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Effect of vital signs on triage decisions

ANNALS OF EMERGENCY MEDICINE 2002年第3期39卷 223-232页

作者： Cooper, RJ Schriger, DL Flaherty, HL Lin, EJ Hubbell, KA Univ Calif Los Angeles Sch Med Ctr Emergency Med Los Angeles CA USA

Study objective: We sought to determine whether knowledge of vital signs changes nurse triage designations (TDs), We also sought to determine whether patient age and ability to communicate modify the effect of vital signs on triage decisions. Methods: We performed a prospective observational study, in 24 emergency departments, of nurse-assigned TDs of all ED patients undergoing triage. Nurses performed their typical triage routine, except that they chose 1 of 5 hypothetical TDs (call 911, ED <2 hours, physician's office 2 to 8 hours, physician's office 8 to 24 hours, or home care) before and after measurement of vital signs. The main outcome measure was the change of TD after knowledge of a patient's vital signs, with stratification on the basis of patient age and communication barriers. The secondary outcome was the final ED disposition. Results: Six hundred twenty-five experienced triage nurses at 24 different EDs collected data on 14,285 patients. TDs were downgraded (decreased in urgency) in 2.4% of patients, and 5.5% were upgraded (increased in urgency) after vital signs were known. Changes were more likely to occur in the young (less than or equal to2 years old;11.4%) and the elderly ( greater than or equal to75 years old;9.9%) than in those 3 to 74 years of age (7.5%). When nurses reported a communication barrier, a change in post-vital signs TD was also more common (11.2% versus 7.7%). The post-vital signs TD better predicted patient ED disposition. Conclusion: In this sample, 92.1% of the nurses' TDs were not affected by the knowledge of patient vital signs. For the including many patients from vulnerable populations, the vital signs changed the nurses' assessments of the patients' triage designation. Methods of triage that do not determine vital signs may not adequately reflect the urgency of the patient's presentation.

关键词：数据收集决策急症护理/方法急诊室医院/组织和管理护理评估/方法前瞻性研究伤病员分拣/方法女(雌)性人类男(雄)性

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Using the Delphi technique to design a self-reporting triage survey tool

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Accident and Emergency Nursing 2001年第4期9卷 235-241页

作者： Fry, Margaret Burr, Gayle Emergency Department St George Hospital Kogarah NSW 2217 Gray Street Australia University of Sydney NSW 2006 Mallet Street Australia

A useful addition to any researcher’s methodological repertoire is the Delphi technique. This technique facilitates group communication to develop research items that are contextually specific. For the first time this method was utilised to develop a self-reporting triage survey tool that would explore current practice and begin to explore triage decision-making. The triage role is complex, often crisis-driven and demands speed and accuracy on the part of the triage nurse. This role involves patient assessment, initiating investigations, patient referral and management. The study used the Delphi technique to produce a triage survey tool that would assist in broadening our understanding of current triage practice within Australia. © 2001 Elsevier Science Ltd. All rights reserved.

关键词：澳大利亚决策德尔菲技术急症护理/方法急诊室医院/组织和管理卫生保健调查/仪器和设备护士作用/心理学试点项目问卷调查/标准伤病员分拣/方法人类

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Evaluation of potential closed head injury in patients with known coagulopathy

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International Journal of Trauma Nursing 1999年第2期5卷 43-48页

作者： Jorgensen, Kathryn Ann Emergency Department Lehigh Valley Hospital Center Allentown PA United States St. Luke's Hospital Bethlehem PA United States Family Nurse Practitioner Program Allentown Coll. S. Francis de Sales United States Lehigh Valley Hospital Center Cedar Crest and I-78 Emergency Department Allentown PA 18105-1556 United States

A case report is provided of an elderly "minor" trauma patient in whom an acute subdural hematoma developed. The division of traumatology and surgical critical care worked with other hospital departments to develop and implement a trauma care guideline, promote ongoing communication between departments, and monitor compliance with the guideline.

关键词：颅脑损伤/并发症危重病人医疗急症护理/方法血肿硬膜下/诊断血肿硬膜下/病因学血肿硬膜下/外科学手术中护理诊疗准则(主题) 危险因素血小板增多原发性/并发症体层摄影术 X线计算机老年人人类男(雄)性

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Administration of blood products.

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International journal of trauma nursing 2000年第3期6.0卷 95-100页

作者： McMahon, M. Adapted from McMahon M. Administration of blood products. In: Proehl JA editor. Emergency nursing procedures 2nd ed. Philadelphia: WB Saunders 1999:240–8

Int J Trauma Nurs 2000;6:95–100.

关键词：血液成分输血/方法血液成分输血/护理急症护理/方法护理估计人类

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Accident prevention in the A&E department.

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Accident and emergency nursing 1999年第3期7卷 164-167页

作者： Bateman, R. Wright, S. Accident and Emergency Department West Cumberland Hospital Whitehaven United Kingdom

Accident and Emergency units are often regarded as the 'shop window' of a health service. While the priority is to attend to those in need of emergency services, there may also be opportunities for health education amongst a 'captive audience', particularly in relation to accident prevention. This report illustrates how the influence of one A&E department was used amongst primary school children to increase their awareness of cycle safety. Educational materials were developed, a series of visits to schools was planned, which over 600 children attended, and a competition organised. Initial responses from the children were very positive, and an analysis of subsequent cycle injury levels is now under way. The project formed part of a wide ranging practice development programme within a large district general hospital in Whitehaven in collaboration with St Martin's College Department of Nursing. It combined the need to develop quality services and staff in tandem. The outreach educational approach is now being examined for adoption in other areas of the Trust.

关键词：事故预防自行车运动/损伤儿童福利急症护理/方法急诊室医院/组织和管理头部防护装置健康教育/方法健康促进/方法医院公立/组织和管理方案评价成年人儿童人类

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临床路径在急诊护理管理中的应用

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中国误诊学杂志 2008年第26期8卷 6435-6436页

作者：李静陈永琴张志贤重庆三峡中心医院急救部 404000

目的:探讨临床护理路径在急诊护理工作中应用的效果。方法:随机选择患者200例,分为观察组和对照组,对照组实施传统的抢救流程,观察组按照临床护理路径对患者实施急救。结果:观察组抢救时间明显缩短,护理漏项及纠纷明显减少,抢救成功率... 详细信息

目的:探讨临床护理路径在急诊护理工作中应用的效果。方法:随机选择患者200例,分为观察组和对照组,对照组实施传统的抢救流程,观察组按照临床护理路径对患者实施急救。结果:观察组抢救时间明显缩短,护理漏项及纠纷明显减少,抢救成功率、护理质量及患者满意度明显提高(均P<0.05)。结论:临床护理路径对提高抢救成功率,减少护理差错有积极意义。

关键词：急症护理/方法

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Male catheterization

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Accident and Emergency Nursing 2001年第4期9卷 257-263页

作者： Hadfield-Law, Lisa Baileys Consulting Charlbury Oxfordshire OX7 3PR Church Street United Kingdom

The insertion of catheters into male emergency patients is fairly common practice and is associated with a worryingly high rate of infection. Everyday pressures within the department, along with the added stress of resuscitation can result in inappropriately trained or skilled staff undertaking this procedure. The issue of gender and whether female nurses should catheterize male patients may also affect this vulnerable group of patients. Acquiring the psychomotor skills of inserting a urethral catheter is only one part of preparation for practice. Emergency nurses must know when and when not to resort to catheterization. Choosing the type and size of catheter requires careful judgment. What will you do if insertion proves difficult? Prevention of infection is of paramount importance and there are an increasing number of evidence-based sources of information, which are crucial to formulating procedures and informing every day practice. In the pressured surroundings of A&E departments, it is easy to ignore the vulnerability of men requiring catheterization, both from a physical and psychological point of view. Making the effort to explain the procedure, listen to questions and concerns and record relevant details in the notes, will take only a few extra moments. There is no doubt that urinary catheterization is not without complications. It is associated with significant morbidity and occasionally, mortality. © 2001 Harcourt Publishers Ltd.

关键词：麻醉药局部/治疗应用气囊扩张术/仪器和设备气囊扩张术/方法急症护理/方法感染控制/方法润滑护士病人关系成年人儿童人类男(雄)性

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Unexpected birth in A&E departments

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Accident and Emergency Nursing 2001年第4期9卷 242-248页

作者： McLoughlin, Aileen M.P. University of Manchester Sch. of Nursing Midwifery and Dent. Gateway House Manchester M60 7LP Piccadilly South United Kingdom

This paper discusses the current advice on and management of a woman who gives birth unexpectedly. It is written from the perspective of a midwife teacher who, whilst having fifteen years of midwifery experience, has not practised within an A&E department. However, lectures on the subject of unexpected birth to students undertaking trauma modules have led me to the conclusion that this event provokes anxiety in even the most experienced staff. Reflection upon their practice and discussion also leads them to appreciate that there are many invaluable skills, which are already part of every trauma nurse's repertoire and which are transferable to the situation of unexpected birth. An outline of the occasions when women may present unexpectedly in labour will be offered, followed by an outline of the physiology of normal labour and suggested management. This paper is not intended to replace departmental protocols;rather it offers some useful and basic information for guidance and will hopefully allay some anxieties regarding the skills required to effectively assist a woman to give birth. © 2001 Harcourt Publishers Ltd.

关键词：接生产科/方法否认(心理学) 急症护理/方法急诊室医院大不列颠分娩发动/生理学分娩发动/心理学妊娠/生理学妊娠/心理学女(雌)性人类

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Triage decision making: educational strategies.

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Accident and emergency nursing 1999年第2期7卷 106-111页

作者： Cioffi, J. Faculty of Health University of Western Sydney Hawkesbury NSW Australia.

Patient triage in Accident and Emergency departments requires emergency nurses to make rapid decisions based on their knowledge and experiences. The development of triage decision-making skills can be addressed through the use of simulations, 'thinking aloud' technique, reflection and the decision rules of experienced emergency nurses. Clinical educators and experienced emergency nurse mentors are encouraged to recognize that skill acquisition in triage decision making requires practice before registered nurses can engage fully in the process of triaging patients in the emergency department. It is essential to experience the process of triage decision making in order to develop an understanding of the clinical information attended to, the sequence in which the information is processed and the rules used to combine information leading to a decision on the triage category for each patient. By using triage simulations developed from 'real triage cases' the process of decision making can be experienced by nurses. Further, if these simulations are accompanied by the collection of verbal protocols, nurses have opportunities retrospectively to explore their decision making with reflection. In addition, the presentation and use of decision rules used by experienced triage nurses can enhance the development of skills in novice triage nurses.

关键词：临床工作能力决策决策树教育护理继续/方法急症护理/教育急症护理/方法健康知识态度实践护理评估/方法护理人员医院/教育护理人员医院/心理学角色扮演伤病员分拣/方法人类

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Effect of cutaneous stimulation on pain reduction in Emergency Department patients

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Complementary Therapies in Nursing and Midwifery 2000年第1期6卷 25-32页

作者： Kubsch, Sylvia M. Neveau, Therese Vandertie, Kathryn University of Wisconsin Green Bay WI United States Emergency Department St. Mary's Hospital Green Bay WI United States Pain Clinic Bellin Memorial Hospital Green Bay WI United States

Context: the problem of unrelieved pain in Emergency Department (ED) patients as well as contraindications to analgesics and narcotics due to masking of symptoms during the diagnostic period, presents itself as a unique opportunity for ED nurses to utilize non-pharmacological and non-invasive interventions such as cutaneous stimulation (CS) to relieve pain. Objective: to evaluate the effectiveness of a specific protocol of CS, developed by the researchers, in reducing pain levels in ED patients. Another objective was to determine the effect of CS on blood pressure and heart rate. Potential factors that could influence the dependent variables such as age, gender, educational level, location of pain, and site of CS were tested. Design: a one group pre-test post-test experimental design measured variables before and after intervention in all subjects. Sample: after being screened for inclusion, 50 patients (38 adults, 12 children) were admitted to the study and were treated with CS to relieve pain. Results: following CS, subjects reported significantly reduced pain, and demonstrated reduced heart rate, and blood pressure readings. The location of pain significancy influenced heart rate and diastolic blood pressure but not pain level. The most effective site of CS was contralateral to the pain. Age, gender and educational level had no significant affect. Conclusions: the results of this study provide empirical evidence that CS effectively reduces pain, heart rate, and blood pressure in ED patients. The intervention of CS has solid utilization potential and could be easily incorporated into standard ED procedure. Further research is needed to identify threats to internal validity especially that of the caring presence of the nurse. © 2000 Harcourt Publishers Ltd.

关键词：血压临床护理研究急症护理/方法心率按摩/方法按摩/护理疼痛/诊断疼痛/护理疼痛/病理生理学疼痛/心理学疼痛测定病人满意度问卷调查青少年成年人儿童女(雌)性人类男(雄)性

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