Trauma Response Nurse: Bringing Critical Care Experience and Continuity to Early Trauma Care

Nurses under fire: Insights from testimonies of community nurses and midwives in nonhospital settings in the southern Israel conflict zone

Nurses-with or without prehospital care training-may find themselves delivering immediate care to injured individuals outside a healthcare facility, sometimes even in situations where their own life is at risk. This study explores the experiences of community nurses and midwives who provided immediate care during the Hamas militant movement's attack in southern Israel. The researchers collected and analyzed eight nurse and midwife survivors' testimonies published in digital media to gain a deeper understanding of their perspectives. Through qualitative content analysis, common themes, patterns, and insights were identified. The study aimed to contribute valuable knowledge in this field and followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist for methodological rigor. Two themes emerged from the testimonies, focusing on the nurses' swift realization of necessary action under fire and resilience and ingenuity in practice. Despite lacking training and resources, the nurses professionally assessed the situation and improvised creative solutions to care for the wounded. Although they had no prehospital emergency care background, community nurses and midwives were able to respond effectively, providing lifesaving care. The findings highlight the nurses' resilience, adaptability, and dedication in unprecedented situations. However, the study also emphasizes the importance of providing all nurses with baseline prehospital care training and structured planning of this care to empower them to deliver optimal patient care in uncertain and dangerous conditions, especially in and around conflict and disaster zones.

Examining the impact of a paediatric trauma family support service on the quality of life of injured children: A longitudinal cohort study

PURPOSE

We describe and evaluate the introduction of a trauma family support service (TFSS) in an Australian tertiary paediatric hospital.

DESIGN AND METHODS

A longitudinal mixed-methods cohort study evaluated the effectiveness of the TFSS on quality of life. PedsQL4.0 and EuroQol 5D-Y scores were collected at 6 and 12 months at intervention and non-intervention sites and outcomes were compared using a two-sample t-test. Qualitative data from field notes collected during the administration of the quality-of-life measures were analysed using inductive content analysis. Data were integrated during the interpretation of results to expand and strengthen findings.

RESULTS

Data from 192 children were collected (intervention site: 104, control site: 88). Significant increases were seen in the PedsQL and EQ-5D-Y scores at the intervention site compared to the control site at both timepoints, indicating an increase in overall health related quality of life. Two main categories were generated from the qualitative analysis: "Psychosocial impact of trauma" and "Access to psychosocial services."

CONCLUSIONS

The introduction of a dedicated family support service after paediatric injury improved well-being up to 12 months post injury.

PRACTICE IMPLICATIONS

Healthcare providers should emphasise dedicated family support services for paediatric trauma patients, focusing on their psychosocial needs and ensuring access to suitable resources. Paediatric nurses are a major part of this service and should contribute to future research, co-designing and implementing these improved family support services to better serve families affected by paediatric trauma.

Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review

PURPOSE

To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event.

METHODS

The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools.

RESULTS

Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge.

CONCLUSION

This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process.

IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.

Impact of Trauma Resuscitation Emergency Care Nurse Deployment in Trauma Activations in a Rural Trauma Center

BACKGROUND

Although the role of a dedicated trauma nurse has been implemented in an urban setting, it has not been studied in the rural trauma setting. We instituted a trauma resuscitation emergency care (TREC) nurse role to respond to trauma activations at our rural trauma center.

OBJECTIVE

This study aims to determine the impact of TREC nurse deployment on the timeliness of resuscitation interventions in trauma activations.

METHODS

This pre- and postintervention study at a rural Level I trauma center compared the time to resuscitation interventions before (August 2018 to July 2019) and after (August 2019 to July 2020) deploying TREC nurses to trauma activations.

RESULTS

A total of 2,593 participants were studied, of which 1,153 (44%) were in the pre-TREC group and 1,440 (56%) in the post-TREC group. After TREC deployment, the median (interquartile range [IQR]) emergency department times within the first hour decreased from 45 (31.23-53) to 35 (16-51) min ( p = .013). The median (IQR) time to the operating room within the first hour decreased from 46 (37-52) to 29 (12-46) min ( p = .001), and within the first 2 hr, decreased from 59 (43.8-86) to 48 (23-72) min ( p = .014).

CONCLUSION

Our study found that TREC nurse deployment improved resuscitation intervention timeliness during the first 2 hr (early phase) of trauma activations.

Improving Communication and Response to Clinical Deterioration to Increase Patient Safety in the Intensive Care Unit

BACKGROUND

In the critical care setting, early recognition of clinical decompensation is imperative to trigger prompt intervention and optimize patient outcomes.

LOCAL PROBLEM

In a 20-bed surgical intensive care unit of an urban academic medical center, cases of clinical deterioration that highlighted opportunities to improve the communication process prompted a reassessment of health care provider roles and responsibilities.

METHODS

A quality improvement initiative was implemented to enhance communication among intensive care unit clinical staff members, improve the timeliness of reporting clinical deterioration, and ensure implementation of timely, appropriate interventions to eliminate adverse outcomes.

INTERVENTIONS

Nurses were surveyed to determine their perceptions of communication and collaboration among providers. Education was provided that focused on familiarizing nurses with clinical conditions necessitating direct notification of the attending surgical intensivist and included review of a case in which escalation of care did not occur. Multidisciplinary rounds were expanded to engage night-shift nurses in clinical discussions and decision-making. A template was created to document episodes of escalation in the electronic health record.

RESULTS

Since implementation of the quality improvement interventions, no incidents of patient harm or death related to failure to escalate have occurred to date. A total of 16 episodes of escalation for clinical deterioration were documented in the electronic health record. Most nurses reported an increased level of confidence in understanding when to escalate concerns about clinical deterioration.

CONCLUSION

Implementing a multimodal program to empower nurses to escalate clinical concerns directly to the attending physician eliminated adverse events related to failure to escalate.

Analysis of the Influence of Network Continuous Care on the Quality of Life of Patients with Coronary Artery Disease (CAD) after PIC

Studies have shown that most patients after PCI cannot adhere to the cardiac rehabilitation program. The survey found that due to the lack of secondary prevention of cardiac rehabilitation, the phenomenon of drug reduction and withdrawal after PCI is very common after discharge, leading to recurrence of the patient's disease or worsen and repeated hospitalizations, so continuity of care is very important. In this paper, in addition to proposing a network care continuum with artificial intelligence handler in order to improve the healthcare system and provide new ideas for improving the postoperative recovery of CHD patients, we analyze the impact of PCI on the coronary heart disease patients' PCI postoperative quality of life. In the method part, this article introduces the concepts of continuation care and PCI after surgery, introduces the marker delivery algorithm in the field of artificial intelligence, and introduces the SF-36 scale for patient quality of life analysis. This article designs an experiment combining artificial intelligence processors to carry out network continuity care for patients and divides 100 eligible patients into an experimental group and a control group. In the analysis part, the two groups of patients were analyzed in terms of general data comparison, physical function, biochemical indicators, quality of life, and dependence. It can be seen from the experimental analysis that the anxiety and depression of the two groups of subjects have different degrees of decline. The HAMA value of the experimental group is 9.06 ± 0.77, and the HAMD value is 9.18 ± 1.20, which is significantly lower than that of the control group, P < 0.05. It can be seen that the use of network continuation care can reduce the negative emotions of patients more than general care. Through psychological counseling and postoperative follow-up, it can improve the optimism and positive emotions of the patients, reduce the negative emotions of the patients, and improve it to a certain extent.

Intention to Stay in Specialist Trauma Nurses: Relationship With Role Conflict, Stress, and Organizational Support

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.

Pediatric Rapid Response Nurse Deployment to Pediatric Trauma Activations: A Process Improvement Initiative

BACKGROUND

Prolonged emergency department length of stay in trauma patients is associated with increased hospital length of stay and inhospital mortality. This problem is compounded in pediatric patients, as injured children have less physiologic reserve and may exhibit only subtle warning signs before decompensation.

OBJECTIVE

To determine the impact of deploying pediatric rapid response nurses to full trauma activations for patients transferred to the pediatric intensive care unit on emergency department length of stay.

METHODS

This is a before-and-after analysis of a quality improvement initiative deploying pediatric rapid response nurses to full trauma activations. Trauma registry data collected from January 2016 to August 2020 were statistically analyzed. Demographic and outcome variables were assessed by unpaired t test and χ2 analysis.

RESULTS

A total of 94 patients met inclusion criteria as full activations admitted to the intensive care unit during the study period. The preimplementation group (n = 60) was 88% (n = 53) male, with a median age of 6.9 years and a median Injury Severity Score of 21. The postimplementation group (n = 34) was 62% (n = 21) male, with a median age of 5.6 years and a median Injury Severity Score of 17. The emergency department length of stay decreased from median (interquartile range) 48.5 (36.0-84.75) min (preimplementation) to 36.5 (27.5-55.5) min (postimplementation; p = .019).

CONCLUSION

Deployment of pediatric rapid response nurses to full trauma activations facilitates the assessment and transfer of pediatric trauma to the intensive care unit and decreases emergency department length of stay.