Comparison of out of hospital cardiac arrest due to acute brain injury vs other causes.

BACKGROUND: Acute brain injury (ABI) can cause out of hospital cardiac arrest (OHCA). The aim of this study was to compare clinical features, mortality and potential for organ donation in patients with OHCA due to ABI vs other causes. METHODS: From January 2017 to December 2018, all adult patients presenting to ED for OHCA were considered for the study. Two physicians established the definitive cause of OHCA, according to clinical, laboratory, diagnostic imaging and autoptic findings. Clinical features in patients with OHCA due to ABI or other causes were compared. RESULTS: 280 patients were included in the analysis. ABI was the third most frequent cause of OHCA (21, 7.5%); ABIs were 8 subarachnoid hemorrhage, 8 intracerebral hemorrhage, 2 ischemic stroke, 2 traumatic spinal cord injury and 1 status epilepticus respectively. Neurological prodromes such as seizure, headache and focal neurological signs were significantly more frequent in patients with OHCA due to ABI (OR 5.34, p = 0.03; OR 12.90, p = 0.02; and OR 66.53, p < 0.01 respectively) while among non-neurological prodromes chest pain and dyspnea were significantly more frequent in patients with OHCA due to other causes (OR 14.5, p < 0.01; and OR 10.4, p = 0.02 respectively). Anisocoria was present in 19% of patients with OHCA due to ABI vs 2.7% due to other causes (OR 8.47, p < 0.01). In 90.5% of patients with ABI and in 53.1% of patients with other causes the first cardiac rhythm was non shockable (OR 8.1; p = 0.05). Multivariate logistic regression analysis revealed that older age, active smoking, post-traumatic OHCA, neurological prodromes, anisocoria at pupillary examination were independently associated with OHCA due to ABI. Patients with ABI showed a higher mortality compared with the other causes group (19 pts., 90.5% versus 167 pts., 64.5%; p = 0.015). Potential organ donors were more frequent among ABI than other causes group (10 pts., 47.6% vs 75 pts., 28.9%) however the difference did not reach the statistical significance (p = 0.07). CONCLUSIONS: ABI is the third cause of OHCA. Neurological prodromes, absence of chest pain and dyspnea before cardiac arrest, anisocoria and initial non-shockable rhythm might suggest a neurological etiology of the cardiac arrest. Patients with OHCA due to ABI has an unfavorable outcome, however, they could be candidate to organ donation.

Violence towards emergency nurses: A narrative review of theories and frameworks.

INTRODUCTION: Workplace Violence in the health environment is a growing issue worldwide. Emergency department have been identified asa high-risk setting for Workplace Violence and emergency nurses are most exposed to this phenomenon. To address workplace violence in the ED effectively, it is critical to understand frameworks established in the literature to assist in development of appropriate interventions and corrective measures. An overview of available theories of violence towards emergency nurses in the literature is presented herein in the format of a narrative review. METHODS: A search of international literature on WPV theories was conducted in three databases: PubMed, CINAHL, Scopus, and Proquest Central. Articles concerning theories that have direct implications for patient-related violence (client-on-worker Type 2 Violence) in the emergency department were sought. RESULTS: Four hundred and fifty-nine articles were found. Applying established inclusion and exclusion criteria, fourteen of these were included in the review. In the international literature there are 24 theories and frameworks pertaining to violence towards nurses in the emergency department which describe different intervention strategies based on these. DISCUSSION: Both the theories on violence developed by nurses and those derived from other disciplines are complex and many key elements are invariably intertwined. Understanding such theories might be useful to manage violence towards emergency nurses with greater effectiveness.

[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.

Interventions to reduce the risk of violence toward emergency department staff: current approaches.

INTRODUCTION: The phenomenon of workplace violence in health care settings, and especially in the emergency department (ED), has assumed the dimensions of a real epidemic. Many studies highlight the need for methods to ensure the safety of staff and propose interventions to address the problem. AIM: The aim of this review was to propose a narrative of the current approaches to reduce workplace violence in the ED, with a particular focus on evaluating the effectiveness of emergency response programs. METHODS: A search was conducted between December 1, 2015 and December 7, 2015, in PubMed and CINAHL. Ten intervention studies were selected and analyzed. RESULTS: Seven of these interventions were based on sectoral interventions and three on comprehensive actions. CONCLUSION: The studies that have attempted to evaluate the effectiveness of interventions have shown weak evidence to date. Further research is needed to identify effective actions to promote a safe work environment in the ED.

[Unplanned extubations in adult intensive care units: an update]. / Estubazioni non pianificate nei pazienti adulti in terapia intensiva: un aggiornamento.

INTRODUCTION: Unplanned extubations (UEs) in adult Intensive Care Units (ICUs), have recently become an indicator of quality and safety of care. METHOD: A literature review published 10 years ago was updated to analyze any changes in UEs. RESULTS: The cumulative incidence of UEs varied between 0.3% and 27%, before 2000, and more recently, from 0.5% to 35.8%, without substantial changes. The rate of Self Extubations (SE) outweighed the Accidental Extubation (AE), amounting to 50%-100% of all UE. The reintubations rate ranged between 1.81% and 88%. The UEs increase the length of the mechanical ventilation, of ICU and hospital stay, and according to few studies the rate of death with UEs is lower. Major risk factors for UE are: APACHE II score ≥17, agitation, physical restraints, administration of midazolam, and higher levels of consciousness. The implementation of ABCDE bundle in ICUs did not involve additional risks of UE. The prevention includes a sedation with drugs different from benzodiazepines, an early detection of patients' readiness to weaning trial from mechanical ventilation, and the adequate stabilization of the endotracheal tube, with securing systems passing behind the patient's neck. The use of physical restraints is inconsistent, since it can be a risk factor for SE. CONCLUSIONS: For preventing UEs the surveillance of nursing staff is fundamental, if the staffing is adequate to the real workloads in ICU.

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.

[Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units]. / Interventional Patient Hygiene Model. Una riflessione critica sull'assistenza di base in terapia intensiva.

Interventional Patient Hygiene Model. A critical reflection on basic nursing care in intensive care units. Over the past 15 years, the model of medical and nursing care changed from being exclusively oriented to the diagnosis and treatment of acute illness, to the achievement of outcomes by preventing iatrogenic complications (Hospital Acquired Conditions). Nursing Sensitive Outcomes show as nursing is directly involved in the development and prevention of these complications. Many of these complications, including falls from the bed, use of restraints, urinary catheter associated urinary infections and intravascular catheter related sepsis, are related to basic nursing care. Ten years ago in critical care, a school of thought called get back to the basics, was started for the prevention of errors and risks associated with nursing. Most of these nursing practices involve hygiene and mobilization. On the basis of these reflections, Kathleen Vollman developed a model of nursing care in critical care area, defined Interventional Patient Hygiene (IPH). The IPH model provides a proactive plan of nursing interventions to strengthen the patients' through the Evidence-Based Nursing Care. The components of the model include interventions of oral hygiene, mobilization, dressing changes, urinary catheter care, management of incontinence and bed bath, hand hygiene and skin antisepsis. The implementation of IPH model follows the steps of Deming cycle, and requires a deep reflection on the priorities of nursing care in ICU, as well as the effective teaching of the importance of the basic nursing to new generations of nurses.

[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.