse experienced by nurses are rangingfrom acial harassment (lessfrequent, 4.5%), to emotional abuse (up to 62.4%) and being burdened with unmanageable workloads (71%). There is a strong correlation between poor quality of interpersonal relationships and the greater rate of abuse perpetrated by peer colleagues and supervisors. Bullying is significantly higher among those who have less seniority, and are younger. The most common problems reported by victims, range from anxiety, to headache,, gastrointestinal symptoms, and finally to those typical of post-traumatic stress disorder (from 25% to 55%). The victims of bullying have a high proportion of intent to resign (50%), and a 3-fold greater propensity than others to leave the profession (p < 0.001). DISCUSSION: The theory Oppressed Group Behavior is the most reliable to explain bullying and horizontal violence among nurses, although currently not validated. There are difficulties in comparing the data about bullying and horizontal violence from the literature due to the lack of agreed definitions. Studies about prevention and management of problems derived from bullying and horizontal violence are still scant.

[Nursing activities score: differences in nursing workload in three intensive care units]. / Nursing activities score: differenze nei carichi di lavoro infermieristici in tre terapie intensive.

INTRODUCTION: The activities that impact on the nursing workload in an intensive care unit have not been described. AIM: To retrospectively analyze the nursing workload in the three intensive care units-ICU (general, neurosurgery and cardiac surgery) of the same department with the Nursing Activities Score (NAS) to describe the nursing interventions that mostly impact on the workload. METHODS: Retrospective observational study. Patients admitted from January 2006 to December 2012 were included in the study. The NAS was completed every 24 hours around 6 am. RESULTS: Patients included in the study were 7588; their mean NAS score was 61.7 ± 19.02%; 75.9 ± 1.44 in General ICU, 61.6 ± 2.46 Neuro ICU, 62.5 ± 3.06 in the Cardiosurgical ICU. The items that mostly impacted on the nursing workload were the need of monitoring and titration, the hygiene procedures, and the Mobilization and positioning. The three procedures were performed with different frequencies in the three ICUs. CONCLUSIONS: The results confirm that the minimum required care in ICUs is around 950 minutes/day. The differences observed in the three ICUs were determined by the different clinical severity and caring complexity of the patients.

Lateral hostilities among nurses employed in intensive care units, emergency departments, operating rooms, and emergency medical services. A national survey in Italy.

BACKGROUND: Lateral hostilities (LHs) are "nasty, unkind, aggressive behavior between colleagues working at comparable organizational levels." When LHs occur "at least once a week for a period of not less than 6 months," they become "bullying." The frequency of lateral violence in health care literature varies from 5.7% to 65%. OBJECTIVES: The aim of this study was to explore the extent of LH and the effects on the quality of lives of Italian nurses working in prehospital emergency medical system, emergency department, intensive care unit, and operating rooms. METHODS: A descriptive study was conducted through an online survey in the Web site of the National Italian Association of Critical Care Nurses (ANIARTI). RESULTS: A total of 1504 nurses filled up the questionnaire, with 1202 valid data entries (79.9%). Of this group, 739 (61.5%) were women and 951 (79.1%) had experienced some form of LH at least once in the last 12 months, whereas 269 (22.4%) felt to be victims of bullying. The number of transfers to other departments/services due to LH was 43 cases (3.6%), and 829 (69%) experienced psychophysical disorders attributed to LH experienced in the span of the year. DISCUSSION: Lateral hostility is a frequent occurrence that calls for implementation of management policies to achieving an overall improvement of the work environment climate.

[Lateral hostilities among emergency and critical care nurses. Survey in five hospitals of the Tuscany Region]. / Ostilità laterali nei gruppi infermieristici di area critica. Indagine su cinque presidi ospedalieri della regione Toscana.

Lateral hostilities among emergency and critical care nurses. Survey in five hospitals of Tuscany Region. Introduction. Lateral hostilities (LHs) are a kind of workplace violence. They are defined as varieties of cruel, rude, antagonistic interactions between people at the same hierarchical level. Nurses are affected by LH from 5.7% to 65%, leading to reduced work motivation, psycho-physical disorders, and in some cases, drop out of the nursing profession. Objective. To quantify the LHs among nurses in the emergency departments (ED) and intensive care units (ICU) in 5 hospitals of Tuscany (Italy). To show the impact on the quality of their psycho-physical and professional lives. Method. Exploratory-descriptive study, through closed-ended questionnaire. Results. 360/444 nurses (81%); 294 (81.6%) were victims of LHs during the past 12 months. Gossiping, complaints shared with others without discussing with the concerned person, and sarcastic comments were the most reported LHs. LHs occur more in EDs than ICUs (respectively 90% and 77%; p=0.0038). No statistically significant differences were observed for gender, age, or years of experience. The 17.7% of nurses asked to be moved from the ward, and 6.9% left it; 6.9% respondents had thought to leave the nursing profession; 235 (65.2%) experienced at least one LHs related disorder during the last year. Most reported symptoms were low morale, anxiety, and sleep disturbances. Conclusions. The incidence of LH and related disorders is high in EDs and ICUs, determining a low professional and psycho-physical quality of life.

Characteristics of patients who leave the ED triage area without being seen by a doctor: a descriptive study in an urban level II Italian University Hospital.

OBJECTIVE: In this paper, we describe demographic and clinical features of patients who left the triage area before the visit in the emergency department of Azienda Ospedaliera Universitaria Careggi in 2006. METHODS: This is a descriptive retrospective study. Data was collected from electronic medical charts. RESULTS: We recorded 45,019 patients who arrived in the emergency department. Of those, 904 left without being seen (2%; Male 51.5%; Female 48.2%). The mean age was 41 years (median 37; range 14-95). We found that this was more common during June and July (114 and 107 cases) and on Mondays (20.5%), with lower rates on Saturdays and Sundays (11.3% and 9%). Two-hundred thirty-nine patients were not Italian. Patients' waiting times before leaving without being seen collected from the nursing notes were recorded in 457 cases (50.5%), and showed a median of 70 minutes (range 0-386). There was a significant difference between this value and the median of waiting times (95 minutes) calculated from the ending time of medical charts in the same group of patients (Wilcoxon Signed Rank Test - P < 0.0001). It confirms the hypothesis that the patients' length of stay before leaving the triage area, gathered from medical charts, isn't reliable because of the delayed ending of charts. After 72 hours from the leave, 17 patients returned. The outcome were: 2 admissions in general ward and 6 new cases of leaving without being seen. CONCLUSIONS: There was a prevalence of low-priority triage-level patients compared to the general ED case mix. The rate of patients' leaves follows the indications of Tuscany Region (patients' leaves <5% total ED population).

[See & treat emergency department: the shift from doctors to nurses with advanced skills. A literature review]. / See & treat in pronto soccorso: dal medico all'infermiere con competenze avanzate. Una revisione della letteratura.

AIM: Overcrowding and long waiting times are among the chronic problems of emergency Departments. The effectiveness and safety of See and Treat approach were assessed searching the available literature. METHOD: The following key words were searched in Medline: See and Treat, Minor Injuries Unit, Fast Track, Emergency Department, and Emergency Nurse Practitioner selecting articles in English and Italian. RESULTS: The 21 articles selected include 15 original studies, 2 systematic reviews and 3 letters. The large majority of the studies support the implementation of an advanced nurse practitioner (ANP) to screen patients and reduce waiting times for patients with minor codes. Although the results of the studies come to the same conclusion, the methodological quality is weak and the costs of the implementation of an ANP need to be further explored. DISCUSSION: To implement a minor injury service the role and competences of ANPs need to be discussed, together with role boundaries with medical doctors. Patients should be able to choose if they prefer to be visited by a doctor. Guidelines and protocols should be implemented and strictly followed.

[Use of devices for spine immobilization for trauma patients at the emergency department: review of the literature]. / Utilizzo degli immobilizzatori della colonna vertebrale nel traumatizzato in dipartimento di emergenza: revisione della letteratura.

Trauma care implies the use of various devices for partial or total spine immobilization in order to prevent secondary damages due to medical interventions. The aim of this review of the medical and nursing literature of the last 10 years is the analysis of the latest evidences produced and the comparison with the recommendations provided by the most recent clinical guidelines. The following key-words were used ("cervical collar", "spinal board", "trauma", "vacuum mattress", "stretcher", "emergency department", "spinal trauma") and clinical trials, surveys and descriptive studies were searched in Pub-med. According to the most recent studies the spine table should be removed within two hours from the arrival to the Emergency Department in favour of a stretcher with a padded rigid surface. Safety straps for securing the patient on the spinal board should replace spider burlap for trauma patients. Of utmost importance is the correct positioning of a cervical collar of the right size, the positioning of low pillows under occipitis in order to obtain the neutral position of the head and its stabilization through the blocking of the head and trunk.