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Aim: The study aimed to explore the experiences of care and recovery among older patients treated for physical trauma. Design: A qualitative study with a constructivist grounded theory design. Methods: Fifteen in‐depth interviews with older adults recovering from physical trauma were conducted and analysed between 2019 and 2023, in accordance with grounded theory methodology. Results: The findings show that for older patients who suffered physical trauma, the core category was the strive to recapture autonomy. This was achieved by means of Adaptation, Reflection and Interactions, which constitute the three main categories. Recovery involves facing and navigating various new life challenges, such as increased dependency on others, managing difficult symptoms and adapting in various ways to everyday life. The recovery process was influenced by fear, hope and the attitude towards new challenges. Conclusion: Older adults being cared for after a traumatic event have a difficult path to recovery ahead of them. Dealing with increased unwanted dependency on others was a main concern for the participants. Undertreated symptoms can lead to undesired isolation, delayed recovery and further increase unwanted dependency. On the other hand, hope, which was defined as having a positive approach to life and longing for the future, was a strong accelerating factor in the recovery process. Impact: As a result of this study, we have established that older patients experience the initial period after trauma as difficult and that support in the initial phase can be helpful when returning home. As healthcare services are under increasing pressure because of an ageing population, this study contributes by addressing an understudied population and clarifying their concerns. Reporting Method: Reporting adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. Patient or Public Contribution: No patient or public involvement. [ABSTRACT FROM AUTHOR]

Background: Traumatic injury survivors often experience negative health consequences, impacting recovery. No studies have assessed the feasibility of evaluating the resiliency of hospitalized trauma patients using the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Purpose: The purpose of this study was to determine the most efficient method to collect survey responses on the CD-RISC-10. Methods: This cross-sectional study used a convenience sample of admitted patients with traumatic injury. Patients were randomized to complete the CD-RISC-10 using pen and paper, tablet, or workstation on wheels. Results: Of the 161 patient surveys, the tablet-based survey took the shortest time to complete (2 minutes, 21 seconds), and the paper survey resulted in the lowest percentage of missed questions (0.5%). Trauma patients reported high levels of resiliency. Conclusion: The CD-RISC-10 can be easily administered to trauma patients. Clinicians should balance efficiency and patient preferences when deciding on a survey collection method. [ABSTRACT FROM AUTHOR]

BACKGROUND: The care of patients undergoing low-volume, high-risk emergency procedures such as bedside laparotomy (BSL) remains a challenge for surgical trauma critical care nurses. OBJECTIVES: This study evaluates simulation and microlearning on trauma nurse role ambiguity, knowledge, and confidence in caring for patients during emergency BSL. METHODS: The study is a single-center, prospective pretest-posttest design conducted from September to November 2022 at a Level I trauma center in the Mid-Atlantic United States using simulation and microlearning to evaluate role clarity, knowledge, and confidence among surgical trauma intensive care unit (STICU) nurses. Participants, nurses from a voluntary convenience sample within a STICU, attended a simulation and received three weekly microlearning modules. Instruments measuring role ambiguity, knowledge, and confidence were administered before the simulation, after, and again at 30 days. RESULTS: From the pretest to the initial posttest, the median (interquartile range [IQR]) Role Ambiguity scores increased by 1.0 (1.13) (p < .001), and at the 30-day posttest, improved by 1.33 (1.5) (p < .001). The median (IQR) knowledge scores at initial posttest improved by 4.0 (2.0) (p < .001) and at the 30-day posttest improved by 3.0 (1.75) (p < .001). The median (IQR) confidence scores at initial posttest increased by 0.08 (0.33) (p = .009) and at the 30-day posttest improved by 0.33 (0.54) (p = .01). CONCLUSIONS: We found that simulation and microlearning improved trauma nurse role clarity, knowledge, and confidence in caring for patients undergoing emergency BSL. [ABSTRACT FROM AUTHOR]

BACKGROUND: Experiencing symptoms of traumatic stress may be the cost of caring for trauma patients. Emergency nurses caring for trauma patients are at risk for traumatic stress reactions. OBJECTIVE: This study explored the stress and coping behaviors experienced by emergency nurses who provide trauma care. METHODS: Focus groups were held at three urban trauma centers in the Midwestern United States: a Level I pediatric trauma center, a Level I adult trauma center, and a Level III adult trauma center. Data were collected between December 2009 and March 2010. Data analysis was guided by the principles of grounded theory. Line-by-line coding and constant comparative analysis techniques were used to identify recurring constructs. RESULTS: A total of 48 emergency nurses participated. Recurring constructs emerged in the data analysis and coding, revealing four major themes: care of the trauma patient, professional practice, personal life, and support. CONCLUSIONS: Nurse job engagement, burnout, and professional and personal relationships are influenced by trauma patient care. The study's resulting themes of care of the trauma patient, professional practice, personal life, and support resulted in the development of the "trauma nursing is a continual experience theory" that can be used as a framework to address these effects. Intentional support and timely interventions based on this new theory can help mitigate the effects of traumatic stress experienced by trauma nurses. [ABSTRACT FROM AUTHOR]

BACKGROUND: Secondary traumatic stress and compassion fatigue have been studied among trauma clinicians yet have not been explored in trauma registry professionals (TRPs). OBJECTIVE: The purpose of this study is to describe the secondary traumatic stress component of compassion fatigue among TRPs. METHODS: A qualitative, phenomenological study was conducted to examine TRPs' experiences with the secondary traumatic stress component of compassion fatigue. The primary investigator assembled a multidisciplinary team of researchers, including nursing leadership, registry educators, mental health experts, and qualitative researchers. Two focus groups were held virtually in January 2021, using an interview guide designed by the research team. Participants were recruited via an email sent to a list of colleagues known to the research team from training classes held nationally and selected for their diverse clinical experiences, years in the role, demographic background, and trauma center representation. The recorded sessions were independently transcribed and analyzed by a five-member subgroup of the research team; the analysis concluded in December 2022. RESULTS: Nine TRPs participated in the focus groups. Participants came from Level I, II, and III adult and pediatric trauma centers and military centers. Four themes emerged from the data: disquieting and rewarding work, reactions and emotional responses, the influence of personal histories and background, and coping strategies. CONCLUSION: A qualitative analysis of focus group discussions revealed the secondary traumatic stress component of compassion fatigue is present in the TRP. [ABSTRACT FROM AUTHOR]

Establishing research priorities provides focus and direction for limited resources among organizations and increasing impact in a focused area. The Emergency Nurses Association (ENA) Foundation sought to identify research priorities to guide funding decisions in its extramural grants program. A modified Delphi research strategy was used to build consensus among ENA members and key leaders to determine research focus areas. Two Delphi rounds were conducted. In the first round, 81 emergency nurses participated in providing a list of potential research foci. In the second round, 221 emergency nurse leaders recommended which research topics should be prioritized. Descriptive statistics (frequencies, percentages) were calculated for each research topic. The topics were clustered together and rank ordered by frequency/percentage. Eight research priorities were identified: emergency department overcrowding, workplace violence, nurse well-being, appropriate use of the emergency department, new graduate training, mental health care, disaster training, and diversity, equity, and inclusion research. These identified research priorities offer direction for determining ENA Foundation funding priorities. In addition, the research priorities provide strategic direction to emergency nurse researchers to promote a rich depth of research that can make a meaningful impact to science and emergency nursing practice. [ABSTRACT FROM AUTHOR]

Background: Being a relative to a trauma patient may be a dramatic experience. Often, trauma centre nurses do not feel they have the competences needed to meet relatives experiencing a crisis. Therefore, a need exists to enhance their crisis management competencies. Objective: To investigate relatives' experiences of a nursing crisis management intervention on information, inclusion and support, including the importance of these needs in two Danish trauma centres. Design: A prospective intervention study based on interrupted time series. The intervention, conducted in 2020–2021, consisted of a crisis management training programme. Setting(s): The Trauma Centre of the Aarhus University Hospital and Aalborg University Hospital in Denmark. Participants: Relatives (18+ years) of critically ill or injured patients (n = 293). Methods: Data were collected using a 32-item questionnaire. The primary outcome was relatives’ overall experience of the quality of the information, inclusion and support measured on a visual analogue scale (VAS) (0–10). Secondary outcomes were changes in risk ratios and scores between the periods for each of the three main variables. The outcome was measured as weighted and non-weighted scores, taking into account the importance of each variable. Besides use of interrupted time series, predictive and weight-adjusted analyses were performed. Time series comprised a before-period (6 months), an implementation period (3 months) and an after-period (6 months). Due to ceiling effect, the predictive analysis was dichotomized using the median scores for information, inclusion and support. Results: Overall, no differences were observed between the participants' characteristics in each of the three periods. Comparing the implementation period with the after-period revealed a statistically significant positive difference between the relatives’ assessment of crisis management [p = 0.009]. Additionally, the probability of scoring >8 from before to after the intervention increased statistically significantly [Risk ratio 1.21, 95 % confidence interval 1.16–1.27]. The secondary outcomes showed that the greatest change over time was inclusion of relatives [Risk ratio, 1.25 95 % confidence interval 1.15–1.35]. Information had the greatest effect on relatives’ experience of nurses’ provision of crisis management and was also the needs area that relatives considered most important. However, information was also the needs area that evolved least during the study. Conclusions: Based on the selected cut-off levels, the intervention appeared to have a positive effect on relatives’ experiences – especially inclusion of relatives. In the weighted analyses, information was considered most important and also had the greatest effect on relatives’ overall experience. Nurses’ crisis management competencies should be prioritized in trauma centres.

SUMMARY: Purpose: Trauma has significant impacts on the livelihoods and well-being of patients. Prompt emergency, medical, and nursing care is the key to reducing mortality rates. Digital platforms have become important for patient care. This research aimed to evaluate patient outcomes after implementing a novel web application operating system in trauma care. Methods: A descriptive comparative study was conducted on trauma patients. The patients were divided into two groups: those who used the developed application (n = 70) and those who did not (n = 70). The patients’ characteristics, the time of the trauma team's arrival at the emergency department (ED) and the length of stay in the ED, and patients' outcomes were collected from electronic medical records and the application database. A statistical analysis was performed to evaluate this data. Sixty registered nurses who used the application completed the survey on the feasibility of the application. Results: The activated trauma intervals for the non-application-used group and the application-used group were 5.0 ± 1.1 and 3.1 ± 0.4 minutes, respectively (p = .010). The length of stay in the ED for the non-application-used group and the application-used group were 30.1 ± 5.1 and 18.3 ± 6.2 minutes, respectively. A high level of agreement confirms the feasibility of the application. Conclusions: This application improves patient outcomes in terms of length of stay. This mobile application can improve the cooperation and communication and efficacy of the trauma care team.

Purpose: The purpose of this study was to understand the characteristics and clinical outcomes of older patients with trauma before and during the COVID-19 pandemic. Methods: General characteristics, trauma-related characteristics, and clinical outcomes of older patients who visited the emergency department with trauma before the COVID-19 pandemic (March 2018 to February 2020) and during the pandemic (March 2020 to February 2022) were compared and analyzed. Results: A total of 2,270 older patients visited the emergency department due to trauma during the study periods. The proportion of ‘hypertension (yes)’ and ‘diabetes (yes)’ was higher in patients who visited the hospital during the pandemic than before the COVID-19 pandemic. ‘Falls and contact injuries,’ ‘injury- door time (after 24 hours),’ ‘Injury Severity Score (very severe injury),’ and the proportion of ‘injury site (external),’ were high. The ratio of ‘emergency department results (admission to the ward, intensive care unit)’ and ‘admission result (discharge)’ during the pandemic period was higher than before the pandemic. The survival time of subjects before the pandemic was longer than that of the pandemic period, but there was no significant difference between the two groups. Conclusion: Through this result, it was found that there were differences in the trauma-related characteristics and clinical outcomes of geriatric trauma patients before and during the pandemic. In preparation for infectious diseases that may occur in the future, it is necessary to prepare an effective geriatric trauma management strategy. [ABSTRACT FROM AUTHOR]

Reporting suspected child maltreatment in pediatric settings presents unique challenges. Variation in mandated reporter training may lead to discomfort and emotional dysregulation. Failure to collaborate inter-professionally potentially results in suboptimal care for vulnerable children and families. A-TEAM promotes awareness, transparency, empathy, a nonjudgmental strategy, and management by an interprofessional team when referring patients for child protective services evaluation. A faculty trained in pediatric trauma nursing led the development of A-TEAM. Integrating nursing and social work expertise protects the integrity of family-centered patient care. The A-TEAM approach may be a valuable contribution to the continuing education of pediatric health care professionals. [ABSTRACT FROM AUTHOR]

Background: Trauma is one of the most significant problems and challenges of a contemporary and industrial culture that has been addressed in most nations. Due to the significance of pre-hospital care in the trauma treatment system, the current study was conducted with the aim to examine the impact of learning-based education based on a modified team. Methods: From among the 207 emergency center personnel in Baghdad, stratified random sampling was used to select 140 to participate in a clinical trial. The participants were divided into intervention and control groups. The intervention group was trained in trauma management using a problem-based learning strategy, whereas the control group received no training. The data collection tools included a demographic information form and the Brief Trauma Questionnaire (BTQ). The SPSS software was used for data analysis. Results: Multiple post-hoc comparisons showed that the mean score of trauma patient management skills did not significantly differ between the two groups during the pretest (P = 0.918). However, a statistically significant difference was seen between the two groups during the posttest and follow-up stages (P < 0.001). An analysis of variance revealed that the interaction effect of time and intervention on the mean score of trauma patient management skills was statistically significant (P < 0.001). Conclusion: Finally, it is concluded that taking appropriate, accurate, and scientific measures will reduce mortality due to trauma and irreversible complications in the family and society. [ABSTRACT FROM AUTHOR]

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Objective: To review the available information on clinical practice guidelines for person-centred and current handover practices between emergency care practitioners (ECPs) and healthcare professionals in emergency departments (EDs). Collating existing clinical practice guidelines may improve handover practices., Eligibility Criteria: Clinical practice guidelines for person-centred handover practices between ECPs and healthcare professionals in EDs. ECPs transporting and handing patients over to healthcare professionals in EDs. Healthcare professionals including doctors and nurses working in EDs, who are involved in handovers with ECPs. Studies conducted in EDs, emergency rooms or emergency centres in any geographical area. No language or time restrictions were applied. The search included published and unpublished studies, opinion papers as well as primary sources, and evidence synthesis. All qualitative and quantitative research designs were included., Sources of Evidence: The literature on clinical practice guidelines for person-centred handover practices was reviewed. Three electronic databases were searched: MEDLINE (PubMed), CINAHL (EBSCO) and Scopus from inception to May 2023 with no time limits set for the inclusion of published literature in the review. Six guideline organisations were also searched., Charting Methods: A data extraction tool was developed, pilot-tested and used to extract data from the included studies., Results: 19 studies met the inclusion criteria. Various mnemonics exist for handover practices. Where mnemonics are not used, participants have identified important information that should be included during handover practices. We did not find any clinical practice guidelines or information on person-centred handover practices in any of the reviewed articles., Conclusions: Currently, there is no gold standard for person-centred handover practices, which has led to various practices being implemented. Currently, there is a paucity of literature on person-centred handover practices. Most articles expressed a need for standardised handover practices; however, not all aspects of handover practices can be standardised and should be kept patient and context-specific., Trial and Protocol Registration: This scoping review protocol was registered on Figshare (10.6084/m9 /m9.figshare.21731528)., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The Trauma-Informed Climate Scale-10 is a short form developed to efficiently measure staff perceptions of the values of trauma-informed care within the service environment. This study aimed to evaluate the reliability and validity of the Korean version of the Trauma-Informed Climate Scale-10 (K-TICS-10) among Korean nurses., Methods: The K-TICS-10 underwent a linguistic validation process, including translation, back-translation, and expert committee review. Data were collected from 218 nurses in tertiary general hospital in South Korea. Internal consistency reliability was assessed using Cronbach's α. Structural validity was tested through confirmatory factor analysis. Convergent validity was examined using Pearson's correlation with affective commitment and burnout. Item-convergent validity was evaluated to examine the internal structure of the scale., Results: The Korean version of the TICS-10 demonstrated reliable internal consistency, with Cronbach's α of .82. The fitness of the modified model was acceptable (χ2/Df = 2.85, goodness-of-fit index = .92, root mean square error of approximation = .09, standardized root mean square residual = .08, Normed fit index = .88, Tucker-Lewis index = .88, and comparative fit index = .91). Convergent validity of the K-TICS-10 was confirmed by significant correlation with affective commitment (r = .56, p <.001) and burnout (r = -.53, p <.001), respectively. The average extracted variances (.34) and composite reliability (.81) indicated adequate convergent validity of the items., Conclusion: The findings of this study support the satisfactory psychometric properties of the K-TICS-10, indicating its utility for evaluating the trauma-informed climate among nursing work environment in Korea., (Copyright © 2024. Published by Elsevier B.V.)

Nurses working with major trauma patients in ward environments in the UK are expected to evidence their knowledge and skills in a set of national competencies. This article describes a bespoke major trauma course and a coaching and portfolio development programme designed to enhance ward nurses' knowledge and skills, help them evidence their competence and support their professional development. Evaluation of the course showed an overall improvement in nurses' self-rated competence and confidence in a range of relevant major trauma topics and clinical skills. Evaluation of the coaching and portfolio development programme showed that nurses believed their knowledge and skills had improved after taking part and that they valued the opportunity for professional development., Competing Interests: None declared, (© 2024 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.)

Background: Children experiencing trauma are at risk of developing acute and chronic stress disorders. In 2022, the American College of Surgeons Committee on Trauma required verified pediatric trauma centers to screen at-risk patients and provide mental health provider referrals as needed., Objective: The study objective is to assess the current readiness of pediatric trauma centers to meet the new American College of Surgeons requirements., Methods: This study used an exploratory, electronic, cross-sectional survey design. The Pediatric Trauma Society distributed a survey on mental health screening practices to its members in February 2023. Results were summarized with descriptive statistics. Chi-square test was used to compare responses of Levels I and II pediatric trauma centers., Results: There were 91 survey responses from the PTS membership of 1247 (response rate of 7.3%). Fifty-nine participants were from Level I and 27 from Level II pediatric trauma centers. 63.8% of Level I and 51.9% of Level II center respondents currently screened for acute stress (χ2(1) = 1.09, p = .30). Of these, 75.7% of Level I and 57.1% of Level II center respondents routinely screened all admitted trauma patients (χ2(1) = 1.68, p = .19). However, only 32.4% of Level I and 21.4% of Level II respondents reported having outpatient acute stress referral protocols. For pediatric trauma centers currently without screening, 65% of Level I and 46.2% of Level II pediatric trauma center respondents felt they needed more than six months to establish a program (χ2(1) = 1.15, p = .28). Most respondents (68.9%) reported staff shortages as a barrier to the delivery of acute stress services., Conclusions: Pediatric trauma center compliance with acute stress screening requirements for verification is variable. Pediatric trauma centers may benefit from technical assistance with acute stress screening., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Society of Trauma Nurses.)

BackgroundTrauma, especially severe trauma, has become a significant public health problem worldwide. This postulates higher requirements on the core competence of trauma nurses. However, limited scales exist to assess it validly and reliably. This study aims to develop and evaluate the psychometric properties of the Trauma Nurse Core Competency Scale (TNCCS).MethodsThis study included three stages. First, scale development was based on a broad literature review and two rounds of Delphi expert consultation. Then, a pre-investigation was conducted with 106 trauma nurses, and a formal scale was formed. Finally, scale evaluation of reliability and validity, based on a cross-sectional study, was tested with 1,107 trauma nurses. Content validity and structure validity were used to evaluate the validity of TNCCS. The Cronbach's α coefficient and the split-half reliability coefficient were used to evaluate the reliability of TNCCS.ResultsThe final scale contained 46 items under three dimensions, which were Knowledge and skills (21 items), Comprehensive literacy (20 items), and Professionalism & physical and mental health (5 items). The Content Validity Index (CVI) of the total scale was 0.980. The goodness-of-fit indices (χ2/df = 3.547, RMSEA = 0.065, GFI = 0.929, CFI = 0.912, NFI = 0.904, IFI = 0.929) signified a good fit for this model. The Construct Reliability (CR) ranged from 0.89 to 0.98, and the Average Variance Extracted (AVE) ranged from 0.62 to 0.69. The Cronbach's α coefficient of the scale was 0.99, ranging from 0.90 to 0.98 for the subscales. The split-half reliability coefficient was 0.84.ConclusionsThe TNCCS demonstrated good validity and reliability, and it could be used to assess the core competency of trauma nurses. The present study has valuable implications for nursing managers to take corresponding measures to train and improve the core competence of trauma nurses.

BACKGROUND: Specialist trauma nurses contribute to shortening hospital stay, lowering intensive care unit readmission rates, and improving treatment outcomes through early detection and management of health problems in trauma patients. However, Korean specialist trauma nurses have a higher turnover rate than other nurses due to negative factors like unclear job descriptions and inconsistent job activities. OBJECTIVE: This study aimed to examine the levels of and relationships among role conflict, occupational stress, perceived organizational support, and intent to stay in Korean specialist trauma nurses. METHODS: We enrolled 53 specialist trauma nurses from eight regional trauma centers in Korea. Data on role conflict, occupational stress, perceived organizational support, and intent to stay were collected using a structured questionnaire. Mann–Whitney U test, Kruskal–Wallis test, and Bonferroni post hoc tests were conducted to examine differences in intent to stay. Spearman's correlation coefficients were used to examine correlations between the key variables. RESULTS: High intent to stay was associated with periodic job training, job satisfaction, and perceived high workload. Role conflict was positively correlated with occupational stress, whereas both were negatively correlated with perceived organizational support. Intent to stay was negatively correlated with occupational stress and positively correlated with perceived organizational support. CONCLUSIONS: Effective improvement measures that lower occupational stress and increase perceived organizational support will help maintain the positions of specialist trauma nurses. These results highlight the need to specify the scope of practice and implement practical measures like career development programs that enhance professional nursing competencies to retain specialist trauma nurses. [ABSTRACT FROM AUTHOR]

Objective: Despite participating in scenario training, many medical first responders (MFRs) perceive themselves as inadequately prepared to respond to mass casualty incidents (MCIs). The objective of this study was to conduct a comprehensive examination of traditional MCI scenario training methods, focusing on their inherent strengths and limitations. An investigation into the perceptions of MFRs who had participated in MCI scenario training was carried out to identify potential areas for improvement and provide recommendations for refining MCI training protocols., Design: Qualitative inductive approach using semistructured interviews that took place between October 2021 and February 2022. Data were analysed with qualitative content analysis., Setting: MCI scenario training involving four organisations (three emergency medical services and one search-and-rescue organisation) tasked with responding to MCIs, collectively representing four European Union countries., Participants: 27 MFRs (17 emergency medical services personnel and 10 search-and-rescue volunteers) were recruited to participate in the study., Results: Two categories and seven associated subcategories (shown in parentheses) were identified as influencing the learning outcomes for MFRs: Training in a context mirroring real-world incidents (conducting incident scene risk assessment, realistic representation in casualties, incorporating scenario variety into the curriculum, interagency collaboration, role alignment when training incident site management) and use of a pedagogical framework (allowing for mistakes, the importance of post-training evaluation)., Conclusions: This study reaffirms the value of traditional MCI scenario training and identifies areas for enhancement, advocating for realistic scenarios, interagency collaboration, improved incident site management skills and thorough post-training evaluation. It suggests a shift in MCI training conceptualisation and delivery. The potential of virtual reality technologies as a valuable addition to training methods is explored, with a note on the need for further research to ascertain the long-term effectiveness of these technologies. However, the selection of a training method should consider programme goals, target population and resources., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care., Objective: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients., Methods: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics., Results: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor., Conclusions: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes., Competing Interests: The authors have no conflicts of interest or funding to declare., (Copyright © 2024 Society of Trauma Nurses.)

Background: High acuity trauma and patients in cardiopulmonary arrest are not frequently seen in all pediatric Level I trauma centers. Yet, nurses are required to manage these patients in fast-paced, high-pressure environments., Objective: This project aims to develop and evaluate an education program for high-risk, low-volume equipment and skills in the pediatric emergency department setting., Methods: This is a pre- and post-quality improvement study conducted in a Northeastern United States pediatric Level I trauma center. Emergency department nurses were invited to view videos detailing high-risk, low-volume equipment use. For the convenience of access, Quick Response (QR) codes linked to the videos were placed on each piece of equipment reviewed. General self-efficacy and levels of self-efficacy in using the equipment were assessed before the intervention and again after 4 weeks from January to February 2023., Results: A total of 43 pediatric emergency nurses participated in the education. The mean aggregate general self-efficacy score was 32.93. Mean scores in all areas (Level 1 rapid infuser, fluid warmer, blood administration, and securing an endotracheal tube) improved after the intervention., Conclusions: Easily accessible, brief refresher videos linked to QR codes in the pediatric emergency department can help empower nurses who need to use high-risk, low-volume equipment., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Society of Trauma Nurses.)

Objectives: Despite numerous published concept analyses of nursing competency, the specific understanding of trauma nursing competency in emergency departments remains limited, with no clear definition. This study aimed to clarify the definitions and attributes of trauma nursing competencies in emergency departments., Design: Walker and Avant's method was used to clarify the concept of trauma nursing competency in emergency departments., Data Sources: PubMed, EMBASE, CINAHL and RISS were searched from inception to 23 April 2023., Eligibility Criteria: Relevant studies that included combinations of the terms 'nurse', 'nursing', 'emergency', 'trauma', 'competency', 'capability' and 'skill' were selected. We restricted the literature search to English and Korean full-text publications, with no limit on the publication period; grey literature was excluded., Data Extraction and Synthesis: This study uses defining attributes, antecedents and consequences extracted through data analysis. To aid comprehension of the model, related and contrary cases of the concept were created, and empirical referents were defined., Results: After excluding duplicates, irrelevant studies, incomplete texts and articles unrelated to the context and study population, 15 of the initial 927 studies were included. Five additional studies were added after a manual search of the references. The final concept analysis therefore included 20 studies. The attributes of trauma nursing competency for emergency nurses included 'rapid initial assessments considering injury mechanisms', 'priority determinations based on degrees of urgency and severity', 'clinical knowledge of trauma nursing', 'skills of trauma nursing', 'interprofessional teamwork' and 'emotional care'., Conclusions: The concept analysis revealed that it is possible to promote the enhancement and development of trauma nursing competency in emergency departments across various contexts, such as clinical practice, education, research and organisational settings. This could ultimately improve trauma nursing quality and treatment outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The treatment of trauma patients requires significant hospital resources. Numerous protocols exist to triage the injured patient and determine the level of care they may require. The purpose of this work is to describe an institutional trauma nurse screening procedure and to evaluate its effectiveness in triaging injured patients., Methods: This retrospective study was conducted at a large, tertiary trauma center from January to June 2021. Patients were assessed by trauma nurse clinicians (TNC) utilizing a standardized screening process to determine suitability for trauma activation. If the patient did not meet activation criteria, they were sent to the main Emergency Department for evaluation and treatment. Patients could be activated later by the emergency physician. The primary variables of interest were number of activations after initial "rule out," injury severity score (ISS) for patients who were activated, mechanism of injury, and disposition., Results: A total of 1874 TNC screenings were performed. Of these, 1449 (77%) patients did not meet trauma activation criteria. Only 41 (2.8%) patients initially ruled out were later activated by the emergency physician and admitted for treatment of injuries. The average ISS of all activated patients was 9 ± 6. Thirty-six patients had an ISS ≤ 15, four between 16 and 25, and only one patient had an ISS > 25. Twenty-seven patients were admitted to the ward, five went to step-down units, and five required intensive care unit admission. Four patients required operative intervention for their injuries., Conclusion: These results suggest that nursing screening protocols can be safe, effective tools for triage of trauma patients., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Supplemental Digital Content is Available in the Text. Background: Secondary traumatic stress is common for emergency nurses working in trauma care, but it is unknown whether this secondary traumatic stress negatively correlates to work productivity. Objective: The purpose of this research was to examine the relationship between secondary traumatic stress and work productivity of emergency nurses who provide trauma patient care in the emergency department. Methods: This study used a cross-sectional survey design with a systematic random sample of emergency nurses. Respondents (N = 255) completed the Impact of Events Scale-Revised (IES-R) and the Healthcare Productivity Survey (HPS) on the basis of trauma patient care within the preceding 30 days. A 2-tailed Pearson correlation was calculated to explore the relationship between secondary traumatic stress and work productivity for emergency nurses providing trauma patient care. Results: Mean IES-R score was 19.1, and HPS score was 2.7. About 38% of respondents reported high secondary traumatic stress, and 29% reported decreased work productivity. Although overall correlation between IES-R and HPS was not significant, IES-R-Intrusion was significantly correlated with HPS-Cognitive Demands (p =.003) and HPS-Safety and Competency (p =.011), IES-R-Avoidance with HPS-Safety and Competency (p =.003), and IES-R-Hyperarousal with HPS-Cognitive Demands (p =.002) and HPS-Handle/Manage Workload (p =.015). Conclusions: Secondary traumatic stress and decreased work productivity were significant problems for some emergency nurses. To address this problem, employers can provide stress reduction and management techniques to emergency nurses providing trauma patient care. In addition, emergency nurses need to be proactive in seeking social support and using stress mitigation and reduction programs. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Burnout and anxiety compromise physical and mental well-being of nurses and jeopardize patient safety. Personal, professional, and workplace characteristics have been associated with burnout and anxiety across diverse practice settings, yet none in rural, community trauma centers. We sought to identify the severity and predictors of burnout and anxiety in the trauma nursing staff of a rural Level I trauma center. Methods: A convenience sample of trauma nurses from the emergency department (ED), intensive care unit (ICU), and trauma ward was voluntarily surveyed using a demographic questionnaire, the Maslach Burnout Inventory (MBI) subscales: depersonalization (DP), emotional exhaustion (EE), and reduced personal accomplishment, as well as the Generalized Anxiety Disorder seven-item (GAD-7) scale. Multivariable linear regression identified the significant predictors of burnout and anxiety. Results: Ninety-six nurses completed surveys (response rate: 83.5%). Married or divorced status, and ICU or trauma ward job assignments were associated with significantly lower adjusted DP scores. Thus, the model-predicted score for a single ED nurse was 15 versus a predicted score of 7 for a divorced ICU or trauma ward nurse, p <.001 for each group. The GAD-7 model demonstrated that race/ethnicity (Asian compared with White, coefficient: −5.06, p =.03), number of children (2 compared with 0, coefficient: −2.54, p =.02), and job tenure (5–10 years vs. <2, coefficient: −3.18, p =.01) were each associated with fewer GAD-7 points. Conclusion: Depersonalization and anxiety vary across the trauma nursing workforce based on identifiable personal and work-related risk factors. Group-specific, targeted interventions are needed to effectively reduce burnout and anxiety in trauma nursing staff. [ABSTRACT FROM AUTHOR]

Background: Pediatric trauma triage and transfer decisions should incorporate the likelihood that an injured child will require pediatric trauma center (PTC) resources. Resource utilization may be a better basis than mortality risk when evaluating pediatric injury severity. However, there is currently no consensus definition of PTC resource utilization that encompasses the full scope of PTC services., Methods: Consensus criteria were developed in collaboration with the Pediatric Trauma Society (PTS) Research Committee using a modified Delphi approach. An expert panel was recruited representing the following pediatric disciplines: prehospital care, emergency medicine, nursing, general surgery, neurosurgery, orthopedics, anesthesia, radiology, critical care, child abuse, and rehabilitation medicine. Resource utilization criteria were drafted from a comprehensive literature review, seeking to complete the following sentence: "Pediatric patients with traumatic injuries have used PTC resources if they..." Criteria were then refined and underwent three rounds of voting to achieve consensus. Consensus was defined as agreement of 75% or more panelists. Between the second and third voting rounds, broad feedback from attendees of the PTS annual meeting was obtained., Results: The Delphi panel consisted of 18 members from 15 institutions. Twenty initial draft criteria were developed based on literature review. These criteria dealt with airway interventions, vascular access, initial stabilization procedures, fluid resuscitation, blood product transfusion, abdominal trauma/solid organ injury management, intensive care monitoring, anesthesia/sedation, advanced imaging, radiologic interpretation, child abuse evaluation, and rehabilitative services. After refinement and panel voting, 14 criteria achieved the >75% consensus threshold. The final consensus criteria were reviewed and endorsed by the PTS Guidelines Committee., Conclusion: This study defines multidisciplinary consensus-based criteria for PTC resource utilization. These criteria are an important step toward developing a criterion standard, resource-based, pediatric injury severity metric. Such metrics can help optimize system-level pediatric trauma triage based on likelihood of requiring PTC resources., Level of Evidence: Diagnostic Test/Criteria; Level II., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Being a relative to a trauma patient may be a dramatic experience. Often, trauma centre nurses do not feel they have the competences needed to meet relatives experiencing a crisis. Therefore, a need exists to enhance their crisis management competencies., Objective: To investigate relatives' experiences of a nursing crisis management intervention on information, inclusion and support, including the importance of these needs in two Danish trauma centres., Design: A prospective intervention study based on interrupted time series. The intervention, conducted in 2020-2021, consisted of a crisis management training programme., Settings: The Trauma Centre of the Aarhus University Hospital and Aalborg University Hospital in Denmark., Participants: Relatives (18+ years) of critically ill or injured patients ( n = 293)., Methods: Data were collected using a 32-item questionnaire. The primary outcome was relatives' overall experience of the quality of the information, inclusion and support measured on a visual analogue scale (VAS) (0-10). Secondary outcomes were changes in risk ratios and scores between the periods for each of the three main variables. The outcome was measured as weighted and non-weighted scores, taking into account the importance of each variable. Besides use of interrupted time series, predictive and weight-adjusted analyses were performed. Time series comprised a before-period (6 months), an implementation period (3 months) and an after-period (6 months). Due to ceiling effect, the predictive analysis was dichotomized using the median scores for information, inclusion and support., Results: Overall, no differences were observed between the participants' characteristics in each of the three periods. Comparing the implementation period with the after-period revealed a statistically significant positive difference between the relatives' assessment of crisis management [ p = 0.009]. Additionally, the probability of scoring >8 from before to after the intervention increased statistically significantly [Risk ratio 1.21, 95 % confidence interval 1.16-1.27]. The secondary outcomes showed that the greatest change over time was inclusion of relatives [Risk ratio, 1.25 95 % confidence interval 1.15-1.35]. Information had the greatest effect on relatives' experience of nurses' provision of crisis management and was also the needs area that relatives considered most important. However, information was also the needs area that evolved least during the study., Conclusions: Based on the selected cut-off levels, the intervention appeared to have a positive effect on relatives' experiences - especially inclusion of relatives. In the weighted analyses, information was considered most important and also had the greatest effect on relatives' overall experience. Nurses' crisis management competencies should be prioritized in trauma centres., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Burnout is a psychological syndrome resulting from repeated stressors experienced in the workplace that centers on emotional exhaustion, detachment from the job, and a sense of ineffectiveness. It has been previously demonstrated that burnout exists in the health care workforce, but there has been limited investigation of burnout in nurses who primarily provide care for patients who have been traumatically injured. The purpose of this study was to explore factors associated with burnout reported by trauma nurses. Methods: This was a secondary analysis of a cross-sectional survey distributed at a large, academic Level I trauma center that serves both adult and pediatric patients. For this analysis, only the Burnout subscale of the Professional Quality of Life scale Version 5 (ProQOL) was used. Multivariate hierarchical regression was used to determine factors associated with burnout reported by trauma nurses. Results: Protective factors included being female, being married, and better quality of sleep. Risk factors included having a mental health diagnosis and working with adult populations. Conclusions: These results provide an important contribution to the burnout risk profile for trauma nurses and may provide insight into future investigations as well as development and testing of tailored interventions to mitigate burnout in trauma nurses. [ABSTRACT FROM AUTHOR]

Optimal management of trauma-related hemorrhagic shock begins at the point of injury and continues throughout all hospital settings. Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals. Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians. This article discusses the general principles underlying the pathophysiology and clinical management of traumarelated hemorrhagic shock and updates readers on nursing practices used in its management. [ABSTRACT FROM AUTHOR]

Introduction: As key members of interprofessional teams working in complex settings, nurses in trauma centers require trauma nursing core competency., Purpose: This study sought to determine the levels and relationships of the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers among Korean regional trauma center nurses., Methods: This cross-sectional, descriptive, and correlational survey involved a convenience sample of 190 Korean trauma center nurses. Data were collected using a web-based self-reporting questionnaire about the perceived importance and performance of trauma nursing core competency, as well as the interprofessional collaborative competency and associated barriers. Data were analyzed using descriptive statistics, Pearson's correlation, and multiple regression (Enter method) analyses., Results: The perceived performance and importance of interprofessional collaborative competency, the perceived importance of trauma nursing core competency, and the perceived barriers to resources, training, competency, and interest significantly affected trauma nursing core competency performance, accounting for 64.5 % of the variance., Conclusions: Training programs are needed to improve the core and interprofessional collaborative competencies of trauma nurses. Individual, team, and organizational approaches are essential to addressing the perceived barriers. The effects of training programs on the core competency of trauma nurses should be validated., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Objective: To assess the Clinical Characteristics and Outcomes of Traumatic Brain Injury in Patients Admitted to the Surgical Ward of Jimma Medical Center, Southwest Ethiopia from January to July 2022., Design and Setting: A hospital-based prospective observational study was conducted among 175 patients admitted with Traumatic Brain Injury at Jimma Medical Center from January to July 2022. Data were collected by structured questionnaires and a convenient sampling technique was used. For data entry, Epidata V.4.6.0.5 software was used and exported to Stata V.14.0.2 for analysis. The Cox regression model was fitted to evaluate the predictors of mortality and variables with a p value <0.05 at 95% CI were taken as statistically significant predictors., Results: The incidence of in-hospital mortality was 22 (12.6%). The mean length of hospital stay was 6 days. In-hospital complications were recorded in 32.0% of patients. A Glasgow Coma Scale (GCS) score of <8 on admission (adjusted HR (AHR)=6.2, 95% CI 0.75 to 51), hyperthermia (AHR: 1.7, 95% CI 1.02 to 3.05) and lack of prehospital care (AHR: 3.2, 95% CI 2.2 to 8.07) were predictors of mortality in patients with traumatic brain injury., Conclusion: In-hospital mortality was recorded in over one-tenth of patients with traumatic brain injury. The GCS score of <8 on admission, hyperthermia and lack of prehospital care positively affected the outcome of patients with traumatic brain injury. Screening of patients for hyperthermia and antipsychotics should be strengthened to reduce death. However, a multicentred study is needed for further evidence. Giving priority to the patients with those predictors will decrease the number of deaths., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In response to regulators of nursing education and the Institute of Medicine, an academic–service partnership was formed between a research-intensive school of nursing and a tertiary health care facility. In that partnership, clinical experiences occurred mostly within 1 organization. This case report showcases the development, implementation, and revisions within our capstone immersion course, designed to ease the new graduates’ transition into practice, including transitions to critical care nursing. Herein, we highlight our successes and challenges of implementing the clinical component within 2 critical care units focused on trauma and neurosurgical care of complex patients. Its purpose is to describe the planning and orientation phase, illustrate the mentoring processes used to achieve the educational outcomes, and describe the benefits and challenges of such an immersion experience. Our redesigned clinical immersion course in high-acuity nursing is facilitated by our partnership and resulted in improved RN-NCLEX rates, facilitation of best practices, and ease of transition into novice graduate nurse roles. [ABSTRACT FROM AUTHOR]