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 © 2012 Published by Elsevier Inc. All rights reserved. Australasian Emergency Nursing Journal1574-6267152May 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.aenj.org.au/article/PIIS157462671200047X/abstract?rss=yesEditorial Board10.1016/S1574-6267(12)00047-XAustralasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-Xiiiiiihttp://www.aenj.org.au/article/PIIS1574626712000481/abstract?rss=yesContents10.1016/S1574-6267(12)00048-1Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-Xivivhttp://www.aenj.org.au/article/PIIS1574626712000365/abstract?rss=yesSummary: Background: Rapid and accurate testing of blood ketone levels (BKL) can assist in the assessment of insulin insufficiency and detection of diabetic ketoacidosis (DKA) in the acute care setting. We assessed the potential for introducing point of care measurement of BKL into an Australian emergency department.Methods: After providing informed consent, 72 patients (80 separate presentations) with insulin-requiring diabetes who presented to an emergency department with hyperglycaemia (capillary blood glucose level of ≥10.0mmol/L) underwent testing for BKL at triage. Staff were guided by a protocol developed for interpretation of elevated BKL≥1.0mmol/L and subsequent actions. Urine ketones and arterial blood gas testing occurred as usual. Time to testing was recorded for all measures.Results: BKL testing occurred immediately in 91% of the presentations, whereas urine ketones and arterial blood gas testing was uncommon (24% and 15% respectively) and not immediate. Elevated BKL (≥1.0mmol/L) occurred in 17% of presentations, of whom five were diagnosed with DKA within the Emergency Department. However, testing for BKL decreased over the duration of the study. Patients most frequently tested for BKL were younger (58.59 years) than patients who were not tested (79.5 years) (p=.011).Conclusions: Implementation of point of care BKL testing in the Emergency Department can assist in the detection of significant numbers of patients with insulin insufficiency, however, ongoing education and support is required to sustain the change in practice.Implementing point of care blood ketone testing in the Emergency DepartmentJen M. Kinsella, George Barker, Jennie King, Mary G.T. Webber, Michael Boyd, Kenneth W.K. Ho, Robyn Gallagher10.1016/j.aenj.2012.04.002Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-XResearch6367http://www.aenj.org.au/article/PIIS1574626712000341/abstract?rss=yesSummary: Background: Women experiencing complications associated with early pregnancy often present to the Emergency Department (ED). An Early Pregnancy Assessment Clinic (EPAC) was implemented in one Australian ED to specifically address acute needs of women with complications of early pregnancy.Methods: This mixed methods study incorporated two parts: Part 1 utilised content analysis of semi-structured interviews conducted with health care professionals and EPAC women to evaluate the EPAC structures and processes. Part 2 was an observational study describing characteristics and temporal trends of women presenting to an ED with problems of early pregnancy over a 6-year period. Findings from Part 1 are presented in this paper; results from Part 2 are presented in an ensuing paper.Findings: EPAC structures included the utilisation of a private environment situated within the ED as well as primary care management and delivery from a nurse who had ED experience and advanced pregnancy related knowledge. EPAC processes included appropriate referral and good communication. These processes enabled the delivery of a service between a variety of healthcare providers located within the hospital and community.Conclusions: The multi-disciplinary, nurse-led, ED based EPAC model of care implemented facilitated continuity of care for a subset of ED patients. It may be useful in EDs elsewhere.A structure and process evaluation of an Early Pregnancy Assessment Clinic (EPAC) in one Australian Emergency Department: Part 1Julia Crilly, Kim Wendt, Nicole Beatson10.1016/j.aenj.2012.03.001Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-16Australasian Emergency Nursing Journal2012-04-16152S1574-6267(12)X0003-XResearch6876http://www.aenj.org.au/article/PIIS1574626712000298/abstract?rss=yesSummary: Background: More than one in five pregnancies ends in miscarriage. Women experiencing complications associated with early pregnancy often present to the Emergency Department (ED). In 2005, an Early Pregnancy Assessment Clinic (EPAC) was implemented in one Australian ED to specifically address acute needs of women with complications of early pregnancy.Methods: This mixed methods study incorporated two parts: Part 1 utilised content analysis of semi-structured interviews conducted with health care professionals and EPAC women to evaluate the EPAC structures and processes. Part 2 was an observational study describing characteristics and temporal trends of ED presentations involving problems of early pregnancy over a 6-year period (2004–2009). Results from Part 2 are presented in this paper; findings from Part 1 are presented in a previous paper.Results: Over the 6-year period 4958 presentations were made to the ED from women with complications of early pregnancy. Outcomes that improved over time included: time to see a clinician, ED length of stay, hospital admission rate and the number of pathology tests ordered per presentation. These outcomes were particularly noted to improve following the implementation of the EPAC.Conclusions: Changes to service delivery for a select patient group (in this case women presenting to the ED with complications during early pregnancy) can impact positively on patient and service provider outcomes.An evaluation of early pregnancy outcomes in one Australian Emergency Department: Part 2Kim Wendt, Julia Crilly, Nicole Beatson10.1016/j.aenj.2012.01.003Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-18Australasian Emergency Nursing Journal2012-04-18152S1574-6267(12)X0003-XResearch7785http://www.aenj.org.au/article/PIIS1574626712000328/abstract?rss=yesSummary: Background: Women who have problems in early pregnancy frequently present to the emergency department (ED). The aim of this qualitative study was to describe the experience of early pregnancy care in the ED from the perspective of women.Methods: This study used a qualitative design involving semi-structured interviews with women who attended five hospital EDs in Hunter New England Area Health Service during late 2009 and early 2010. Out of 200 letters sent, 16 women agreed to be interviewed to describe their experience of care in the ED. Thematic analysis was used to analyse the interview transcripts.Results: Privacy, dignity, compassion and respect were important to participants. Many women reported that they were not given a private room in the ED and were distressed by the constant traffic of people nearby. Overall, participants reported that ED staff treated them with compassion and respect, though this was sometimes limited by the busy environment. Most participants wanted more information such as pamphlets and few were offered follow-up support or a counselling referral.Conclusions: The findings of this study suggest that EDs should enhance their management of women with problems in early pregnancy including allocating them to beds with sufficient privacy, providing them with access to written information and referrals to counselling.Women's experience of early pregnancy care in the emergency department: A qualitative studyAlexandra Warner, Anne Saxton, Devon Indig, Kathleen Fahy, Leanne Horvat10.1016/j.aenj.2012.02.002Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-16Australasian Emergency Nursing Journal2012-04-16152S1574-6267(12)X0003-XResearch8692http://www.aenj.org.au/article/PIIS157462671200033X/abstract?rss=yesSummary: Background: Missed diagnoses are very common in patients with multiple injuries. To help nurses identify missed injuries, this study aimed to develop and evaluate a clinical nursing practice guideline (CNPG) for the initial assessment of multiply injured patients admitted to the trauma ward in a provincial hospital in southern Thailand.Method: The CNPG was developed using evidence-based knowledge of trauma assessment and the Advanced Trauma Life Support guideline. The CNPG was used by 18 nurses working in the trauma ward. They implemented the CNPG with 34 multiply injured patients. The outcome measures of the CNPG use were the nurses’ self-reported compliance with the use of the CNPG, the nurses’ satisfaction with using the CNPG, and the percentage of missed injuries detected as a result of the use of the CNPG.Results: Most nurses (83.33%) reported complying with the CNPG and 72.2% of them indicated that their satisfaction with using the CNPG was at a high level. Missed injuries were discovered at a rate of 14.6% of the total injuries diagnosed in the injured patients within 24h of ward admission.Conclusion: Further research needs to be conducted to establish if the CNPG could be more widely applied to improve the quality of care and increase the safety of those with multiple injuries.The development of clinical nursing practice guideline for initial assessment in multiple injury patients admitted to trauma wardWipa Sae-Sia, Praneed Songwathana, Pornpen Ingkavanich10.1016/j.aenj.2012.02.003Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-18Australasian Emergency Nursing Journal2012-04-18152S1574-6267(12)X0003-XResearch9399http://www.aenj.org.au/article/PIIS1574626712000304/abstract?rss=yesSummary: Background: There is in Sweden an ongoing debate about the extent to which the practice of triage contributes to patient safety. This paper reports the findings of a study of nurses’ perceptions of the impact of experience and safety of the Manchester Triage System (MTS) within emergency departments in Western Sweden.Methods: Data was collected from 74 triage nurses using a questionnaire containing 37 short form questions of Likert-type, analyzed descriptively and measured the covariance. Data was also collected with two open questions by using the critical incident technique and content analysis.Results: The results described that the combination of the MTS method, the nurses’ experience and organizational factors accounted for 65% of patient safety. The study indicated that nurses’ experience contributed to higher patient safety than the model itself. A standardized assessment model, like MTS, can rarely capture all possible symptoms, as it will always be constrained by a limited number of keywords and taxonomies. It cannot completely replace the skills an experienced nurse develops over many years in the profession.Conclusions: The present study highlights the value of triage nurse's experience. The participants considered experience to contribute to patient safety in emergency departments. A standardized triage model should be considered as additional support to the skills an experienced nurse develops.Nurses working with Manchester triage – The impact of experience on patient securityBerit Forsman, Susanne Forsgren, Eric D. Carlström10.1016/j.aenj.2012.02.001Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-23Australasian Emergency Nursing Journal2012-04-23152S1574-6267(12)X0003-XResearch100107http://www.aenj.org.au/article/PIIS1574626712000031/abstract?rss=yesSummary: Introduction: Traumatic injury is a leading cause of premature mortality and preventable morbidity worldwide. It is considered that nurses perform an integral role in the assessment and management of major trauma, and any in hospital resuscitation.Aim: This systematic search and integrative review of the literature aims to determine the state of knowledge of the impact of nursing roles in trauma and other hospital patient resuscitation.Results: Following a comprehensive stringent search and screening process, 18 articles were included in the review. Ten articles focused on trauma resuscitation and 8 described other resuscitation nursing roles in other contexts such as part of a Rapid Response Team (RRT). Nine papers were original research papers, with a mixture of methods, the remaining 9 articles were literature reviews. Quantitative research, with the exception of one paper, was restricted to the impact of the team rather that the individual nursing role. Analysis found that nurses contribute significantly to verbal and non-verbal communication, leadership and effective team work in resuscitation. The use of expert nurses has been demonstrated to facilitate effective treatment of patients at high risk of mortality.Conclusion: Nurses contribute significantly to communication, leadership and effective team work, which ultimately impact patient outcomes. Although there is literature to support the nurse adopting a leadership role during resuscitation it is limited and demonstrates the need for further dedicated research.What is the impact of nursing roles in hospital patient resuscitation?Alana Clements, Kate Curtis10.1016/j.aenj.2012.01.002Australasian Emergency Nursing Journal 15, 2 (2012)2012-04-18Australasian Emergency Nursing Journal2012-04-18152S1574-6267(12)X0003-XLiterature Review108115http://www.aenj.org.au/article/PIIS1574626712000353/abstract?rss=yesSummary: The Alfred Emergency and Trauma Centre has been organising, establishing and staffing a medical centre at The Australian FORMULA 1™ Grand Prix since its inception to Melbourne in 1996. A team of specialist staff are selected to best facilitate care to the FORMULA 1™ staff, the drivers and to the team personnel that travel the circuit every year. From primary health care and health promotion, to medical review and critical care reception from track incidents, the team is equipped to resuscitate the critically ill and stabilise prior to transfer to the Alfred Hospital. The logistics and organisation required to stage a medical centre involves intense planning, knowledge and experience. This paper will discuss the Australian Grand Prix Medical Centre (AGPMC) requirements, overview the development of the on track medical team personnel and equipment and provide a snapshot of the types of presentations seen at the 2011 event.The Australian FORMULA 1™ Grand Prix Medical Centre, Melbourne, March 2011Natasha Jennings, Andrew Waugh, John Di Nunzio, Nathan McCracken, Lucy Cayford, Emma Newton-Brown, John Spencer10.1016/j.aenj.2012.04.001Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-XDiscussion Paper116120http://www.aenj.org.au/article/PIIS1574626712000523/abstract?rss=yesPhillipa Moore Prize 201210.1016/S1574-6267(12)00052-3Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-X121121http://www.aenj.org.au/article/PIIS1574626712000535/abstract?rss=yesCENA Emergency Department of the Year10.1016/S1574-6267(12)00053-5Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-X122122http://www.aenj.org.au/article/PIIS1574626712000547/abstract?rss=yesCENA Emergency Nurse of the Year10.1016/S1574-6267(12)00054-7Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-X123123http://www.aenj.org.au/article/PIIS1574626712000559/abstract?rss=yesBen Morley Scholarship 201210.1016/S1574-6267(12)00055-9Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-X124124http://www.aenj.org.au/article/PIIS1574626712000560/abstract?rss=yesCENA Application Form10.1016/S1574-6267(12)00056-0Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-X125125http://www.aenj.org.au/article/PIIS1574626712000493/abstract?rss=yesInstructions to Authors10.1016/S1574-6267(12)00049-3Australasian Emergency Nursing Journal 15, 2 (2012)2012-05-01Australasian Emergency Nursing Journal2012-05-01152S1574-6267(12)X0003-XIII