Wound management provided by advanced practice nurses: a scoping review protocol.

OBJECTIVE: The objective of this review is to examine the current state of the literature regarding wound care provided by advanced practice nurses globally. Specifically, this review will examine the similarities and differences in the wound care practice of advanced practice nurses, including nurse practitioners, clinical nurse specialists, and advanced practice registered nurses. INTRODUCTION: Advanced practice nurses have graduate education and advanced scope of practice. The addition of advanced wound care training provides unique opportunities for advanced practice nurses to provide wound care. INCLUSION CRITERIA: This review will consider advanced practice nurses who are nurse practitioners or registered nurses with graduate education and advanced training (certification/education) in wound care. The wound care can be provided independently or as a part of a team, in any setting. METHODS: The proposed review will be conducted in accordance with the JBI methodology for scoping reviews. The databases searched will include MEDLINE, CINAHL, ProQuest Nursing and Allied Health, Cochrane Database of Systematic Reviews, and Scopus. To reflect changes in advanced practice nursing scope of practice, searches will be limited to articles published from 2011. Articles in languages other than English will be translated. Titles and abstracts will be independently reviewed by two reviewers, and relevant sources will be retrieved in full and reviewed. Any disagreements will be resolved through discussion or with an additional reviewer. The similarities and differences in wound care practice (type of wound, practice setting, treatments) will be extracted using a data extraction tool. Any modifications will be detailed in the scoping review. Extracted data will be presented in a descriptive format

Physical assessment skills taught in nursing curricula: a scoping review.

OBJECTIVE: This scoping review sought to establish the current state of knowledge regarding physical assessment skills taught globally in undergraduate nursing curricula. Explicitly, the review aimed to determine which skills are being taught via curricula and which skills are performed by students in clinical placements, as well as what physical assessment skills are being used by registered nurses in practice. INTRODUCTION: Nursing programs are expected to teach the physical assessment skills required for entry-level registered nurses to practice competently. The discrepancy lies in determining which skills are essential to teach entry-level nurses and which are unessential. INCLUSION CRITERIA: Studies that examined physical assessment skills taught to students in any undergraduate registered nursing program or used by registered nurses in practice were considered. Physical assessments included all techniques or skills taught in any year of a university or college teaching global registered nursing curricula. METHODS: Databases searched included MEDLINE (Ovid), CINAHL Complete (EBSCO), Scopus, and Cochrane Central Register of Controlled Trials (Ovid). Sources of unpublished studies included ProQuest Dissertations and Theses Global, OpenGrey, Open Access Theses and Dissertations, and Google Scholar. Studies published in English between January 2008 and November 2019 were included. Two independent reviewers screened titles and abstracts. Studies meeting the inclusion criteria were imported into the Covidence systematic review manager. Extracted data were presented in a descriptive format, including characteristics of included studies and relevant key findings. RESULTS: Thirteen records were extracted for synthesis: one integrated review, one author reflection, one mixed methods study, and 10 quantitative studies. The sources represented a global context: the United States, New Zealand, Turkey, Australia, Norway, Korea, Italy, and one of unknown origin. Three studies examined physical assessment skills routinely taught in global nursing curricula. Three studies explored physical assessment skills routinely used by students during nursing programs. Seven studies examined which physical assessment skills were routinely performed by registered nurses in practice. In the studies, there were 98 to 122 physical assessment skills taught in global nursing programs. However, only 33 skills were routinely taught in curricula, and of those, only 20 were the same across all studies (core skills). Students in nursing programs routinely performed 30 physical assessment skills, and six of the 30 skills were the same across all studies (core skills). Of the six core skills routinely performed by students, five were also routinely taught in nursing curricula in the included studies. Registered nurses routinely performed 39 physical assessment skills, and 11 skills were the same across all studies (core skills). Ten of the physical assessment skills taught in curricula were routinely performed by registered nurses in practice. CONCLUSION: This scoping review provides insight into physical assessment skills taught in nursing curricula and used by registered nurses in practice. This knowledge is essential for curriculum revisions and planning as it provides insight on how to best meet the needs of future nursing students

Beyond Money and Grantmaking: The Emerging Role of Community Foundations

Content pending

A Systematic Review Of The Types And Causes Of Prescribing Errors Generated From Using Computerized Provider Order Entry Systems in Primary and Secondary Care

Objective To understand the different types and causes of prescribing errors associated with computerized provider order entry (CPOE) systems, and recommend improvements in these systems. Materials and Methods We conducted a systematic review of the literature published between January 2004 and June 2015 using three large databases: the Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline. Studies that reported qualitative data about the types and causes of these errors were included. A narrative synthesis of all eligible studies was undertaken. Results A total of 1185 publications were identified, of which 34 were included in the review. We identified 8 key themes associated with CPOE-related prescribing errors: computer screen display, drop-down menus and auto-population, wording, default settings, nonintuitive or inflexible ordering, repeat prescriptions and automated processes, users’ work processes, and clinical decision support systems. Displaying an incomplete list of a patient’s medications on the computer screen often contributed to prescribing errors. Lack of system flexibility resulted in users employing error-prone workarounds, such as the addition of contradictory free-text comments. Users’ misinterpretations of how text was presented in CPOE systems were also linked with the occurrence of prescribing errors. Discussion and Conclusions Human factors design is important to reduce error rates. Drop-down menus should be designed with safeguards to decrease the likelihood of selection errors. Development of more sophisticated clinical decision support, which can perform checks on free-text, may also prevent errors. Further research is needed to ensure that systems minimize error likelihood and meet users’ workflow expectations

An analysis of prehospital critical care events and management patterns from 97 539 emergency helicopter medical service missions : A retrospective registry-based study

BACKGROUND It is largely unknown how often physicians in emergency helicopter medical services (HEMS) encounter various critical care events and if HEMS exposure is associated with particular practice patterns or outcomes. OBJECTIVES This study aimed: to describe the frequency and distribution of critical care events; to investigate whether HEMS exposure is associated with differences in practice patterns and determine if HEMS exposure factors are associated with mortality. DESIGN A retrospective registry-based study. SETTING Physician-staffed HEMS in Finland between January 2012 and August 2019. PARTICIPANTS Ninety-four physicians who worked at least 6 months in the HEMS during the study period. Physicians with undeterminable HEMS exposure were excluded from practice pattern comparisons and mortality analysis, leaving 80 physicians. MAIN OUTCOME MEASURES The primary outcome measure was a physician's average annual frequencies for operational events and clinical interventions. Our secondary outcomes were the proportion of missions cancelled or denied, time onsite (OST) and proportion of unconscious patients intubated. Our tertiary outcome was adjusted 30-day mortality of patients. RESULTS The physicians encountered 62 [33 to 98], escorted 31 [17 to 41] and transported by helicopter 2.1 [1.3 to 3.5] patients annually, given as median [interquartile range; IQR]. Rapid sequence intubation was performed 11 [6.2 to 16] times per year. Physicians were involved in out-of-hospital cardiac arrest (OHCA) 10 [5.9 to 14] and postresuscitation care 5.5 [3.1 to 8.1] times per year. Physicians with longer patient intervals had shorter times onsite. Proportionally, they cancelled more missions and intubated fewer unconscious patients. A short patient interval [odds ratio (OR); 95% confidence interval (CI)] was associated with decreased mortality (0.87; 95% CI, 0.76 to1.00), whereas no association was observed between mortality and HEMS career length. CONCLUSION Prehospital exposure is distributed unevenly, and some physicians receive limited exposure to prehospital critical care. This seems to be associated with differences in practice patterns. Rare HEMS patient contacts may be associated with increased mortality.Peer reviewe

Endotracheal intubation skill acquisition by medical students

During the course of their training, medical students may receive introductory experience with advanced resuscitation skills. Endotracheal intubation (ETI – the insertion of a breathing tube into the trachea) is an example of an important advanced resuscitation intervention. Only limited data characterize clinical ETI skill acquisition by medical students. We sought to characterize medical student acquisition of ETI procedural skill.11Presented as a poster discussion on 17 October 2007 at the annual meeting of the American Society of Anesthesiologists in San Francisco, CA.The study included third-year medical students participating in a required anesthesiology clerkship. Students performed ETI on operating room patients under the supervision of attending anesthesiologists. Students reported clinical details of each ETI effort, including patient age, sex, Mallampati score, number of direct laryngoscopies and ETI success. Using mixed-effects regression, we characterized the adjusted association between ETI success and cumulative ETI experience.ETI was attempted by 178 students on 1,646 patients (range 1–23 patients per student; median 9 patients per student, IQR 6–12). Overall ETI success was 75.0% (95% CI 72.9–77.1%). Adjusted for patient age, sex, Mallampati score and number of laryngoscopies, the odds of ETI success improved with cumulative ETI encounters (odds ratio 1.09 per additional ETI encounter; 95% CI 1.04–1.14). Students required at least 17 ETI encounters to achieve 90% predicted ETI success.In this series medical student ETI proficiency was associated with cumulative clinical procedural experience. Clinical experience may provide a viable strategy for fostering medical student procedural skills

Comparison of the Airtraq® and Truview® laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins

<p>Abstract</p> <p>Background</p> <p>Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq^®and Truview^®laryngoscopes may reduce this risk.</p> <p>Methods</p> <p>We compared the efficacy of these devices to the Macintosh laryngoscope when used by 21 Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Airtraq^®and Truview^®laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan^®manikin.</p> <p>Results</p> <p>The Airtraq^®reduced the number of optimization manoeuvres and reduced the potential for dental trauma when compared to the Macintosh, in both the normal and simulated difficult intubation scenarios. In contrast, the Truview^®increased the duration of intubation attempts, and required a greater number of optimization manoeuvres, compared to both the Macintosh and Airtraq^®devices.</p> <p>Conclusion</p> <p>The Airtraq^®laryngoscope performed more favourably than the Macintosh and Truview^®devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting.</p

Comparison of the Airtraq® and Truview® laryngoscopes to the Macintosh laryngoscope for use by Advanced Paramedics in easy and simulated difficult intubation in manikins

<p>Abstract</p> <p>Background</p> <p>Paramedics are frequently required to perform tracheal intubation, a potentially life-saving manoeuvre in severely ill patients, in the prehospital setting. However, direct laryngoscopy is often more difficult in this environment, and failed tracheal intubation constitutes an important cause of morbidity. Novel indirect laryngoscopes, such as the Airtraq^®and Truview^®laryngoscopes may reduce this risk.</p> <p>Methods</p> <p>We compared the efficacy of these devices to the Macintosh laryngoscope when used by 21 Paramedics proficient in direct laryngoscopy, in a randomized, controlled, manikin study. Following brief didactic instruction with the Airtraq^®and Truview^®laryngoscopes, each participant took turns performing laryngoscopy and intubation with each device, in an easy intubation scenario and following placement of a hard cervical collar, in a SimMan^®manikin.</p> <p>Results</p> <p>The Airtraq^®reduced the number of optimization manoeuvres and reduced the potential for dental trauma when compared to the Macintosh, in both the normal and simulated difficult intubation scenarios. In contrast, the Truview^®increased the duration of intubation attempts, and required a greater number of optimization manoeuvres, compared to both the Macintosh and Airtraq^®devices.</p> <p>Conclusion</p> <p>The Airtraq^®laryngoscope performed more favourably than the Macintosh and Truview^®devices when used by Paramedics in this manikin study. Further studies are required to extend these findings to the clinical setting.</p

Familie und Schule: zwei Orte der Erziehung.

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