Journal of emergency nursing : JEN : official publication of the Emergency Department Nurses Association
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Comparative Study
Cardiopulmonary Resuscitation Feedback: A Comparison of Device-Measured and Self-Assessed Chest Compression Quality.
High-quality cardiopulmonary resuscitation is the foundation of cardiac arrest care. Guidelines specify chest compression depth, recoil, and rate, but providers often fail to achieve these targets. Furthermore, providers are largely unable assess the quality of their own or other peoples' chest compressions. Chest compression feedback devices can improve chest compression quality; their use is endorsed internationally, but they remain largely absent in clinical care. This article analyzes preclinical data collected during a quality improvement project. It describes provider demographics and perceptions about their chest compression quality and correlates them to measured chest compression quality, compares clinician perception of chest compressions to objective measures, and describes the effect of feedback on compression quality. ⋯ Our findings suggest that participants' demographics were not correlated with chest compression quality and that providers cannot reliably assess chest compression quality. The data also demonstrate that with minimal training, feedback can significantly improve chest compression quality.
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In the emergency department, troponin assays are commonly used and essential in the evaluation of chest pain and diagnosis of acute coronary syndrome. This study was designed to assess the potential impact of implementing point-of-care troponin testing by comparing the time to point-of-care laboratory result and time to conventional laboratory result. ⋯ Point-of-care troponin testing provided results in a median time 29 minutes quicker than the conventional troponin assay. This result is statistically significant and has the potential to greatly improve time to disposition in all patients with chest pain requiring a troponin assay.
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Multicenter Study
Factors Affecting Attitudes Toward Defibrillator Use Among Clinical Nurses in South Korea: A Cross-Sectional Study.
Nurses are often first responders to in-hospital cardiac arrests. However, many nurses do not perform defibrillation even when required. Nurses' attitudes toward defibrillator use are influenced by social and psychological context. This descriptive, cross-sectional study explored factors affecting attitudes toward defibrillator use among nurses in South Korea. ⋯ To improve clinical nurses' attitudes toward defibrillator use, improving their self-confidence, image, and job fit through ongoing assessment and retraining on defibrillation is required. In addition, relevant institutional support and systematic guidelines should be provided.
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Blood culture contamination above the national threshold has been a consistent clinical issue in the ED setting. Two commercially available devices were examined that divert an initial small volume of the specimen before the collection of blood culture to reduce skin contamination. ⋯ Initial specimen-diversion devices supplement present standard phlebotomy protocols to bring down the blood culture contamination rate.
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The purpose of this facility-level case report was to describe our facility's leadership process of applying the Donabedian model to structure an early response to the coronavirus disease pandemic relative to emergency care. Using the Donabedian model as a guide, both structure and process changes were implemented to maintain high-quality clinical outcomes as well as ED staff safety and engagement. ⋯ Clinical, service quality, and staff safety outcomes were evaluated to demonstrate that the collaborative changes that follow a known process improvement model can be used to address the coronavirus disease pandemic. Further study is needed to compare the outcomes of this facility-level case study with those of others to evaluate the success of the measures outlined.