PubMed · 15889887
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2005. Simulation competency course is a first.. https://pubmed.ncbi.nlm.nih.gov/15889887/
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Violence in the emergency department (ED) is of constant concern to emergency practitioners. Much research has been conducted on this topic but it appears that there has been no attempt to systematically evaluate the methods that have been used to investigate this problem. Therefore, the purpose of this paper is to review the research methods in order to identify the most effective approach for future use and to reveal gaps in the understanding of this problem. Most studies that have been conducted to investigate violence in the ED are descriptive in nature with the most common type retrospective or prospective surveys. Few interview-based studies have been conducted but these have provided an in-depth understanding of the perspectives and feelings of staff involved in the patient violence. However, none of the methods used have provided insight into the perspectives of patients or perpetrators of violence in the ED. To date, it appears that no observational or predictive studies pertaining to this problem have been conducted. Combining questionnaire-based and interview-based prospective surveys with observations could be an ideal method to investigate violence in the ED, as it would permit the researcher to investigate this complex problem more thoroughly and holistically.
OBJECTIVES: To determine the effect of introducing a rapid enzyme-linked immunosorbent assay (ELISA) D-dimer on the percentage of emergency department (ED) patients evaluated for pulmonary embolism (PE), the use of associated laboratory testing, pulmonary vascular imaging, and the diagnoses of PE. METHODS: Patients evaluated for PE during three 120-day periods were enrolled: immediately before (period 1), immediately after (period 2), and one year after the introduction of a rapid ELISA D-dimer in the hospital. The frequency of ED patients evaluated for PE with any test, with D-dimer testing, and with pulmonary vascular imaging and the frequency of PE diagnosis during each time period were determined. RESULTS: The percentage of patients evaluated for PE nearly doubled; from 1.36% (328/24,101) in period 1 to 2.58% (654/25,318) in period 2 and 2.42% (583/24,093) in period 3. The percentage of patients who underwent D-dimer testing increased more than fourfold; from 0.39% (93/24,101) in period 1 to 1.83% (464/25,318) in period 2 and 1.77% (427/24,093) in period 3. The percentage of patients who underwent pulmonary vascular imaging increased from 1.02% (247/24,101) in period 1 to 1.36% (344/25,318) in period 2 and to 1.39% (334/24,093) in period 3. There was no difference in the percentage of patients diagnosed as having PE in period 1 (0.20% [47/24,101]), period 2 (0.27% [69/25,318]), and period 3 (0.24% [58/24,093]). CONCLUSIONS: In the study's academic ED, introduction of ELISA D-dimer testing was accompanied by an increase in PE evaluations, D-dimer testing, and pulmonary vascular imaging; there was no observed change in the rate of PE diagnosis.
INTRODUCTION: It is widely acknowledged that nurses are crucial components in healthcare system. In their roles, nurses are regularly confronted with a variety of biological, physical, and chemical hazards during the course of performing their duties. The safety of nurses themselves, and subsequently that of their patients, depends directly upon the degree to which nurses have knowledge of occupational hazards specific to their jobs and managerial mechanisms for mitigating those hazards. The level of occupational safety and health training resources available to nurses, as well as management support, are critical factors in preventing adverse outcomes from routine job-related hazards. This study will identify gaps in self protective safety education for registered nurses working in emergency departments as well as for nursing students. Furthermore, this study reviews the nature and scope of occupational nursing hazards, and the degree to which current nursing education and position descriptions (or functional statements) equip nurses to recognize and address the hazards inherent in their jobs. METHOD: This study has three parts. First, a literature review was performed to summarize the nature and scope of occupational nursing hazards. Second, the safety components of position descriptions from 29 Veterans Affairs (VA) hospitals across the United States were obtained and evaluated by an expert panel of occupational health nurses. Finally, an expert panel of occupational health nurses evaluated the degree to which nursing accreditation standards are integrated with OSHA's list of known emergency department hazards; and a separate expert panel of occupational health nurses evaluated the degree to which current VA emergency department nursing position descriptions incorporated hazard recognition and control strategies. CONCLUSION: Ultimately, prevention of job-related injuries for nurses, and subsequently their patients, will depend directly on the degree to which nurses can identify and control the varied occupational hazards specific to jobs. Neither accreditation standards nor position descriptions adequately integrate common occupational hazard recognition and control strategies, nor do they adequately prepare nurses to identify and control hazards specific to nursing. A research approach that specifically addresses the current lack of formal on-the-job training for nurses regarding job-related hazard recognition and avoidance strategies is presented.