DOCSLIB.ORG

Emergency Nurse Ultrasound Guided Peripheral IV Insertion (USGPIV)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Emergency Nurse Ultrasound Guided Peripheral IV Insertion (USGPIV) Evidence NK3-3, USGPIV PowerPoint Education Emergency Nurse Ultrasound Guided Peripheral IV Insertion (USGPIV) Stephanie C. Mullennix, BSN, RN, CEN Drew Peklo, BSN, RN, CEN Charles Monaghan, BSN, RN, CEN Chad Galdys, BSN, RN, EMT-B January 16, 2015 Evidence NK3-3, USGPIV PowerPoint Education Objectives ■ Discuss the clinical significance of difficult IV access ■ Review evidence-based research in support of USGPIV access in the ED ■ Demonstrate knowledge of upper arm anatomy ■ Demonstrate critical safety steps when performing USGPIV access ■ Demonstrate proper technique when using the Bard ® guidewire catheter for USGPIV cannulation ■ Demonstrate proper documentation of USGPIV placement 2 Evidence NK3-3, USGPIV PowerPoint Education Clinical Significance Why do we need to learn to use Ultrasound Guided Peripheral Intravenous in the ED? ■ Conditions such as obesity, chronic illness, hypovolemia, IV drug abuse and vasculopathy can challenge the emergency nurse in obtaining IV access. ■ Difficulty obtaining peripheral intravenous (PIV) access can delay treatment for patients in the emergency department (ED). ■ Patients who experience multiple PIV attempts in the ED may receive a central venous catheter (CVC) due to lack of suitable PIV sites. 3 Evidence NK3-3, USGPIV PowerPoint Education Evidence to Support the Use of USGPIV ■ ENA gives the use of Ultrasound-guided access a level A (highest recommendation) as a viable option for nurses for those patients with known difficult access. ■ Empirical support is evident in current literature, including systematic reviews and meta-analysis on the use of USGPIV cannulation by RN’s to increase the success rate of establishing PIV access in ED patients with difficult access. ■ Some studies have presented that there may be a correlation in decreasing central venous catheter insertion rates in the ED with a successful USGPIV program. 4 Evidence NK3-3, USGPIV PowerPoint Education Clinical Indications for USGPIV Use The use of USGPIV should be considered if the patient has an order for a peripheral IV and meets any of the following criteria: ■ The patient has had two failed attempts utilizing a standard IV insertion method. ■ The patient has a known history of poor vascular access. ■ The patient has no visible or palpable veins. ■ The patient requires venous access for imaging studies with no visible or palpable veins in the appropriate location. 5 Evidence NK3-3, USGPIV PowerPoint Education Criteria ■The RN is limited to using ultrasound guidance to establish peripheral IV with catheters that are at a minimum of 1.75 inches and a maximum of 2.5 inches long (midline catheters are defined as catheters that are > 3cm, midline placement is restricted to physicians) ■18 and 20 gauge catheters are appropriate for US placement ■Veins cannulated with ultrasound guidance should not exceed a vessel depth of 2.0 cm ■USGPIVs are not considered central catheters ■USGPIV should be limited to two attempts. If more than two attempts are unsuccessful, contact the provider for further guidance. 6 Evidence NK3-3, USGPIV PowerPoint Education Ultrasound Technology ■ Ultrasound machines are expensive—take care of our resources ■ Ensure you the clean the ultrasound machine immediately before and after patient use ■ Return to the appropriate location after use ■ Plug it in when your done 7 Evidence NK3-3, USGPIV PowerPoint Education Considerations ■ The preferred area for establishing USGPIV is between the distal forearm and mid arm ■The Brachial Vein should be used ONLY as a last resort due to the close proximity to the Brachial Artery and Median Nerve ■Utilize the appropriate size http://vascularultrasound.net/wp-content/uploads/2010/08/armveins2-copy.jpg gauge for the appropriate clinical indication 8 Evidence NK3-3, USGPIV PowerPoint Education Preparation and Infection Prevention Prevent patient-to-patient microbial cross-contamination: ■Immediately prior to patient use the ultrasound probe must be cleaned with a germicidal disposable wipe and allowed to dry completely prior to contact with patient skin and following completion of the procedure. ■ A sterile probe cover will be used for all USGPIV starts (large transparent dressing placed over the thin line of ultrasound gel). 9 Evidence NK3-3, USGPIV PowerPoint Education Site & Catheter Selection ■ Consider range of motion/restricted movement in selecting sites. Avoid points of direct flexion when possible. ■ If upper arm presents the only suitable vessels, often the Cephalic Vein is best, followed by Basilic. ■ Avoid the Brachial Vein due to risk of arterial or nerve compromise. ■ If no appropriate target vessel is identified during the US survey, contact the patients attending physician to determine appropriate access for the patient. 10 Evidence NK3-3, USGPIV PowerPoint Education Review of Vein Anatomy-Middle Upper Arm 11 http://www.ultrasoundpaedia.com/uploads/53003/ufiles/dvt-arm/dvt%20arm%20normal/upper-arm-vein-anatomy.jpg Evidence NK3-3, USGPIV PowerPoint Education Site Selection-Ultrasound View Basilic Vein Brachial Nerve Bundle Brachial Brachial Artery 12 http://img.medscape.com/pi/emed/ckb/clinical_procedures/79926-104340-1433943-1464224.jpg Evidence NK3-3, USGPIV PowerPoint Education Artery vs. Vein Ivy Leauge Nurse.com Meer, Medscape, 2011, pg 5 13 Evidence NK3-3, USGPIV PowerPoint Education Can you recognize a thrombus within a vessel? ■ Clot in upper arm vessel ■ Hallmark feature is the lack of compression in the vessel 14 Evidence NK3-3, USGPIV PowerPoint Education Tips for Success ■ Hold the probe perpendicular to the skin to obtain the best image. Don’t tilt the probe. ■ Track the needle on the Ultrasound Screen, not on the patients arm. ■ 15-30 degree angle for insertion. U ■ Avoid extreme steep angles as this S may kink the catheter ■ Use a “C” grip to hold the probe, using your wrist /fingers to stabilize the probe hand Skin ■ Don’t overdo it with the gel! Vein ■ Practice, Practice, Practice. ■ Simulators will be available. 15 Evidence NK3-3, USGPIV PowerPoint Education Sustainment of a Successful USGPIV Program ■ Policy ■ Education ■ Training ■ Competency 16 Evidence NK3-3, USGPIV PowerPoint Education Competency Plan ■ Nurses will participate in an initial class consisting of didactic and hands on learning. ■ Nurses will successfully cannulate 5 simulated USGPIVs. ■ Staff will successfully perform 3-5 peer validated USGPIV insertions. ■ Educators will keep record of documented education and competency. ■ Nurses who have attended the initial training will demonstrate 2 peer validated competencies on an annual basis. 17 Evidence NK3-3, USGPIV PowerPoint Education Policy Review and Reference SH Clinical Policy 18 Evidence NK3-3, USGPIV PowerPoint Education Documentation Documentation: I-View (“Lines” documentation band) ■ IV site/location ■ Gauge ■ Site condition ■ Site Dressing ■ IV patency ■ Use of Liquid Adhesive ■ Use of Ultrasound for guidance ■ Number of attempts 19 Evidence NK3-3, USGPIV PowerPoint Education References Arbique, D., Bordelon, M., Dragoo, R., Huckaby, S., (2014). Ultrasound-Guided Access for Peripheral Intravenous Therapy. Academy of Medical-Surgical Nurses, 23, 3, 9-14. Retrieved from http:///search.ebscohost.com.proxy2cl.msu.edu/login.aspx?direct=true&db=rzh&AN=2012637663&site=ehost-live Au, K., A., Rotte, M., J., Grzybowski, R., J., Ku, Fields, J., M. (2012). Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. The American Journal of Emergency Medicine, 30, 1950-1954. doi: 10.1016/j.ajem.2012.04.016 Egan, G., Healy, D., O’Neill, H., O., Clarke-Moloney, M., Grace., P., A., Walsh, S., R. (2013). Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emergency Medicine Journal, 30, 521-526. doi:10.1136/emermed-2012-201652 Emergency Nurses Association (2011). Clinical Practice Guideline: Difficult Intravenous Access. Institute for Emergency Nursing Research, 3, 1-15. Retrieved from www.ena.org Ismailoglu, E., G., Zaybak, A., Akarca, F., K., Kiyan, S. (2014). The effect of the use of ultrasound in the success of peripheral venous catheterization. International Emergency Nursing. doi: 10.1016/j.jen.2014.07.010 Maiocco, G., Coole, C. (2012). Use of ultrasound guidance for peripheral intravenous placement in difficult-to access patients. Journal of Nursing Care Quality ,27, 1, 51-55. doi:10.1097/NCQ0b013e31e31822b4537 Miles, G., Salcedo, A., Spear, D. (2012) Implementation of a successful registered nurse peripheral ultrasound-guided intravenous catheter program in an emergency department. Journal of Emergency Nursing, 38, 353-356. doi: 10.1016/j.jen.2011.02.011 Ultrasound Guided PIV Placement: Retrieved on August 15, 2013 from http://www.ivyleaguenurse.com/courses/Ultrasound_Guided_PIVs.pdf Weiner, S., G., Sarff, A., R., Esener, D., E., Shroff, S., D., Budhram, G., R., Switkowski, K., M., …Darvish, A., H. (2013). The Journal of Emergency Medicine, 44, 3, 653-660.doi:10.1016/j.jemermed.2012.08.021 20 Evidence NK3-3, USGPIV PowerPoint Education SPECTRUM HEALTH Attendance USGPIV 1/15/2015 - 1/16/2015 Please sign in below. Name Signature Evidence NK3-3, USGPIV PowerPoint Education eo el \{V\ \JaV1Qe Po\ Attendance I Meeting Name 1 .
Load more

Recommended publications
  • Emergency Care
    P: Emergency Care Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. 141 Major Competency Area: P Emergency Care Competency: P-1 Date: January 16, 2017 Emergency Nursing **LPNs will not independently triage/Canadian Triage Assessment Scale (CTAS) patients, this process must be done in collaboration with the inter-professional team** A Licensed Practical Nurse will: P-1-1 Demonstrate knowledge and ability to apply critical thinking and critical inquiry throughout the nursing process in emergency nursing. P-1-2 Demonstrate knowledge and ability to perform a comprehensive health assessment. P-1-3 Demonstrate knowledge and ability to perform nursing procedures and interventions in an emergency setting as defined by scope of practice and according to agency policy. P-1-4 Demonstrate knowledge and ability to obtain, assess and monitor diagnostic tests and lab values according to agency policy. P-1-5 Demonstrate knowledge and ability to communicate, collaborate and consult with emergency care team. 142 Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. Competency: P-1 Page: 2 Emergency Nursing A Licensed Practical Nurse will: P-1-6 Demonstrate knowledge and ability to obtain additional education and certification in emergency assessment, intervention and care including: emergency assessment certifications o cardiac life support o emergency neonatal care o emergency nursing o emergency pediatric nursing o pediatric life support o trauma nursing additional certifications
    [Show full text]
  • Journal of Emergency Nursing
    Journal of Emergency Nursing Volume 31, Issue 6, Pages 515-612 (December 2005) 1. Table of Contents • CONTENTS LIST Pages A3-A8 2. Editorial Board • EDITORIAL BOARD Pages A11-A12 3. Author Guidelines • MISCELLANEOUS Pages A15-A16 4. Info for Readers • MISCELLANEOUS Page A20 President's Message 5. A Time for Giving • ARTICLE Page 515 Patricia Kunz Howard Editorial 6. Happy Holidays! • EDITORIAL Page 516 Gail Pisarcik Lenehan Letters 7. Head for the Hill • CORRESPONDENCE Page 517 Peter Kamon 8. Nurse/Victim: The Fallacy of the Divide • CORRESPONDENCE Page 518 James MacColl Research 9. A Descriptive Study of the Perceptions of Workplace Violence and Safety Strategies of Nurses Working in Level I Trauma Centers • ARTICLE Pages 519-525 Martha Catlette Clinical 10. Emergency Response to the Gulf Coast Devastation by Hurricanes Katrina and Rita: Experiences and Impressions • ARTICLE Pages 526-547 Iris C. Frank 11. The Creation of a Behavioral Health Unit as Part of the Emergency Department: One Community Hospital's Two-Year Experience • ARTICLE Pages 548-554 Christina Lewis, Gina Sierzega and Diana Haines Case Review 12. A 4-year-old Boy With Pulmonary Hemosiderosis and Respiratory Distress Requiring Use of a Cuffed Endotracheal Tube • SHORT COMMUNICATION Pages 555-557 Emily Colyer CEN Review Questions 13. Knowledge Assessment and Preparation for the Certified Emergency Nurses Examination • MISCELLANEOUS Pages 558-559 Carrie A. McCoy Clinical Notebook 14. Allow Natural Death: A More Humane Approach to Discussing End-of-Life Directives • SHORT COMMUNICATION Pages 560-561 Crissy Knox and John A. Vereb 15. A Percutaneous Coronary Intervention Kit and Program and PCI Kit: Reducing Door-to-Cath Lab Time • SHORT COMMUNICATION Pages 562-563 Julie Bunn and Elizabeth Coombes 16.
    [Show full text]
  • Nursing Workforce Standards for Type 1 Emergency Departments
    Nursing Workforce Standards for Type 1 Emergency Departments October 2020 Contents Foreword Foreword 3 Patients depend on acute care delivered in our Emergency Departments (EDs). We Scope 4are the frontline of the NHS. An appropriate Glossary of Nursing Roles in the Emergency Department 5 ED workforce is the most important factor for providing safe, effective, high quality Nursing Workforce Standards for emergency care in a timely, cost-effective Type 1 Emergency Departments 7and sustainable manner. This requires a balanced team of nurses, doctors, allied Converting the nursing workforce model health professionals and support staff, with into a Whole Time Equivalent (WTE) number 14 appropriate knowledge and skills. Determining the financial cost of the total WTE nursing workforce 15 Over time a number of organisations have endeavoured to make recommendations References 16 regarding the nursing workforce in EDs [1,2]. However, specific standards have Professor Dame Donna Kinnair Appendix - Approaches that may be used Chief Executive and General Secretary never previously been established. of the Royal College of Nursing to determine the nursing workforce 17 Authors and acknowledgments 18 Therefore, in the collective interests of patient safety and quality of care, the Royal College of Nursing (RCN) Emergency Care Association (ECA) and the Royal College of Emergency Medicine (RCEM) have collaborated to define, for the first time, the nursing workforce standards for Type 1 EDs. This collaboration represents something greater than just a workforce standard – it represents a recognition that the ED team is truly multidisciplinary. Dr Katherine Henderson President of the Royal College of Emergency Medicine 2 3 Scope Glossary of Nursing Roles in the Emergency Department Adapted from the RCN ECA National Foundation Staff Nurse: A Registered Nurse who This document details the nursing These standards are not intended for use Curriculum and Competency Framework is either newly qualified, or new to emergency workforce standards for Type 1 EDs.
    [Show full text]
  • Lee Patient ED Nursing Lead Transformation Tom Sagdahl ED Matron
    The Impact of Implementing ‘Fast-Track’ Streaming for Complex Walk-in Patients in an Emergency Department Lee Patient ED Nursing Lead Transformation Tom Sagdahl ED Matron Background Mean initial assessment times Jun-15 Jul-15 Apr-15 Many EDs have now developed Rapid Assessment and Treatment (RAT) models. This is the process of undertaking a rapid patient assessment and determining what investigations and immediate treatment is needed (1). This approach takes advantage of time efficiencies from parallel processing. Studies suggest there are advantages of this process including a reduction 20 in time to treatment, length of stay, left without being seen rates (3) and improved patient care 19 and experience (4). 18 17 16 At St Thomas’ (as in many ED’s), RAT is undertaken in the Major treatment area and walk-in 15 patients are assessed using a traditional nurse triage/assessment process. For patients with 14 complex needs, this can often mean there is a considerable delay in reaching the appropriate 13 12 treatment area and having a RAT assessment. At St Thomas’, walk-in patients were streamed 11 as they arrived which aimed to risk assess patients and direct to the most appropriate care. 10 This process however was only in operation from 10.00 to 20.00 each day. 9 (minutes) 8 7 6 5 Case for Change 4 At St Thomas’ ED work was undertaken by the emergency nursing team working with the Trust time assessment initial Mean 3 2 Transformation team and 20:20 to review the initial assessment process. It was found that Process for Walk-In Patients 1 although the overall mean initial assessment time was 12 minutes, there was a wide variation in 0 the mean time particularly in the evening.
    [Show full text]
  • US States and Territories Modifying
    U.S. States and Territories Modifying Licensure Requirements for Physicians in Response to COVID-19 (Out-of-state physicians in-person practice; license renewals) Last Updated: September 15, 2021 States with Waivers: 22 + DC + GU + USVI States with Waivers, not allowing new applications: 0 States without Waivers (or closed waivers): 28 States allowing OOS physicians long-term or permanent privileges: 4 + CNMI + PR On January 28, 2021, HHS announced the fifth amendment to the Public Readiness and Emergency Preparedness (PREP) Act, authorizing any healthcare provider who is licensed or certified in a state to prescribe, dispense, or administer COVID-19 vaccines in any other state or U.S. territory. The amendment also authorizes any physician, registered nurse, or practical nurse whose license or certification expired within the past five years to partake in the immunization effort, but first must complete a CDC Vaccine Training and an on-site observation period by a currently practicing healthcare professional. State Note Citation • The Alabama Board of Medical Examiners and the Medical Licensure Commission have adopted emergency administrative rules and procedures allowing for the emergency ALBME Press Release licensing of qualified medical personnel. These measures will allow physicians and physician assistants who possess full and unrestricted medical licenses from appropriate medical licensing agencies to apply for and receive temporary emergency licenses to Board of Med Guidance practice in Alabama for the duration of the declared COVID-19 health emergency. • Re: renewals - The Board and Commission recognize the difficulty licensees may have meeting the annual continuing medical education requirement in 2020 due to the public Temporary Emergency health emergency.
    [Show full text]
  • Position Description
    POSITION DESCRIPTION POSITION TITLE: LICENSED PRACTICAL NURSE DEPARTMENT: ACUTE CARE & PERSONAL CARE HOME PROGRAM CLASSIFICATION: LICENSED PRACTICAL NURSE UNION: MNU REPORTING RELATIONSHIPS POSITION REPORTS TO: CLINICAL TEAM MANAGER, MANAGER, SUPERVISOR, CLINICAL RESOURCE NURSE POSITIONS SUPERVISED: The following classifications may report to the incumbent: Health Care Aides Unit Clerks Other LPN’s & Nurse II’s when the LPN is assigned charge responsibilities POSITION SUMMARY The Licensed Practical Nurse provides comprehensive nursing care to patients/ residents/ clients in accordance with established standards, policies, and procedures. Licensed Practical Nurses recognize and fulfill their Professional responsibilities by practicing within the scope of practice of the Licensed Practical Nurses Act, the approved College of Licensed Practical Nurses of Manitoba (CLPNM) Scope of Practice and Entry–Level Competencies, provincial and federal legislation and within the guidelines of professional ethics. The position of Licensed Practical Nurse functions in a manner consistent with, and supports the Mission, Vision and Values of the Interlake-Eastern Regional Health Authority. ESSENTIAL FUNCTIONS AND DUTIES Function and duties include but are not limited to the following: IERHA – Licensed Practical Nurse Page 1 of 9 Responsibilities: 1. The LPN is required to practice in accordance with the following to their level of scope of practice, expertise, training and experience The Licensed Practical Nurses Act of Manitoba The CLPNM Standards
    [Show full text]
  • The Role of Emergency Nurses in Emergency Preparedness and Response
    The Role of Emergency Nurses in Emergency Preparedness and Response Description Hospitals, and especially emergency departments (EDs), are an essential link in the medical system for emergency preparedness planning, response, and recovery.1 As a result, emergency nurses may routinely encounter patients who have been exposed to hazardous materials or infectious diseases, who are victims of no-notice events, or who are evacuees from an immediate threat to life. These patients may present via the emergency medical system, by private vehicle, or without prior notification and unrelated to a disaster.2–5 Disaster affected patients might also present to the ED in large volumes, creating a surge in patient visits, which can paralyze EDs that are not prepared. The United States Department of Homeland Security’s National Response Framework describes a disaster as “… any natural or manmade incident, including terrorism, which results in extraordinary levels of mass casualties, damage, or disruption severely affecting the population, infrastructure, environment, economy, national morale, or government functions.”16(p1) The increased risk associated with climate change and the need for coordination across the healthcare community to respond to the health effects of climate-related emergencies have been highlighted by the World Health Organization (WHO). Both the increased risk and the need for coordination requires focus as disaster plans are developed.6 Over the past decade more severe weather events associated with climate change have resulted in loss of life, injuries, and public health impacts.7 Optimal care for disaster patients is best achieved using a systematic, standardized approach across all facets of the healthcare system.1,8 A leading method for preparing to manage all types of disaster events is an all-hazards, capability-based approach to preparedness.
    [Show full text]
  • A Qualitative Study of Workflow and Information Systems Within Emergency Departments in the UK
    A qualitative study of workflow and information systems within Emergency Departments in the UK. By: Eliza M Mazlan A thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy The University of Sheffield Faculty of Social Sciences Information School JANUARY 2017 TABLE OF CONTENTS CONFERENCE PAPERS AND POSTER ................................................................. i DOCTORAL CONSORTIUM ............................................................................... i LIST OF FIGURES .............................................................................................. ii LIST OF TABLES ............................................................................................... iv LIST OF APPENDICES ........................................................................................ v GLOSSARY OF ACRONYMS ............................................................................. vii GLOSSARY OF TERMS ...................................................................................... x FLOW CHART DIAGRAM KEYS ........................................................................ xv ACKNOWLEDGMENT .................................................................................... xvi ABSTRACT ................................................................................................... xvii CHAPTER 1: INTRODUCTION ............................................................................1 1.1. Overview .................................................................................................................................
    [Show full text]
  • Effects of a Telephone Follow-Up Call on Patient Satisfaction in the Emergency Department
    Running head: PATIENT SATISFACTION 1 Effects of a Telephone Follow-Up Call on Patient Satisfaction in the Emergency Department Kathryn McCary, Cynthia Hestermann, and Abby Richardson Creighton University PATIENT SATISFACTION 2 Abstract Problem: Patient satisfaction has been identified as a key element of success in a competitive healthcare market, being used as an indicator of quality care as well as reimbursement incentives. Emergency Departments (ED) can have an important impact on patient satisfaction, as the ED can be the initial hospital contact for many patients. The problem identified for this project is the need for high patient satisfaction in the ED setting. Purpose: To determine the effectiveness of a telephone follow up call (TFC) on patient satisfaction. Methods: This study was conducted at two EDs within a multi-hospital, non-profit system. Sampled patients received a follow up call from a trained registered nurse within 72 hours of discharge, based on previously established hospital protocol. The sample inclusion criteria consisted of: (1) a patient in the ED of one of two study hospitals, (2) an adult over 19 years of age correlating with Nebraska state law, (3) English speaking, (4) access to a working telephone, and (5) verbal consent to participate in the study. Patients were asked to participate in a satisfaction survey following the initial follow-up call. Participants were asked 3 questions for the survey and demographically categorized by gender and age. Results: One hundred three patients were included in the study. Of these patients, 68.9% were female, 31.1% were male. Twenty-two point 3 percent of the patients contacted were between 19-29 years old, 19.4% of the patients were between 30-39 years old, 13.6% of the patients were between 40-49 years old, 15.5% of the patients were between 50-59 years old, 9.7% of the total patients were between 60-69 years old, 9.7% of the patients were between 70-79 years old, and 9.7% of the patients were over the age of 80.
    [Show full text]
  • Nursing Documentation in the Emergency Department: Nurses’ Perspectives
    Title Page NURSING DOCUMENTATION IN THE EMERGENCY DEPARTMENT: NURSES’ PERSPECTIVES by Paula Caroline Grainger A thesis submitted to Victoria University of Wellington, New Zealand in partial fulfilment of the requirements for the degree of Master of Nursing (Clinical) Victoria University of Wellington 2007 Grainger (2007) Nursing Documentation In The Emergency Department: Nurses’ Perspectives Abstract Nursing documentation is a required aspect of care, but for various reasons it can be curtailed. Nursing records are a critical aspect of communication and without them coordinated and safe care can be difficult to achieve. Study aim: To explore emergency nurses’ perspectives and practices about the quality, importance and value of emergency nursing documentation in relation to their personal beliefs, past experiences and preferred systems of documentation; the practical and contextual factors that influence documentation practices within an emergency department (ED); their interests in documentation tools or systems; and their interests in relation to further development of documentation practices and systems. Methodology and design: A qualitative descriptive study (informed by Sandelowski). Ten emergency nurses from one ED in New Zealand were recruited. Participants were interviewed using interactive interview methods, and completed a Likert scale to identify the relevance of internationally recognised general influences on documentation to their own practices in the context of an ED. Findings: The participants’ practices were influenced by factors in the workplace including competing priorities for time e.g. care provision vs. documentation, competition for access to patient records, and extant culture in relation the purpose, content and frameworks for documentation. Documentation practices were influenced by the participant’s own clinical histories, philosophies, familiarity with particular frameworks and education.
    [Show full text]
  • Ultrasound Guided Intravenous Access by Nursing Versus Resident Staff in a Community Based Teaching Hospital: a (Noninferiority) Trial
    Hindawi Publishing Corporation Emergency Medicine International Volume 2015, Article ID 563139, 4 pages http://dx.doi.org/10.1155/2015/563139 Clinical Study Ultrasound Guided Intravenous Access by Nursing versus Resident Staff in a Community Based Teaching Hospital: A (Noninferiority) Trial Thomas Carter,1 Chris Conrad,1 J. Link Wilson,1 and Godwin Dogbey2 1 Emergency Department, Southern Ohio Medical Center, Portsmouth, OH 45662, USA 2CORE Research Office, Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, USA Correspondence should be addressed to Thomas Carter; [email protected] Received 28 May 2015; Revised 15 July 2015; Accepted 19 August 2015 Academic Editor: Wen-Jone Chen Copyright © 2015 Thomas Carter et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objectives. Ultrasound (US) guidance is a safe and effective method for peripheral intravenous (IV) catheter placement. However, no studies have directly compared the success rate of emergency medicine (EM) residents and nurses at using this technique especially in community hospital settings. This prospective “noninferiority” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs. Methods. A group of 5 EM residents and 11 nurse volunteers with at least two years’ experience underwent training sessions in hands-on practice and didactic instruction with prospective follow-up. Two failed attempts on a patient using standard approach by an emergency department (ED) nurse were deemed to be “difficult sticks” and randomly assigned to either a nurse or resident, based on the day they presented.
    [Show full text]
  • N: Emergency Care
    N: Emergency Care College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. 123 Major Competency Area: N Emergency Care Competency: N-1 Date: June 1, 2015 Emergency Nursing A Licensed Practical Nurse will: N-1-1 Demonstrate knowledge and ability to apply critical thinking and critical inquiry throughout the nursing process in emergency nursing. N-1-2 Demonstrate knowledge and ability to perform a comprehensive health assessment: cardiovascular endocrine eye, ear, nose and throat integumentary gastrointestinal medications neurological obstetrics/gynecology orthopedic pediatrics psychiatric renal/genitourinary respiratory sexual assault/domestic violence trauma N-1-3 Demonstrate knowledge and ability to perform nursing procedures and interventions in an emergency setting as defined by scope of practice and according to agency policy. N-1-4 Demonstrate knowledge and ability to obtain, assess and monitor diagnostic tests and lab values according to agency policy. N-1-5 Demonstrate knowledge and ability to communicate and collaborate with emergency care team. 124 College of Licensed Practical Nurses of Alberta, Competency Profile for LPNs, 3rd Ed. Competency: N-1 Page: 2 Emergency Nursing A Licensed Practical Nurse will: N-1-6 Demonstrate knowledge and ability to obtain additional education and certification in emergency assessment, intervention and care including: emergency assessment certifications o cardiac life support o emergency neonatal care o emergency nursing o emergency pediatric nursing
    [Show full text]