Search

Childhood injury is the largest cause of paediatric hospitalisation in Australia. Parents' psychological wellbeing is important in enabling them to support their children's recovery, however little is known about parents' psychosocial support needs during their child's admission to the emergency department. This study explores the experiences and support needs of parents of critically injured children in the emergency department. An exploratory qualitative approach was used. Semi-structured face to face interviews were conducted with 40 parents of 30 critically injured children aged 0–12 years across 4 Australian hospitals. Transcribed data were managed using NVivo 10 and qualitative content analysis was performed. Four themes of parent experience emerged from analysis: being in shock and distress; feeling challenged by the ed environment; dealing with urgent priorities; and having immediate needs met. There is a need for easy-to-understand information for parents in the ED following their child's injury. Recommendations include use of a checklist for emergency clinicians on what information to provide parents and provision of anticipatory guidance to parents on what to expect psychologically following injury. A dedicated family support coordinator is needed to support parents and children throughout the injury trajectory. [ABSTRACT FROM AUTHOR]

• Research needs to consider provider and system factors that contribute to nosocomial infections and/or sepsis post-burns. • Focusing on healthcare workers' actions during care that are likely to influence infectious outcomes is paramount by screening for at-risk patients as well as initiation of infection prevention strategies. • Patients with extensive burns are frequent users of various healthcare services and transit through different departments and hospital settings. As such, multi-centre approach reviewing provider and system factors is warranted in future research. In comparison to general trauma patients, loss of skin barrier amongst the burns cohort predisposes them to a higher risk of nosocomial infections and sepsis, and this often leads to unfavourable morbidity and mortality outcomes. This integrative review aimed to explore existing literature to identify risk factors related to nosocomial infections and/or sepsis in adult burns patients following hospital admission. Electronic searches for journals published between 2007 and 2021 were performed in CINAHL, Scopus and Medline, and key journals were hand-searched. Inclusion criteria was: (1) peer-reviewed, primary studies; (2) qualitative, quantitative or mixed-methods studies; (3) study participants had sustained burns-related injury and developed nosocomial infections and/or sepsis during the course of hospitalisation. Studies were appraised using the Critical Appraisal Skill Program checklists. 15 studies ranging from 'poor' to 'fair' to 'moderate' quality were included in the final review. Patient factors that contributed to the development of nosocomial infections and/ or sepsis included: (1) Full thickness burns; (2) age; (3) % Total Burns Surface Area; and (4) Herpes Simplex Virus activation. Several provider-system risk factors were identified by 'poor' quality studies and further research is required to substantiate those findings. Findings remained inconclusive due to the lack of 'good' quality studies however, there was an overemphasis on patient-related risk factors instead of healthcare workers or the system. Future research may focus on activation of the latest infection prevention strategies and early enforcement of care bundles. Through identification of related risk factors, it may reduce the incidence of nosocomial infection and/or sepsis post-burns. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic physical injury is abrupt, painful, debilitating, costly and life-altering. The experience of emotional wellbeing following traumatic physical injury has not been well investigated, and the role of health services and how services can support the emotional recovery of injured patients has not been well understood. This has impacted on care provision and contributed to a lack of evidence-informed guidance for clinicians to support patients' emotional wellbeing.Aim: To explore the patient experience of emotional wellbeing following injury and to understand how injured patients manage their emotional wellbeing.Method: The study comprises the follow-up qualitative phase of a mixed-methods explanatory sequential study. Semi-structured interviews were conducted with a purposive sample of 14 participants admitted to hospital following physical injury. Participants were purposely selected where they had reported high levels of depression, anxiety and stress on the DASS-21 at 3 and 6-months after injury. The qualitative data were analysed using thematic analysis.Results: Three main themes were identified: experiencing the many impacts of injury; facing the emotional journey following injury; and being supported and managing the impacts of injury. Key findings were the extreme negative emotional responses experienced many months after the injury; a strong physical link between the emotional and physical aspects of health; participant reluctance to seek emotional support; a lack of emotional support provision by the health service and a subsequent need for individual and group support in order to develop resilience in the injured person. Finally, male participants who reported extreme emotional responses after injury, including suicidality, were less likely to seek help for their symptoms.Conclusion: Injured patients can experience substantial negative emotional responses following injury. The lack of support provided by health services to injured patients identified highlights the importance of in-hospital screening for emotional wellbeing and follow-up post-discharge, and a support network for patients to reduce the negative impacts of injury on their mental health. There is a need for anticipatory guidance frameworks for clinicians. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To investigate the state of knowledge on the relationship between physical trauma and mental health in patients admitted to hospital with traumatic physical injury. Background: Adults who sustain traumatic physical injury can experience a range of mental health problems related to the injury and subsequent changes in physical health and function. However early screening and identification of mental health problems after traumatic physical injury is inconsistent and not routine during the hospital admission process for the physically injured patient. Methods: Integrative review methods were used. Data were sourced for the period 1995–2010 from EMBASE, CINAHL, MEDLINE and PsycINFO and hand searching of key references. Abstracts were screened by 3 researchers against inclusion/exclusion criteria. Forty-one papers met the inclusion criteria. Data were retrieved, appraised for quality, analysed, and synthesised into 5 main categories. Results: Forty-one primary research papers on the relationship between mental health and traumatic physical injury were reviewed. Studies showed that post-traumatic stress disorder, depression and anxiety were frequent sequelae associated with traumatic physical injury. However, these conditions were poorly identified and treated in the acute hospital phase despite their effect on physical health. Conclusion: There is limited understanding of the experience of traumatic physical injury, particularly in relation to mental health. Greater translation of research findings to practice is needed in order to promote routine screening, early identification and referral to treatment for mental health problems in this patient group. [Copyright &y& Elsevier]

Summary: 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. [ABSTRACT FROM AUTHOR]

Summary: Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?’ sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN Critical Care Nursing. Sydney: Elsevier; 2006.]. How well patients are cared for has a direct effect on their sense of wellbeing and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of “holding” wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed. [Copyright &y& Elsevier]

Summary: Emergency nurses are expected to work under pressure to many standards, guidelines and protocols related to patient care, and often in an advanced practice role. These expectations can sometimes take priority over basic nursing care once emergency/resuscitative intervention has occurred. However, posing the question ‘How would I want this patient to be cared for if they were my grandmother/father/child?’ sets a benchmark for nursing practice [Fulbrook P, Grealy B. Essential nursing care of the critically ill patient. In: Elliot D, Aitken L, Cheboyer W, editors. ACCCN critical care nursing. Sydney: Elsevier; 2006]. How well patients are cared for has a direct effect on their sense of well-being and their recovery. Effective communication is essential to good nursing care and patient outcomes. The length of stay of the patient in the ED may be extended, and the use of “holding” wards while waiting for investigation results of patients for probable discharge necessitates the ED nurse to consider basic but essential aspects of nursing care that will be discussed. Other essential aspects of care such as psychosocial; including culture, pain management and infection control are beyond the scope of this paper. [Copyright &y& Elsevier]

• This is one of a few researches studying the experience of waiting in an Iranian ED. • Individuals with lower or non-urgent priorities expecting to be treated urgently. • Self-seeking behaviors without caring about what happened to other people. • One's priority-seeking behaviors triggered similar emotions and behaviors in others. • The mentality of 'me first, others later' contributed to a negative environment. Waiting is an inevitable experience in all emergency departments (EDs). This waiting time may negatively influence the patients and their relatives' satisfaction, healthcare professionals' (HCPs) performance, and the quality of care provided. This study aims to explore, gain understanding of and describe what it is like to wait in an Iranian emergency department (ED) with particular focus on cultural features. A focused ethnographic approach based on Spradley's (1980) developmental research sequence was conducted in the ED of a tertiary academic medical center in northwest Iran over a 9-month study period from July 2017 to March 2018. Participant observation, ethnographic interviews and examination of related documents and artefacts were used to collect data. All the data were recorded in either field notes or verbatim transcripts and were analysed using Spradley's ethnographic data analysis method concurrently. The overarching theme of "Me first, others later" emerged. Within this overarching theme there were seven sub-themes as follows: human-related factors, system-related factors, patients and their relatives' beliefs and behaviors, HCPs' beliefs and behaviors, consequences for patients and their relatives, consequences for HCPs, and consequences for ED environment and care process. The mentality 'me first, others later' as the main cultural barrier to emergency care, strenuously undermined our positive practice environment. An accountable patient/relative support liaison, a clearly-delineated process of ED care delivery, guidelines for providing culturally competent ED care, and public awareness programs are needed to address the concerns and conflicts which establish a mutual trust and rapport. [ABSTRACT FROM AUTHOR]