Australasian Emergency Nursing Journal RSS feed: Current Issue. As the official journal of the College of Emergency Nursing Australasia (CENA), the The Australasian Emergency Nursing Journal (AENJ) serves the professional practice needs of emergency nurses by providing them with high-quality information directly relevant to their contemporary practice. As an international peer-reviewed journal, the AENJ is a conduit for clinical, applied, and theoretical research and scholarship in emergency nursing that is original and innovative. The Journal is published four times a year. ERA Ranking: A (as at December, 2010) Peer-Review Process: Double-blind, external peer review Nursing Consult Visit our nursing resource, Nursing Consult To purchase books on Emergency Nursing or to browse our comprehensive range of Nursing titles, please visit us at shop.elsevier.com.au. Go to: Shop.elsevier.com.au/Emergency http://www.aenj.org.au/?rss=yesElsevier Inc.en © 2011 Published by Elsevier Inc. All rights reserved. Australasian Emergency Nursing Journal1574-6267144November 2011 © 2011 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.aenj.org.au/article/PIIS1574626711002576/abstract?rss=yesEditorial Board10.1016/S1574-6267(11)00257-6Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8iiiiiihttp://www.aenj.org.au/article/PIIS1574626711002588/abstract?rss=yesContents10.1016/S1574-6267(11)00258-8Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8ivivhttp://www.aenj.org.au/article/PIIS1574626711002370/abstract?rss=yesThis issue of the Australasian Emergency Nursing Journal foreshadows the release of an important development in defining the future role of triage in this country. The Australian Triage Process Review (ATPR) is due for release in late 2011. A summary of the ATPR work was recently presented at the 9th International Conference for Emergency Nursing in Adelaide. In the context of the ATPR review, it is timely to consider what the critical issues are at present for evaluating the safety and quality of triage services into the future.How do we define quality at triage?Marie F. Gerdtz10.1016/S1574-6267(11)00237-0Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8Editorial215216http://www.aenj.org.au/article/PIIS1574626711001224/abstract?rss=yesSummary: Introduction: The aim of the systematic review was to examine (i) the impact of afterhours primary care models on ED, ambulance services and or general practitioners and (ii) the effectiveness of these services (afterhours) on nurse practitioners and/or the medical doctors delivery of care.Method: Articles were assessed using the Critical Appraisal Skills Programme (CASP) making sense of evidence tools and covered the period from 1970 to 2011. The data sources searched were: Cumulative Index to Nursing and Allied Health literature, Medline, EMBASE, The Cochrane Database of Systematic Reviews, PubMed, Science Direct and Proquest.Results: A total of 2268 were retrieved and 419 studies were identified. Eighty-seven studies were found to be relevant. Nine countries are represented in the data. There were few relevant Randomised Controlled Trials (n=5). The evidence was largely based on quasi experimental (time series), before and after or comparative studies. Studies were usually set within a single hospital or community setting with heterogeneous samples, short sample periods, and or measured a single outcome such as patient satisfaction.Conclusions: Six models were identified from the review which highlighted evidence that afterhour care models can reduce GP workload and to a lesser extent ED and ambulance services. Potentially these models could ease acute care work load, improve access across the vast geographical distances of Australia.A systematic review of the impact of afterhours care models on emergency departments, ambulance and general practice servicesMargaret M. Fry10.1016/j.aenj.2011.09.001Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Systematic Review217225http://www.aenj.org.au/article/PIIS1574626711000887/abstract?rss=yesSummary: Introduction: A retrospective exploratory study was conducted to (i) explore the practice patterns of a Transitional Emergency Nurse Practitioner (TENP) working across two urban Emergency Departments (ED); (ii) identify the demographic characteristics of the TENP patient cohort; and (iii) identify if TENP patients were appropriately and timely managed.Method: The study was conducted across two hospital sites over two consecutive years for a 3-month period. Data collection occurred during the months of December through to February. TENP patients were identified by hospital electronic medical record and were then grouped into a model that included ‘Fast Track’ or ‘See and Treat’ cohort. The cohorts were then analysed for diagnostic groups, age, sex, length of stay, triage category, and re-presentations.Results: The TENP worked a total of 600h (Site 1 252h; Site 2 348h) across the study period. The TENP managed a total of 481 patients (262 Site 1; 220 Site 2) during the study period. The majority of patients (412; 84%) were managed in the ‘See and Treat’ cohort (Site 1 246, 94%; Site 2 166, 75%) and 70 patients (16%) were managed in the ‘Fast Track’ cohort (Site 1 16, 4%; Site 2 54, 25%). The median length of stay for TENP managed patients was 143min, with 96% of patients leaving the ED in less than 8h. There were no TENP unplanned re-presentations at either site. The TENP managed more male patients across both sites. The majority (75%) of patients the TENP managed had musculoskeletal and/or wound conditions or injuries.Conclusion: TENP practice across the two Sydney metropolitan ED sites was similar. The model adapted for Tertiary Referral centres was appropriate for smaller urban EDs. The study supports existing evidence of timely and appropriate care being delivered by TENPs across Australian EDs. Given the work practice similarities, the study demonstrates that State and/or National standards and policies could be developed for emergency advanced practice roles.A review of the Transitional Emergency Nurse PractitionerMatthew Lutze, Andrew Ratchford, Margaret Fry10.1016/j.aenj.2011.06.003Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Research226231http://www.aenj.org.au/article/PIIS1574626711001236/abstract?rss=yesSummary: Deep vein thrombosis (DVT) is the third leading cause of morbidity in critically ill trauma patients but it can be prevented by performing appropriate risk assessment and preventive strategies. The purpose of this study was to evaluate of implementing a clinical nursing practice guideline (CNPG) for preventing DVT in critically trauma patients at Songklanagarind Hospital. The CNPG content with 37 items initially developed from evidence-based knowledge related to DVT and its prevention was validated and approved by the consensus of an expert panel. The ‘expert panel’ consisted of a clinical (critical surgical patients) nurse specialist, a trauma surgeon, a medical doctor who experts in developing CNPG, and two surgical care nurse educators. The revised 30 from 37 items were tested for reliability thereafter and yielded of 0.90 and 1.00, respectively. Forty-two nurses participated in this study. The effectiveness of this CNPG was evaluated in terms of (1) feasibility and difficulty of using the CNPG, (2) nurse's satisfaction in implementation of CNPG, and (3) the patient's femoral blood flow velocity before and after 7 days. Results have shown that 23 items were performed by more than 90% of nurses and there were 7 items performed at rates lower than 90%. 79% of nurses rated their satisfaction at high (M=8.06, SD=0.96). There were no differences in femoral venous blood flow velocity before and after 7 days and without signs of DVT. The findings indicated that the use of evidence-based clinical practice guidelines for deep vein thrombosis prevention could enhance the quality of care in terms of early detection for DVT and maintaining blood flow velocity in those patients who are at risk. Further study could be explored to confirm its effectiveness with the large sample size.Evaluation of a clinical nursing practice guideline for preventing deep vein thrombosis in critically ill trauma patientsPraneed Songwathana, Kesorn Promlek, Kanitha Naka10.1016/j.aenj.2011.09.002Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Research232239http://www.aenj.org.au/article/PIIS1574626711001194/abstract?rss=yesSummary: Advanced Life Support (ALS) certification has become a mandatory requirement for most critical care nurses in Australia. The purpose of this review is to critically evaluate current literature in relation to ALS training and certification for critical care nurses. There is some evidence in the literature that ALS training programs can improve patient outcome following cardiac arrest. Teaching methods vary including simulation training, e-learning and lecture based courses. Of continued concern is the consistent message that competence declines rapidly following ALS courses. Whilst many critical care units require evidence of annual ALS assessment there is little evidence that this translates into ongoing practical competence or confidence. Recommendations from regulatory bodies and ALS training literature reinforce that frequent, relevant and practical learning activities may be more effective, however it is unclear from the review if this occurs nor if critical care nurses remain confident in their skills as time passes.Advanced life support training and assessment: A literature reviewNoelene Maree Williams10.1016/j.aenj.2011.07.001Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Literature Review240245http://www.aenj.org.au/article/PIIS1574626711001212/abstract?rss=yesSummary: Catastrophic disasters occur infrequently. Large numbers of health professionals are required to respond and many will have neither the experience nor training to provide effective care. Nurses are often the first on the scene and the first to instigate care to those in need. The aftermath of such disasters provides an opportunity for reflection. Responders are reminded of the pain and suffering they witnessed and, in many cases, experienced. There is also the opportunity to learn from these experiences with the potential to enhance our ability to respond to similar events in the future.This article describes the development and subsequent pilot testing of a short training program developed and delivered to 50 senior nurses who were involved in the earthquake in the Sichuan Province, China, in May 2008. The experiences and knowledge gained following the Sichuan earthquake, and shared by all during the course, have been used to inform current training programmes in emergency and disaster preparedness for nurses. These courses are now being delivered in China and other countries. Key issues that will be explored in the paper include; course design, content and delivery, and consideration of the well being of participants who have been responders in the recent disaster. The lessons learned from this course will add to the growing literature on the preparation of nurses for emergency or disaster situations which is essential to ensure quality care for future disaster victims.Preparing nurses for future disasters—The Sichuan experienceLisa Conlon, Rick Wiechula10.1016/j.aenj.2011.08.001Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Discussion and Debate246250http://www.aenj.org.au/article/PIIS1574626711000826/abstract?rss=yesSummary: Background: Patient privacy and confidentiality (PPaC) is an important consideration for nurses and other members of the health care team. Can a patient expect to have confidentiality and in particular privacy in the current climate of emergency health care? Do staff who work in the Emergency Department (ED) see confidentiality as an important factor when providing emergency care? These questions are important to consider.Methods: This is a two phased quality improvement project, developed and implemented over a six month period in a busy regional, tertiary referral ED.Results: Issues identified for this department included department design and layout, overcrowding due to patient flow and access block, staff practices and department policies which were also impacted upon by culture of the team, and use of space.Conclusions: Changes successful in improving this issue include increased staff awareness about PPaC, intercom paging prior to nursing handover to remove visitors during handover, one visitor per patient policy, designated places for handover, allocated bed space for patient reviews/assessment and a strategy to temporarily move the patient if procedures would have been undertaken in shared bed space. These are important issues when considering policy, practice and department design in the ED.Improving patient privacy and confidentiality in one regional Emergency Department – A quality projectPauline Calleja, Louise Forrest10.1016/j.aenj.2011.05.002Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8Quality Project Report251256http://www.aenj.org.au/article/PIIS1574626711000851/abstract?rss=yesSummary: The case study highlights several complications that commonly develop in trauma patients who sustain blunt chest injuries with underlying lung injury and discusses essential nursing assessment and care. Rib fractures are one of the most common injuries sustained from blunt chest trauma and frequently co-exist with underlying lung injury. Rib fractures alone are associated with high morbidity and mortality. The addition of underlying lung injury such as lung contusions increases the incidence of adverse outcomes. Emergency nursing care must involve thorough assessment and timely intervention with a particular focus on maximising respiratory function and reducing pain. This can be achieved by appropriate oxygen therapy, early chest physiotherapy and adequate analgesic strategies.Assessment, monitoring and emergency nursing care in blunt chest injury: A case studyBelinda Munroe, Kate Curtis10.1016/j.aenj.2011.05.005Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8Case Study257263http://www.aenj.org.au/article/PIIS1574626711000899/abstract?rss=yesSummary: Background: Gunshot wounds are responsible for considerable damage to the body and its structures. Between 1995 and 2005, Gunshot wounds were the second most common cause of murders in NSW, although in comparison to other countries, are uncommon in Australia. However, they do produce high velocity injuries and are associated with numerous potential complications including bony, vascular and nerve injuries, soft tissue destruction, compartment syndrome, delayed wound healing, potential for infection and, a number of psycho-social complications.Methods: The following paper is a case study based on a de-identified patient who presented following a gunshot injury, focussing on neurovascular assessment and communication.Results: This case study generates numerous discussion points including pre-hospital notification, efficient in-hospital trauma team response, effective primary and secondary surveys, intravenous fluid use in penetrating injuries, regular nursing observations and methods for neurovascular assessment, potential causes of vascular compromise in limb injuries, communication and assertiveness, analgesia, and forensic considerations in the emergency department.Conclusion: The importance of neurovascular observations cannot be understated and must be effectively conducted and reported upon in a timely manner when results are not within the normal parameters. Further, patient advocacy and effective inter-disciplinary communication is essential to ensure the patient is provided with a recovery that is uncomplicated and with as minimal morbidities as possible.Gunshot wounds to the leg causing neurovascular compromise—A case studyTaneal Wiseman, Kate Curtis10.1016/j.aenj.2011.06.004Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-24Australasian Emergency Nursing Journal2011-10-24144S1574-6267(11)X0005-8Case Study264269http://www.aenj.org.au/article/PIIS1574626711002357/abstract?rss=yesVale Elaine Killeen10.1016/j.aenj.2011.09.114Australasian Emergency Nursing Journal 14, 4 (2011)2011-10-17Australasian Emergency Nursing Journal2011-10-17144S1574-6267(11)X0005-8Obituary270271http://www.aenj.org.au/article/PIIS1574626711002631/abstract?rss=yesPhillipa Moore Prize 201110.1016/S1574-6267(11)00263-1Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8272272http://www.aenj.org.au/article/PIIS1574626711002643/abstract?rss=yesCENA Emergency Department of the Year10.1016/S1574-6267(11)00264-3Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8273273http://www.aenj.org.au/article/PIIS1574626711002655/abstract?rss=yesCENA Emergency Nurse of the Year10.1016/S1574-6267(11)00265-5Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8274274http://www.aenj.org.au/article/PIIS1574626711002667/abstract?rss=yesBen Morley Scholarship 201210.1016/S1574-6267(11)00266-7Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8275275http://www.aenj.org.au/article/PIIS1574626711002680/abstract?rss=yesCENA Application Form10.1016/S1574-6267(11)00268-0Australasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8276276http://www.aenj.org.au/article/PIIS157462671100259X/abstract?rss=yesInstructions to Authors10.1016/S1574-6267(11)00259-XAustralasian Emergency Nursing Journal 14, 4 (2011)2011-11-01Australasian Emergency Nursing Journal2011-11-01144S1574-6267(11)X0005-8III