The Path to Certification for Emergency Nurse Practitioners.

Certification serves to validate the knowledge, skills, and experience required for clinical practice. Availability of a certification for emergency nurse practitioners (ENPs) has had an arduous path. This article examines the history of ENP certification in the United States, its territories and Canada, and how the certification examination has arrived at its current state.

Validation of Emergency Nurse Practitioner Competencies: Patient Complexity and Clinical Decision Making.

Introduction: Over the past 15 years, the emergency nurse practitioner has been recognized as a nursing specialty role with dedicated scope and standards of practice. However, a paucity of objective data exists to validate the actual practice of emergency nurse practitioners in the emergency care setting. The purpose of this pilot study was to describe the initial acuity of patients assigned to emergency nurse practitioners, actions, decisional complexity, and disposition decisions of advanced practice nurses as they function in emergency departments in a single system.

Lumbar Puncture.

Lumbar puncture (LP) is a procedural skill that is required for practice in the emergency care setting, most often for diagnostic purposes. Rarely, it can also be used therapeutically, to alleviate the pain of patients presenting to the emergency department with acute headache from idiopathic intracranial hypertension. In either case, LP constitutes an invasive procedure in which the subarachnoid space is entered in order to obtain a sample of cerebrospinal fluid from one of the most vulnerable areas of the human anatomy.

CE: Assessing Back Pain in Patients Presenting to the ED.

Although back pain is common, most often benign, and generally resolves in a few days with self-care, nonspecific low back pain that does not resolve with self-care and prompts patients to seek treatment in an ED may result from a serious underlying pathology. In this article, the first in a series on clinical red flags-indicators that can be used in the clinical setting to screen for an elevated risk of severe underlying conditions-the author considers back pain manifestations that may signal the presence of a debilitating or even fatal disease process. Detecting such red flags and communicating their presence to the attending provider can facilitate appropriate diagnosis and management.

Regulatory Challenges to Emergency Medicine Procedural Sedation.

As currently written, national regulatory guidance on procedural sedation has elements that are contradictory, confusing, and out of date. As a result, hospital procedural sedation policies are often widely inconsistent between institutions despite similar settings and resources, putting emergency department (ED) patients at risk by denying them uniform access to safe, effective, and appropriate procedural sedation care. Many hospitals have chosen to take overly conservative stances with respect to regulatory compliance to minimize their perceived risk.

Implementation and Evaluation of Tactical Combat Casualty Care for Army Aviators.

Introduction: The importance of developing military strategies to decrease preventable death by mitigating hemorrhage and reducing time between the point of injury and surgical intervention on the battlefield is highlighted in previous studies. Successful implementation of Tactical Combat Casualty Care (TCCC) throughout elements of the USA and allied militaries begins to address this need. However, TCCC implementation is neither even nor complete in the larger, conventional force.

Leading the Effort to Promote Bleeding Control in Our Communities.

Nurses can prepare the public to save lives following a mass casualty event.

Alcohol Withdrawal Syndrome: Improving Recognition and Treatment in the Emergency Department.

Alcoholism continues to be a persistent health problem in the United States, accounting for up to 62% of emergency department (ED) visits. This quality improvement (QI) project examined whether identifying the benefit for early use of Alcohol Use Disorders Identification Test (AUDIT C) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIW-ar) in the ED would avoid escalation of care and offset poor outcomes of alcohol withdrawal syndrome (AWS). A preimplementation chart review (N = 99) showed an average of 12%-15% of patients requiring escalation of care at the project site.

Implementation and Evaluation of a First-Responder Bleeding-Control Training Program in a Rural Police Department.

Background: In the prehospital environment, nonmedical first responders are often the first to arrive on the scene of a traumatic event and must be prepared to provide initial care at the point of injury. In civilian communities, these nonmedical first responders often include law enforcement officers. Hemorrhage is a major cause of death in trauma, and many of these deaths occur in the prehospital environment; therefore, prehospital training efforts should be directed accordingly toward bleeding control.

Chest Pain: If It Is Not the Heart, What Is It?

Noncardiac chest pain is an angina-type discomfort without indication of ischemia. Diagnosis can be difficult because of its heterogeneous nature. Classification varies by specialty; gastroenterology uses the terminology gastroesophageal reflux disease related versus non-gastroesophageal reflux disease related.

CE: A Review of Current Practice in Transfusion Therapy.

: In the United States, roughly 4.5 million patients per year receive transfusions of various blood products. Despite the lifesaving benefits of transfusion therapy, it is an independent risk factor for infection, morbidity, and death in critically ill patients.

Use of a Virtual Learning Platform for Distance-Based Simulation in an Acute Care Nurse Practitioner Curriculum.

Background: Acute care nurse practitioner (ACNP) programs that use high-fidelity simulation as a teaching tool need to consider innovative strategies to provide distance-based students with learning experiences that are comparable to those in a simulation laboratory.

Objective: The purpose of this article is to describe the use of virtual simulations in a distance-based ACNP program and student performance in the simulations.

Method: Virtual simulations using iSimulate were integrated into the ACNP course to promote the translation of content into a clinical context and enable students to develop their knowledge and decision-making skills.

The Experience of Advanced Practice Nurses in US Emergency Care Settings.

Introduction: Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education.

Measuring Fatigue in Triage: A Pilot Study.

: Given the critical nature of triage in facilitating emergency department (ED) functions, an understanding of the factors that impact triage nurses' ability to accurately assign triage scores and the ways in which these factors may affect various patient outcomes is extremely important; yet, there exists a paucity of such research in the literature. To further develop this knowledge base, an investigation of triage nurse fatigue and the role it may play in the ability to accurately assign triage scores was developed. The purpose of this pilot study was to determine how the length of a triage shift affects perceived fatigue levels among triage nurses.

Henoch-Schönlein Purpura in the ED.

Diagnosing and treating a child with the most common form of pediatric vasculitis.

Disaster Preparedness in the Emergency Department Using In Situ Simulation.

High influxes of patients during disasters have led to increased incidence of medical errors in emergency departments (EDs), ultimately leading to poor patient outcomes. Nearly 30% of errors committed in EDs are due to deficiencies in knowledge and skills, and between 60% and 70% of errors occur due in part from communication breakdowns. The goal of this project was to examine whether in situ simulation will increase health care providers' knowledge of how to perform during a disaster, improve competency in skills related to those actions, and to improve communication regarding the special circumstances inherent to a disaster in the ED.

Exploring the Management of Death: Emergency Nurses' Perceptions of Challenges and Facilitators in the Provision of End-of-Life Care in the Emergency Department.

Introduction: The importance of end-of-life (EOL) care for dying patients and their families is well described; however, little research has been performed in emergency settings. The purpose of this study was to explore emergency nurses' perceptions of challenges and facilitators in the care of patients at the EOL.

Methods: A mixed-methods design using survey data (N = 1,879) and focus group data (N = 17).

Improving comfort and throughput for patients undergoing fractionated laser ablation of symptomatic burn scars.

Introduction: Utilization of fractionated ablation with a carbon dioxide (CO2) laser has shown to be efficacious in the management of symptomatic burn scars. Although effective, this procedure is painful and burn patients traditionally evidence low pain tolerance. For this reason intravenous anesthesia is used during these procedures.