Emergency Nurse : the Journal of the RCN Accident and Emergency Nursing Association

BACKGROUND: Emergency departments (EDs) afford 'teachable moments' for health behaviour change, but staff may not see themselves as public health practitioners and it can be challenging to undertake health promotion activities in emergency care settings. Furthermore, the evidence on health promotion in these settings is limited. AIM: To investigate the views and experiences of emergency nurses and ambulance service paramedics regarding health promotion in emergency care settings...

The control and prevention of infection in emergency departments (EDs) remains challenging because of the complexity of the environment and the consistently high attendance in many EDs. Emergency nurses play an essential role in infection prevention and control in this clinical area. The COVID-19 pandemic has refocused the need for emergency nurses to have a good knowledge and understanding of infection control processes and the clinical skills to protect themselves and patients alike. This article provides an overview of UK epidemiological perspectives, the main pathogens associated with healthcare infections, the importance of reducing pathogen transmission and the emergency nurse's role in antibiotic stewardship...

Temporary lower-limb immobilisation following injury is a risk factor for the development of venous thromboembolism (VTE), which encompasses deep vein thrombosis (DVT) and pulmonary embolism. However, patients are not always risk-assessed for VTE in clinical practice and there is a lack of consensus among healthcare professionals on whether thromboprophylaxis should be offered and to whom. This article uses the fictional case study of a patient with an ankle fracture to explore the literature and guidance on VTE risk assessment and thromboprophylaxis in adults presenting to emergency settings with lower-limb trauma requiring immobilisation...

As cancer diagnoses rise, and more treatment options become available, doctors, nurses and allied health professionals will increasingly encounter more patients with acute oncological emergencies in the emergency department (ED). Neutropenia (low levels of neutrophils in the blood) is a common side effect of systemic anti-cancer therapy, particularly chemotherapy, and has a negative effect on patients' immune system, leaving them vulnerable to infection. Patients who develop neutropenia are at increased risk of developing neutropenic sepsis, a potentially life-threatening condition that requires urgent assessment and treatment within an hour of presentation...

Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department...

It is estimated that between 58% and 82% of children and young people who present to paediatric emergency department (PEDs) have a non-urgent condition. This systematic review of the literature explores why parents of children with non-urgent conditions present to the PED rather than to community healthcare services. Five databases were searched for studies on children and young people's presentations to the PED for the treatment of a non-urgent condition, as identified by a low priority triage code. This article describes and discusses the findings of the 18 included studies...

Tetanus infection is caused by the Clostridium tetani bacterium, which can enter the body through a wound or puncture in the skin. Patients who present to an emergency department (ED) with a laceration, wound or bite require a risk assessment to determine whether the wound is clean, tetanus prone or high-risk tetanus prone. Those assessed as tetanus prone or high-risk tetanus prone, with an uncertain or inadequate immunisation history, should receive tetanus prophylaxis treatment. However, some patients receive this treatment unnecessarily...

Emergency triage is a short-duration, high-volume process so small reductions in the time taken to triage one patient can have large repercussions on the total amount of triage time. At the emergency department of a large inner-city hospital, an efficiency and quality improvement project was undertaken to reduce the time taken to safely triage patients and optimise the use of triage nurses' time. The project involved removing processes that did not contribute to the primary aim of triage, supporting individual triage nurses to improve their performance where needed, and optimising the triage process...

Asthma is a chronic condition of varying intensity that is characterised by symptoms including coughing, wheezing, chest tightness and breathlessness. The article details a case study outlining the consultation and prescribing practice for a five-year-old girl who presented with a cough and breathlessness, and who was subsequently diagnosed with asthma. The author assessed and treated this patient while undertaking her non-medical prescribing qualification, and she outlines the diagnostic and prescribing decision-making process...

In the UK, around 10% of adults aged over 65 years and around one quarter to a half of adults aged over 85 years have frailty. Early identification of frailty can improve patient outcomes, so it is vital that emergency department (ED) healthcare professionals, including nurses, understand and can recognise the signs and symptoms of this health state. This article describes frailty and outlines the relationship between common presenting complaints in older people in the ED and frailty syndromes. The article summarises some commonly used frailty screening tools that have been validated for use in acute and emergency care settings and details a frailty screening tool used in the authors' hospital...

Collaboration and service evaluation are essential enablers for improving models of health and social care. Significant benefits can be achieved when they are combined to form a collaborative service evaluation, particularly when such collaboration involves different clinical professions. This article uses the NHS 111 Wales service to explore a simple example of collaborative service evaluation and to discuss the benefits and challenges identified. While the tabletop exercises described were expected to focus solely on compliance data and the reasons for non-compliance, broader learning was identified for all parties involved...

The presence of stridor in children signifies a partial obstruction in the upper airways, the cause of which may range from mild to life-threatening depending on aetiology. The most common causes of stridor in this population are laryngotracheobronchitis (viral croup) and foreign body aspiration. This article gives an overview of the signs, symptoms and potential causes of stridor and the signs and symptoms of, and diagnostic criteria for, viral croup. The author also discusses evidence-based assessment criteria and treatments and criteria for admission or discharge...

Accidental hypothermia, defined as an unintentional decrease in core body temperature to below 35°C, adversely affects several body systems, including the cardiovascular, central nervous and renal systems. It is classified according to core body temperature from a maximum of 35°C in mild hypothermia to below 24°C in profound hypothermia. Patients with severe hypothermia (28°C-24°C) are at risk of cardiac arrythmias and cardiac arrest. In patients presenting with hypothermia, it is vital to prevent any further heat loss and quickly start rewarming them...

BACKGROUND: Human resource management and employees' performance are fundamental to the success of healthcare organisations. Therefore, it is important to consider the factors that may affect employees' performance. AIM: To determine the relationship between perceived organisational justice, positive organisational behaviour (POB) and the productivity of emergency nurses. METHOD: This was a descriptive-analytical study that involved distributing questionnaires to emergency nurses working in hospitals affiliated with Mazandaran University of Medical Sciences in Iran...

This literature review aimed to explore the clinical outcomes for adult and child patients with scalp lacerations using the hair apposition technique (HAT) compared with the traditional options of sutures and staples for wound closure in the emergency department (ED). Although the research is scant, in the studies examined HAT was received positively by patients, had limited complications, was cost-effective and was suitable for use in the age ranges that met the criteria for its application. Further research is required to support the existing evidence, but the use of HAT for low-risk scalp lacerations in the ED should be considered and is within the scope of all healthcare professionals who undertake appropriate practice of this clinical skill...

This article presents a discussion based on a case study of an eight-month-old boy with petechial rash who presented at the emergency department (ED). Blood tests were obtained and intravenous antibiotics were administered. The patient was admitted to the children's ward and was discharged the next day. It was suspected that the rash was caused by a non-specific viral illness. Non-blanching rashes, such as petechial rash, in well children often lead to diagnostic and treatment dilemmas in the ED. Clinicians fear missing the diagnosis of invasive meningococcal disease, which results in blood tests, cannulation and early administration of antibiotics...

Upper gastrointestinal (GI) bleeding is a common presentation in emergency departments (EDs). This medical emergency has a mortality rate of up to 14%, particularly in men and older people. The most frequent cause of upper GI bleeding is peptic ulcer disease. Management has not changed significantly in the past 50 years and there is ongoing debate in the literature about the most effective treatment protocols. This article uses a case study of a patient who presented to an ED with upper GI bleeding caused by peptic ulcer disease to examine the evidence on treatment and management...

There is a lack of timely administration of an appropriate analgesic for children in acute pain in emergency departments in the UK and elsewhere. Unrelieved acute pain may result in deterioration in a child's physical and psychological condition therefore assessment is essential to enable triage nurses to offer an appropriate analgesic. This should be achieved by using a validated pain assessment tool which, where appropriate, enables the child to self-report their pain. This article describes various validated pain assessment tools for use with children with acute pain and considers how triage nurses can determine which is the most appropriate to use...

Research is essential for the implementation of evidence-based practice and can lead to improvements and innovations in care delivery. Although ultimately beneficial for patients and staff, the data collection involved in research often presents challenges, particularly in the emergency department (ED) setting. This article describes the challenges of undertaking a feasibility trial in a city centre ED. The target research population were adult patients who presented to the ED with an issue related to opioid misuse, for example opioid overdose, injection site wounds and/or abscess, or injury sustained during opioid intoxication...

Magnesium is an intracellular electrolyte and is a vital element in human physiological functioning. A deficiency in magnesium, termed hypomagnesaemia, can affect the neuromuscular, cardiovascular and renal systems. Hypomagnesaemia may be more prevalent in patients with cancer than in the general population. The increasing numbers of cancer diagnoses in the UK means that emergency department (ED) nurses are likely to be involved in care of this population, including those with suspected hypomagnesaemia. This article describes some of the causes and signs and symptoms of hypomagnesaemia and outlines the diagnosis and clinical management of patients with the condition...