Emergency Nurses Association Research Articles

27. Increasing Car Seat Safety: A Multidimensional State Council Initiative

The North Carolina State Council of the Emergency Nurses Association is committed to the concept of primary prevention through public awareness and education. An issue of great concern to the Council has been the lack of understanding by the public about the importance of car seat use, including the need to discard seats that have been involved in a motor vehicle crash of enough severity to render them useless. Currently, North Carolina State law does not prohibit the sale of used car seats in yard sales or consignment stores. The initial goal of the project has been to educate the public regarding car seat safety in general, as well as the criteria for safe seat use after a motor vehicle crash (MVC) as established by the National Highway Traffic Safety Administration (NHTSA). This public education included a media campaign involving one newspaper article for both children and a television spot highlighting a safety seat clinic for national Child Passenger Safety Seat Week. Our Government Affairs, Injury Prevention, and Educational Committees are working collaboratively to address this issue by pursuing state legislators to sponsor bills prohibiting the sale of used car seats and allowing EMS and law enforcement to place an identifying sticker on any seat involved in an impact that renders it unsafe according to NHTSA criteria. This has been enacted in other states, including Pennsylvania's Car Seat Involved in Crash - DO NOT USE Campaign that falls under the Child Safety Protection Act of 1993. The project has been a success in the sense that the Council has had a good response from the media in disseminating educational materials to the public. The new television spot of safety seat use and the new NHTSA criteria will be of great benefit to the public. Gaining the attention of our elected officials has been a challenge; an ongoing effort to meet with state senators and leaders of the appropriate health affairs committees continues. Further legislative updates will be reported at the Scientific Assembly 2004. Car seat safety is a national issue and should be addressed at that level as well. Using North Carolina and Pennsylvania as examples, the Council should proceed with such discussions, collaborating with the ENA Government Affairs Committee to encourage a change in federal mandates. Emergency nurses should educate any person involved in a motor vehicle crash in which a safety seat is involved to inspect the seat following the NHTSA criteria.

A 27-year-old Man With Marfan Syndrome and “Tearing” Nonradiating Chest Pain

Kevin High is Flight Nurse and Clinical Outreach Nurse, Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, Tenn. Angela M. Gleaves is Flight Nurse, Vanderbilt LifeFlight, Vanderbilt University Medical Center, Nashville, Tenn. For reprints, write: Kevin High, 6915 Flat Creek Rd, College Grove, TN 37046; E-mail: kevin.high@vanderbilt.edu. J Emerg Nurs 2005;31:26-7. Available online 21 July 2004. 0099-1767/$30.00 Copyright n 2005 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.05.002

Preparing ED Staff for a JCAHO Survey: Innovative Strategies to Update Staff

Nicki Gilboy, RN, MS, CEN, Beacon chapter, is ED Nurse Educator, Brigham and Women’s Hospital, Boston, Mass; E-mail: ngilboy@partners.org. For reprints, write: Nicki Gilboy, 197 Barretts Mill Rd, Concord, MA 01742; E-mail: ngilboy@partners.org. J Emerg Nurs 2004;30:498-500. Available online 21 July 2004. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.05.005

A 6-month-old With Bilateral Swollen, Painful, and Deformed Hands

Maureen Curtis Cooper, Beacon Chapter, Massachusetts ENA, is Staff Nurse, Pediatric Emergency Department, Boston Medical Center, Boston, Mass. For reprints, write: Maureen Curtis Cooper, RN, BSN, CEN, 21 John St, Malden, MA 02148-6501; E-mail: maureen.cooper@bmc.org. J Emerg Nurs 2004;30:384-7. Available online 28 May 2004. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.03.029

Total Airway Obstruction by a Mucous Plug Relieved With Extreme Positive Pressure: Case Report of a Pediatric Patient

Patricia Shoun is Staff RN, Pediatric ICU, Robert Steelman is Assistant Professor, Pediatric Critical Care, Brent Barber is Pediatric Cardiology Fellow, Matthew Olson is Pediatric Respiratory Therapist, and Mary Frances D. Pate is Pediatric ICU Clinical Nurse Specialist, Doernbecher Children’s Hospital, Oregon Health & Science University, Portland, Ore. For reprints, write: Mary Frances D. Pate, DSN, RN, Doernbecher Children’s Hospital, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; E-mail: patem@ohsu.edu. J Emerg Nurs 2004;30:473-4. Available online 28 May 2004. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.04.005

Trismus and Acute Respiratory Distress in a 63-year-old Woman Ten Days After Stepping on a Firecracker

Deborah A. Hassman is Emergency Department Nurse Practitioner, Evanston Northwestern Healthcare, Evanston, Ill, and Registered Nurse, Lutheran General Hospital Emergency Department, Park Ridge, Ill. Linda Witek-Janusek is Professor, Niehoff School of Nursing, Loyola University, Chicago, Ill. For reprints, write: Deborah A. Hassman, RN, MSN, APN, 859 W Newport #G, Chicago, IL 60657; E-mail: deborahhassman@ comcast.net. J Emerg Nurs 2004;30:526-8. Available online 08 April 2004. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.01.022

Preparing for Clinical NP Practice in an Emergency Care Setting

Elda G. Ramirez, Houston Chapter, is Assistant Professor of Clinical Nursing and Interim Division Head of Emergency Care, School of Nursing, Frank L. Cole, Houston Chapter, is Professor of Nursing, Interim Assistant Dean & Department Chair of Acute and Continuing Care, and Director of Emergency Nurse Practitioner Education, School of Nursing, The University of Texas Health Science Center at Houston, Houston, Tex. For reprints, write: Elda G. Ramirez, MSN, RN, CEN, FNP, 501 W 25th St, Houston, TX 77008; E-mail: Elda.G.Ramirez@uth.tmc.edu. J Emerg Nurs 2004;30:176-8. Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.02.006

Emergency Management of Patients With Implanted Pain Control Devices

Emily A. Davis, MSN, ACNP, is Nurse Practitioner in Pain Management, Duke University Medical Center, Durham, NC. Richard K. Osenbach, MD, is Assistant Professor of Neurosurgery, Duke University Medical Center, Durham, NC. For reprints, write: Emily A. Davis, MSN, ACNP, Duke University Medical Center, Durham, NC 27710; E-mail: davis163@mc.duke.edu. J Emerg Nurs 2004;30:245-7. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2004.01.011

A Delphi Study on Research Priorities for Emergency Nurses in Western Australia

IntroductionThe Delphi Study on Research Priorities for Emergency Nurses in Western Australia Project was designed to allow emergency nurses to design research questions and then rank them in order of priority. MethodsA qualitative methodology allowed the researchers to determine expert opinions from the membership of the Emergency Nurses Association of Western Australia to reach a general consensus related to research questions. ResultsThe results placed nurse-initiated analgesia as the top research priority, with ED staffing issues in second place and ED violence issues in third place. In all, 25 research questions were developed and ranked according to priority. DiscussionDevelopment of these ranked research questions enables researchers not only to pick a research question “off the shelf” but also to be assured that the research question is clinically relevant and is a priority for practicing emergency nurses. These attributes will encourage potential researchers to conduct studies, but they also underscore the importance of the topics for the benefit of those who fund studies.

Pediatric Patient Safety: Common Problems in the Use of Resuscitative Aids for Simplifying Pediatric Emergency Care

Susan M. Hohenhaus, South Carolina Chapter, is Project Manager, and Karen S. Frush is Principle Investigator, Duke University Medical Center, Emergency Medical Services for Children Project, Department of Pediatric Emergency Medicine, Durham, NC. For reprints, write: Susan Hohenhaus, RN, BS, Box 3055, Durham, NC 27710; E-mail: suehohenhaus@sc.rr.com. J Emerg Nurs 2004;30:49-51. 0099-1767/$30.00 Copyright n 2004 by the Emergency Nurses Association. doi:10.1016/j.jen.2003.11.011

Two colleges for emergency nursing in Australia

Some people have recently expressed confusion over two colleges for emergency nursing. The College of Emergency Nursing Australasia (CENA) Ltd, our college, was formed through the amalgamation of all six state emergency nurses associations (New South Wales, Victoria, South Australia, Queensland, Western Australia, and Tasmania) on the 26 November 2002. From my understanding, the Australian College of Emergency Nursing (ACEN) had its origins in the Emergency Nurses Association of New South Wales (ENA of NSW). It was initially intended as an educational subcommittee of ENA of NSW, and later became a separate entity.

The ethics of resuscitation: When is dead, dead?

Some people have recently expressed confusion over two colleges for emergency nursing. The College of Emergency Nursing Australasia (CENA) Ltd, our college, was formed through the amalgamation of all six state emergency nurses associations (New South Wales, Victoria, South Australia, Queensland, Western Australia, and Tasmania) on the 26 November 2002.From my understanding, the Australian College of Emergency Nursing (ACEN) had its origins in the Emergency Nurses Association of New South Wales (ENA of NSW). It was initially intended as an educational subcommittee of ENA of NSW, and later became a separate entity.

One for the road?

As emergency nurses we see far too many drunk drivers causing carnage on our roadways. After many years and many deaths and severe injuries caused by drunk drivers, the Ozark, Missouri, chapter of the US Emergency Nurses Association decided to take part in a community effort to reach our teenage drivers at area high schools.

Family presence during cardiopulmonary resuscitation and invasive procedures: Practices of critical care and emergency nurses

Background: Increasingly, Patients' Families Are Remaining With Them During Cardiopulmonary Resuscitation And Invasive Procedures, But This Practice Remains Controversial And Little Is Known About The Practices Of Critical Care And Emergency Nurses Related To Family Presence. Objective: To Identify The Policies, Preferences, And Practices Of Critical Care And Emergency Nurses For Having Patients' Families Present During Resuscitation And Invasive Procedures. Methods: A 30-ITEM Survey Was Mailed To A Random Sample Of 1500 Members Of The American Association Of Critical-CARE Nurses And 1500 Members Of The Emergency Nurses Association. Results: Among The 984 Respondents, 5% Worked On Units With Written Policies Allowing Family Presence During Both Resuscitation And Invasive Procedures And 45% And 51%, Respectively, Worked On Units That Allowed It Without Written Policies During Resuscitation Or During Invasive Procedures. Some Respondents Preferred Written Policies Allowing Family Presence (37% For Resuscitation, 35% For Invasive Procedures), Whereas Others Preferred Unwritten Policies Allowing It (39% For Resuscitation, 41% For Invasive Procedures). Many Respondents Had Taken Family Members To The Bedside (36% For Resuscitation, 44% For Invasive Procedures) Or Would Do So In The Future (21% For Resuscitation, 18% For Invasive Procedures), And Family Members Often Asked To Be Present (31% For Resuscitation, 61% For Invasive Procedures). Conclusions: Nearly All Respondents Have No Written Policies For Family Presence Yet Most Have Done (OR Would Do) It, Prefer It Be Allowed, And Are Confronted With Requests From Family Members To Be Present. Written Policies Or Guidelines For Family Presence During Resuscitation And Invasive Procedures Are Recommended.

Family Presence During Cardiopulmonary Resuscitation and Invasive Procedures: Practices of Critical Care and Emergency Nurses

Increasingly, patients' families are remaining with them during cardiopulmonary resuscitation and invasive procedures, but this practice remains controversial and little is known about the practices of critical care and emergency nurses related to family presence. To identify the policies, preferences, and practices of critical care and emergency nurses for having patients' families present during resuscitation and invasive procedures. A 30-item survey was mailed to a random sample of 1500 members of the American Association of Critical-Care Nurses and 1500 members of the Emergency Nurses Association. Among the 984 respondents, 5% worked on units with written policies allowing family presence during both resuscitation and invasive procedures and 45% and 51%, respectively, worked on units that allowed it without written policies during resuscitation or during invasive procedures. Some respondents preferred written policies allowing family presence (37% for resuscitation, 35% for invasive procedures), whereas others preferred unwritten policies allowing it (39% for resuscitation, 41% for invasive procedures), Many respondents had taken family members to the bedside (36% for resuscitation, 44% for invasive procedure) or would do so in the future (21% for resuscitation, 18% for invasive procedures), and family members often asked to be present (31% for resuscitation, 61% for invasive procedures). Nearly all respondents have no written policies for family presence yet most have done (or would do) it, prefer it be allowed, and are confronted with requests from family members to be present. Written policies or guidelines for family presence during resuscitation and invasive procedures are recommended.

Consent for emergency medical services for children and adolescents.

Pediatric patients frequently seek medical treatment in the emergency department (ED) unaccompanied by a legal guardian. Current state and federal laws and medical ethics recommendations support the ED treatment of minors with an identified emergency medical condition, regardless of consent issues. Financial reimbursement should not limit the minor patient's access to emergency medical care or result in a breach of patient confidentiality. Every clinic, office practice, and ED should develop policies and guidelines regarding consent for the treatment of minors. The physician should document all discussions of consent and attempt to seek consent for treatment from the family or legal guardian and assent from the pediatric patient. Appropriate medical care for the pediatric patient with an urgent or emergent condition should never be withheld or delayed because of problems with obtaining consent. This statement has been endorsed by the American College of Surgeons, the Society of Pediatric Nurses, the Society of Critical Care Medicine, the American College of Emergency Physicians, the Emergency Nurses Association, and the National Association of EMS Physicians.

Elements of success

During the past 3 years, as an officer of Emergency Nurses Association, I have seen, firsthand, that the stronger the infrastructure of emergency nursing, the stronger each individual emergency nurse's representation. ENA, the only association for emergency nurses in the country, offers such a structure. Whether your elected or appointed ENA representatives are testifying at a congressional hearing about funding for nurses' education, sitting down with the Joint Commission on Accreditation of Healthcare Organizations or a state board of nursing or other health care associations, or writing a position paper, each emergency nurse is better served when as many nurses as possible have joined forces. During my tenure, I have visited many chapters and states, spoken with many members, and listened to state leaders. During these visits and conversations, I have seen, over and over, what I have come to think of as “essential elements” of success for chapters and state councils. I would like to share with you my “blueprint” for a successful chapter/state council.

The 2002 Emergency Nurses Association Assembly

The 2002 Emergency Nurses Association Assembly

The emergency nurse: A spirited survivor

faces the challenges thrown your direction with dignity, compassion, and respect for life and for death. You need to know you are never alone. Your emergency nursing colleagues throughout the world are there to support you, in good times and bad. As the events of September 11 unfolded, E-mail messages and letters of support and sorrow from throughout the United States and such countries as England, Ireland, Belgium, Australia, Turkey, and Canada were shared with nurses in New York and Washington, DC. These letters illustrate the strength of the emergency nursing spirit. The Emergency Nurses Association is a survivor as well, just like its members. As a 31-year-old association, it has faced numerous challenges throughout the years. The year 2001 has brought with it great challenges for ENA and many successes as well. One of this year’s greatest challenges occurred when, because of the interruption in the US transportation system, the Scientific Assembly scheduled for September 14-16 was canceled. However, because a quorum of delegates had arrived in Orlando, we were able to proceed with the General Assembly. We believed it was important not to let the evil acts that were committed completely interrupt our lives, and since we had gathered together, we decided we should go forth for the sake of our colleagues both present and absent. It was bittersweet to be together during that week of September 11. We were all frustrated that there appeared to be little we could do to provide immediate assistance to our colleagues in New York, Washington, DC, and Pennsylvania. There were more fatalities than injured persons in those areas, and although our colleagues were prepared to do whatever they could for the victims, for most The Emergency Nurse: A Spirited Survivor

Links with US nurses.

President of the Emergency Nurses Association (ENA) Mary Jagim took the lead on a new exchange initiative with the RCN A&E Nursing Association.