Search

The phrase 'cut the Gordian knot' describes a bold and direct solution to a complicated problem. Nursing presence has been defined as nurses' ability to pay attention to patients and make them feel that their needs have been considered. In the emergency department (ED), nursing presence can be adversely affected by factors such as fatigue, workplace bullying, moral distress and inadequate staffing levels, which could lead to suboptimal patient outcomes and compromise the goals of nursing. Nursing presence is also important for nurses' job satisfaction and therefore for staff retention. This article explores the combined effects of fatigue, workplace bullying, moral distress and inadequate staffing levels on emergency nurses. To cut the Gordian knot it also provides recommendations for mitigating these issues in EDs through safe staffing decisions that consider patient acuity and skill mix., Competing Interests: None declared, (© 2019 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Emergency care settings in Ireland have struggled with a high volume of service users in recent years. This nationwide crisis led to the establishment of the National Emergency Medicine Programme Strategy in 2012, which identified two key performance indicators for efficiency in emergency care: the patient experience time, which should not exceed six hours from the time of registration to the time of discharge; and patients who do not wait for treatment (DNW) should make up less than 5% of those attending emergency care services. This article explores a quality initiative to improve DNW rates using scheduled return clinics, implemented by a group of advanced nurse practitioners in an emergency department in a Dublin hospital. It reviews the literature on scheduled return clinics and discusses the rationale for the initiative, its implementation, barriers to its introduction and an audit of its effectiveness., Competing Interests: None declared, (©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Encephalitis is a life-threatening condition in which inflammation of the brain tissue occurs. Although it is relatively rare, misdiagnosis or delays in recognition and treatment can have devastating consequences for patients, and there is a high mortality rate. People who survive are often left with neuropsychological impairment. This article describes the pathophysiology of the condition, as well as clinical presentation and treatment, and explains why it can be easily missed. It includes a case study that describes a situation in which the condition was not considered initially as a differential diagnosis, and considers implications for practice.

Emergency departments (EDs) in England have been told they need to start hitting the four-hour target again by March 2018. Health secretary Jeremy Hunt has set the deadline following the announcement of extra money in the Budget.

Getting emergency care back on track was the first of four 'real priorities' highlighted by the health secretary last month at the chief nursing officer for England's summit.

Children who present with transient loss of consciousness (T-LOC) are often first seen in emergency departments (EDs). Reflex anoxic seizure (RAS), vasovagal syncope and prolonged respiratory apnoea are benign, syncopal events that can be generally managed by explanation and reassurance. RAS is a short, paroxysmal, self-reverting episode of asystole that is triggered by pain, fear or anxiety and is caused by increased vagal response. It is an important differential diagnosis in pre-school age children who present with T-LOC, but is often underdiagnosed and can sometimes be misdiagnosed as epilepsy. Nurses working in EDs are among the first healthcare professionals to see children in acute settings and should therefore be aware of RAS, the presenting features and management options. This article discusses the epidemiology, pathophysiology and management of RAS, includes an illustrative case study and discusses the role of ED nurses.

Bell's palsy is a relatively benign condition that affects about 20 in every 100,000 patients a year, and in most cases the signs and symptoms resolve fully within around six months. The defining characteristic of the condition is a unilateral facial palsy, but this is also apparent in other conditions with a more serious prognosis, including strokes, some viral infections and tumours. This article reviews the literature on recognition of Bell's palsy, examines the underlying pathology, and compares it with other conditions associated with facial palsy. The article critically analyses the evidence and guidelines to identify best practice, and considers areas for improvement. Finally, it discusses how this information can be incorporated into practice, and provides guidance for clinicians on differentiating between conditions in which patients present with facial palsy to ensure they are managed appropriately.

Victims of violence often seek assistance from emergency departments, so emergency nurses are ideally placed to identify them, and other 'forensic' patients, and protect the evidence that could support any ensuing legal process. Emergency nurses who are trained to identify, collect and preserve forensic evidence can support the identification, elimination and prosecution of suspects. This article gives an overview of forensic evidence, and explains how emergency nurses can preserve and collect samples effectively.

Essential facts Multimorbidity, in which a person has two or more long term health conditions, is associated with reduced quality of life, higher mortality, polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater health services usage, including unplanned or emergency care.

I spent my final year of nurse training on a management placement in a large emergency department (ED) because I had decided to base my dissertation on a review of literature about the difficulty nurses had identifying domestic abuse.

With an increasing number of older people using emergency services, researchers have raised concerns about the quality of care in an environment that is not designed to address older patients' specific needs and conditions. The comprehensive geriatric assessment (CGA) model was developed to address these issues, and to optimise healthcare delivery to older adults. This article introduces a complementary mnemonic, FRAIL, that refers to important elements of health information to consider before initiating care for older patients - falls/functional decline, reactions, altered mental status, illnesses, and living situation. It is not intended to replace the CGA, but can help to quickly identify high-risk older patients who warrant a more in-depth clinical assessment with CGA.

Public Health England (PHE) figures show that there were four times more measles cases in the second quarter of 2016, representing 167 new confirmed infections, than in the same period last year.

By the end of September, all emergency departments (EDs) that accept trauma patients will have been assessed against rigorous new standards for nurse knowledge and training.

Children with a petechial rash commonly present to emergency departments. The rash can be associated with serious illnesses, such as invasive meningococcal disease (IMD), but is usually associated with less severe conditions. This article discusses the common and important causes of petechial rash, including IMD, viral illnesses, trauma, Henoch-Schönlein purpura and idiopathic thrombocytopenic purpura. It also analyses the National Institute for Health and Care Excellence (NICE) ( 2014 ) pathway for management of petechial rash in children and examines treatment of the various causes. The article includes two relevant case studies and discusses the role of emergency nurses.

Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.

As the profession's new system of revalidation goes live, this article brings together the experiences of emergency nurses from revalidation pilot sites in England, Scotland, Wales and Northern Ireland. A total of 19 sites across the UK, including hospital trusts, tested the process between 2014 and 2015. This gave these trusts the opportunity to prepare their staff and help them to get revalidation ready ahead of the official roll-out. This article aims to help nurses working in emergency departments better understand the process and offers tips for dealing with process issues which are pertinent to them.

Blood loss due to trauma is a leading cause of death in young people and is the result of the 'lethal triad' of hypothermia, acidosis and coagulopathy, which collectively reduce haemostasis. Emergency department nurses can help to reverse the triad through the timely and efficient use of blood products and fluids. This article briefly examines different blood groups, describes the elements of the lethal triad, and discusses the blood products used to transfuse patients with major haemorrhage.

The new system of Nursing and Midwifery Council revalidation comes into effect in April 2016, from which time all nurses and midwives will be required to demonstrate their ability to practise safely and effectively. This article describes how one emergency department has incorporated evidence collection for revalidation into its regular continuing professional development opportunities, and outlines the benefits of this for individual nurses, employers and patients.

Intimate partner violence is a major public health and social problem that affects people everywhere. Nurses can play an important role in identifying victims who present to healthcare settings with domestic abuse-related health issues. Evidence suggests that most women who present to emergency departments have experienced domestic abuse at some point in their lives, but that only 5% are identified by healthcare professionals. To identify and respond to victims effectively, emergency nurses must understand domestic abuse and its associated complexities. This article provides an overview of these issues, including the different types of abuse, and their prevalence, causes and effects on health. The article also explores how emergency nurses can identify and manage the effects of violence at work.

'TIS THE season for tipples and toasts, and festive alcohol-related visits to the emergency department (ED).

Envenomation by spiders or scorpions is a public health problem in many parts of the world and is not isolated to the tropics and subtropics. Spiders and scorpions can be unintentionally transported globally, and keeping them as pets is becoming more popular, so envenomation can occur anywhere. Emergency nurses should be prepared to assess and treat patients who present with a bite or sting. This article gives an overview of the signs, symptoms and treatment of envenomation by species of arachnids that are clinically significant to humans.

Chronic venous leg ulceration is a long-term condition commonly associated with lower-limb injecting and chronic venous hypertension caused by collapsed veins, incompetent valves, deep vein thrombosis and reflux. It is not usually a medical emergency, but intravenous (IV) drug users with leg ulcers can attend emergency departments (EDs) with a different primary complaint such as pain or because they cannot access local primary care or voluntary services. Leg ulceration might then be identified during history taking, so it is important that ED nurses know how to assess and manage these wounds. This article explains how to assess and manage chronic venous leg ulcers in patients with a history of IV drug use, and highlights the importance of referral to specialist services when required, and to local primary care or voluntary services, before discharge to prevent admission and re-attendance.

Traditionally, healthcare professionals have been expected to acquire technical skills while minimal attention has been paid to the non-technical skills (NTS) they require to work in complex health environments, such as resuscitation rooms. This article explains the importance of NTS in improving patient outcomes and why a model of dynamic nurse leadership is useful in resuscitative care.

Blunt abdominal trauma is common following major traumatic injury but may not be recognised quickly enough and is therefore a cause of preventable death in trauma patients. Emergency department nurses have a major role to play in reducing the incidence of unrecognised abdominal trauma by enhancing their knowledge and skills. They can do this by attending trauma-related courses, taking on more expanded roles, carrying out full and comprehensive physical assessments, and ensuring that members of the multidisciplinary team use the wide range of diagnostic adjuncts available to them. This article reviews the anatomy and physiology of the abdominal cavity, explains abdominal trauma, gives an overview of advanced abdominal assessment techniques and diagnostic adjuncts, and reviews some management strategies for uncontrolled haemorrhage that have been adopted in the UK.

The RCN's (2012) Principles of Nursing Practice are a set of statements about the characteristics of high quality nursing care. This article gives an overview of the principles and demonstrates through a personal reflection that emergency nurses can refer to them when planning and delivering compassionate and evidence-based care in complex settings.

Respiratory rate is an early indicator of physiological deterioration and should be recorded with other vital signs in patients who present to emergency departments. This article highlights the importance of recording patients' respiratory rates and describes their place in initial patient assessments. It also reviews findings from an audit of ED patients' notes over a short period to discover whether their respiratory rates had been recorded. These support the results of similar studies in the literature, which show that, despite their importance, respiration rates are documented less often than other vital signs.

Patient group directions (PGDs) enable practitioners who are not independent prescribers to administer or supply patients with medications. They reduce delays in the administration of medication and thereby improve patients' journeys. This article discusses an audit of the use of PGDs in an emergency care centre to ensure that they are used appropriately and regularly.

The Department of Health's four-hour operational standard for waiting times in emergency departments (EDs) was introduced in 2001 to speed up treatment and improve the patient experience. Studies and media reports have shown, however, that the standard has increased pressure on ED staff, particularly nurses. This article refers to an analysis of the literature in an attempt to determine whether the implementation of the standard has been beneficial or detrimental to nurses' work, and offers advice to help nurses meet it with minimum stress.

Respiratory diseases are the third most common presentations to emergency departments (EDs) in the Republic of Ireland. Evidence suggests that early non-invasive ventilation (NIV) is often the treatment of choice, particularly for patients with chronic obstructive pulmonary disease. Therefore, having access to NIV in EDs is likely to improve patient outcomes and reduce the likelihood of their mechanical ventilation.

An audit of the ability of emergency nurse practitioners to interpret X-rays accurately has found that they can practise well within nationally acceptable limits for producing false positive and false negative results.

Most paediatric triage systems used in UK emergency departments (EDs) are adapted from adult tools. Paediatric-specific triage tools have been developed in Australia, Canada and the United States but there is no evidence of a similar tool in use in the UK despite support for its development. Staff at New Cross Hospital, in Wolverhampton, are involved in a project to develop a paediatric-specific triage tool that can be used in EDs, assessment units and walk-in centres throughout the UK. The tool has been piloted in the hospital's paediatric assessment unit already with some success, but is yet to be validated.