What nurses need to know about mobile radiography.

Nurses have a vital role in providing nursing care to patients requiring mobile radiography. Mobile radiography is requested when a patient's condition makes it impossible for them to be transported to the radiology department. All health professionals involved in mobile radiography, such as nurses, medical doctors and radiographers should be knowledgeable in this area. This is even more important in current practice, where nurse consultants and nurse advanced practitioners are assessing and referring patients for limited radiological examinations. However, there is little literature to equip nurses with knowledge about mobile radiography. The aim of this article is to raise awareness of this subject at a time when the number of patients requiring mobile radiography has increased globally, due to the outbreak of coronavirus. Critically ill patients with COVID-19 require portable chest X-rays to diagnose complications of the disease, such as pneumonia.

Effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries: a systematic review.

The aim of this study was to systematically review the literature on the effectiveness of nurse-initiated X-ray for emergency department patients with distal limb injuries. The review protocol was registered with PROSPERO and CINHAL, MEDLINE and EMBASE were searched for studies comparing nurse-initiated vs physician-initiated X-ray. Because of heterogeneity of patients, providers and outcomes, a meta-analysis was not performed. The 16 included studies were conducted between 1971 and 2018 and involved 8881 participants. There were four randomised trials and 12 observational studies that focussed on X-ray request accuracy (n = 14), emergency department processes (n = 6) and patient outcomes (n = 2). The quality of evidence for each outcome ranged from very low-to-moderate. Compared with physician-initiated X-ray, nurse-initiated X-ray uses no more resources, is safe and acceptable to patients. Nurse-initiated X-ray did not reduce time to X-ray or waiting time but in some studies, reduced emergency department length of stay and unplanned follow-up.

Application of quality improvement analytic methodology in emergency medicine research: A comparative evaluation.

OBJECTIVE: Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. METHODS: We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR). QI analytic tools were applied to the data set from this study and evaluated comparatively against the original standard research methodology. RESULTS: The original study concluded that triage nurse-initiated radiographs led to a statistically significant decrease in mean emergency department length of stay. Using QI analytic methodology, we applied control charts and interpreted the results using established methods that preserved the time sequence of the data. This analysis found a compelling signal of a positive treatment effect that would have been identified after the enrolment of 58% of the original study sample, and in the 6th month of this 11-month study. CONCLUSIONS: Our comparative analysis demonstrates some of the potential benefits of QI analytic methodology. We found that had this approach been used in the original study, insights regarding the benefits of nurse-initiated radiography using the OAR would have been achieved earlier, and thus potentially at a lower cost. In situations where the overarching aim is to accelerate implementation of practice improvement to benefit future patients, we believe that increased consideration should be given to the use of QI analytic methodology.

Improving nurse initiated X-ray practice through action research.

INTRODUCTION: Due to increasing demands on hospital Emergency Departments (EDs), the role of registered nurses, with additional training, has been extended to include requesting X-ray examinations. The aim of this study was to evaluate nurse practice guidelines for requesting X-rays in the ED setting and to utilise inter-professional learning and change management theory to promote practice improvements. METHODS: Three hundred and one nurse initiated X-ray (NIX) requests were randomly selected between January and March 2012, and reviewed for observance of local department guidelines and quality of clinical history. The results of this preliminary review were used to inform the investigating team in order to improve and support practice. A collaborative educational intervention utilising inter-professional learning and change management theory was implemented with an aim of improving the clinical history provided in NIX requests and development of a new policy to support clinical practice. A second review was repeated from February to April 2014 to evaluate the success of the educational intervention. RESULTS: Observance of NIX guidelines improved from pre-intervention to post-intervention (48% vs. 90%, P > 0.001). Quality of clinical history also significantly improved in all four essential variable criteria: (1) mechanism of injury; (2) injury location; (3) side of injury; and (4) clinical question. CONCLUSION: This study demonstrates that utilising inter-professional learning and change management theory can contribute to significant improvements in and support clinical practice of NIX in the emergency setting.

Effect of Triage Nurse Initiated Radiography Using the Ottawa Ankle Rules on Emergency Department Length of Stay at a Tertiary Centre.

OBJECTIVE: To determine the effect of triage nurse initiated radiographs using the Ottawa Ankle Rules (OAR) on emergency department (ED) throughput. We hypothesized OAR use would reduce median ED length of stay (LOS) by 25 minutes or more. METHODS: A randomized controlled trial was conducted at a tertiary centre ED with an annual census of over 90,000 patients. Adult patients presenting within 10 days of isolated blunt ankle trauma were eligible. Participants were randomly assigned to standard triage or OAR application by 15 explicitly trained triage nurses. Our primary outcome was ED LOS. Secondary outcomes included triage nurses' and patients' satisfaction. A power calculation indicated 142 patients were required. The Mann-Whitney U test was used to compare the medians between the two groups. RESULTS: Of 176 patients with blunt ankle injury screened, 146 were enrolled (83.0%); baseline characteristics in the two groups were similar. The median/mean ED LOS in the control and OAR groups were 128/143 minutes and 108/115 minutes respectively (median difference 20 minutes; p=0.003). Agreement in OAR use between emergency physicians and nurses was moderate (kappa 0.46/0.77 for foot/ankle rule components), and satisfaction of both nurses and participants was high. CONCLUSION: Triage nurse initiated radiography using OAR leads to a statistically significant decrease of 20 minutes in the median ED LOS at a tertiary care centre. The overall impact of implementing such a process is likely site-specific, and the decision to do so should involve consideration of the local context.

Treatment and prevention of gout.

Gout is a disorder of purine metabolism that primarily occurs in adult males. Elevated plasma uric acid concentrations (hyperuricemia) cause deposits of urate crystals in joint spaces causing severe, repeated attacks of arthritis.

Fratura do acrômio associada a lesão arterial: relato de caso / Fracture of the acromion associated with arterial lesion: case report

A fratura do acrômio com lesão arterial é uma associação rara. O quadro clínico caracteriza-se por dor no ombro, incapacidade funcional e edema do membro acometido, com pulso e temperatura distais diminuídos. A radiografia do ombro e a arteriografia definem o diagnóstico e auxiliam na evolução pós-operatória. Os autores relatam um caso raro de fratura da base do acrômio associada a lesão da artéria ulnar ipsilateral, seu tratamento, bem como a avaliação pré e pós-operatória.

Fracture of the acromion and arterial injury are a rare association. The clinical picture is characterized by shoulder pain, functional disability and swelling of the affected limb with decreased distal pulse and temperature. Radiography of the shoulder and arteriography define the diagnosis and assist in postoperative follow-up. The authors report a rare case of fracture of the acromion associated with injury of the ipsilateral ulnar artery and describe its treatment, as well as pre- and postoperative evaluations.

Radiographic studies in the critical care environment.

Critical care patients present with or develop conditions that require imaging with a variety of radiographic methods. Technological advances such as the introduction of digital imaging instead of screen-film radiography have improved image resolution, readability, management, and portability of results while maintaining confidentiality of patient information. Radiographic imaging in the critical care unit is an integral part of patient management. It is imperative that the critical care nurse be cognizant of radiographic studies and thus be able to collaborate with all health care providers in the administration of quality patient care.

Prevalence, motives and patterns of anticipated radiograph ordering by nurses in accident and emergency departments in France.

BACKGROUND: Although common in many countries, anticipated ordering of radiographs by nurses in Accident and Emergency Departments (AEDs) remains illegal in France. Despite this, some evidence suggests that it is implemented in a number of AEDs. AIM: To describe the current state of the practice of anticipated ordering of radiographs by nurses in France. RESULTS AND CONCLUSIONS: Despite a low response rate (21.2%), the findings (prevalence and implementation patterns) stress the urgency of a broad review of this issue in France.

The expanding role of the infusion nurse in radiographic interpretation for peripherally inserted central catheter tip placement.

The role of the registered nurse has evolved over time from a limited caregiver providing care to the patient under the absolute authority of a physician to an involved participant of the healthcare team. This has resulted in added responsibility and the incorporation of a higher skill level. In institutions across the country, nurses are involved in improving the quality of patient care and assisting in the provision of care in a timely manner with decreased delays in treatment and improved identification of complications associated with procedures. In this article, the process for investigating the potential for expanding the role of the registered nurse to include determination of peripherally inserted central catheter tip placement is discussed.

Radiology nursing.

Radiology nursing is a relatively new field in which nurses can use multiple skills in caring for adult and pediatric patients. The authors present an overview of the role nurses play in interventional radiology, nuclear medicine, ultrasound, magnetic resonance imaging, computed tomography, and mammography. In addition, information about the professional affiliations and certification in the American Radiological Nurses Association is provided.

Clinical competence in caring for paediatric patients.

The ability to demonstrate competence in the modern healthcare arena is becoming increasingly important. Patient safety is of primary importance, but competency documents can also be used to structure professional development and as evidence of practitioners' levels of clinical practice, competence and responsibility. Managing paediatric patients can be highly complex and is surrounded by uncertainty. It requires imagination, advanced decision making and the application of theory and research to practice. Nurses must be able to demonstrate accurate knowledge of physical and psychological development changes of children aged between five and 18 years, and then apply this knowledge to examination and treatment. Nurses must also be able to demonstrate accurate referral to X-ray. Providing good paediatric emergency care has become a high priority and it is hoped that practice standards will improve in line with the national service framework's ten-year plan (DH 2004b). Improving the health and welfare of children is an important investment in our future (Glasper 2005). To this end, all healthcare professionals must strive to deliver high quality, timely and efficient paediatric care.

How 'nil by mouth' instructions impact on patient behaviour.

Preoperative fasting is a necessary intervention to minimise the risk of regurgitation and inhalation of gastric contents while under anaesthesia. But, despite clear written instructions, a significant number of patients choose to fast for a longer than suggested period. It is recommended that to improve practice patients should be reassured that they can maintain their oral intake until being instructed to stop. They should also receive information about oral comfort during fasting and when they can begin to eat and drink after their procedure.