Accompanying critically ill relatives in emergency departments

Background. Family members are a crucial part of the holistic approach to care in emergency departments. In particular, they are a group who are vulnerable, yet have been overlooked when considering care options.

Aim. The primary aim of this systematic review was to appraise research relevant to identifying and meeting the needs of family members who accompany a critically ill person into the Emergency Department (ED). The information was intended to inform future research into the care of these people.

Method. A quality assessment strategy was specifically developed to evaluate the various research designs used. The outcomes of the highest quality studies were used to develop evidence-based clinical practice guidelines to inform clinicians caring for family members who accompany a critically ill person into the ED.

Results. Recommendations for family care drawn from this review provide the foundation for more rigorous methodologies in future research into this topic. Key findings concern family needs for communication, proximity, support, comfort, assurance and to locate meaning in the event.

Conclusion. The review has revealed current knowledge about the care of family members who accompany a critically ill person into the ED that provides guidelines for practice. Despite significant limitations, the knowledge can lead to recommendation to guide and inform future intervention research.

Families needs in emergency departments: instument development

Background. Families who accompany critically ill relatives in emergency departments (EDs) are an integral part of the care unit. However, there are few empirical data on their needs during this phase of care. In order to guide quality care, general and specific needs of families accompanying these critically ill relatives should be systematically examined.

Aim. The aim of this pilot project was to test the tool, methods and analysis plan for a study to examine the perceived needs of family members accompanying critically ill patients in EDs and their perceptions of ED staff's ability to meet these needs.

Method. Over a 6-week period in 1996, 84 relatives who met the inclusion criteria were recruited to the study. A postal questionnaire, to uncover the needs of family members, was pilot tested. The questionnaire consisted of 40 need statements reflecting five major themes: meaning, proximity, communication, comfort and support. Of the 84 relatives selected for the study, 73% returned completed questionnaires.

Results. The findings of this pilot study suggest that the questionnaire is a valid and reliable tool for researchers wishing to examine and rank the needs of family members who accompany critically ill people in EDs. In addition, the analysis plan was found to be appropriate.

Conclusions. This pilot study provides both a method and a tool for further research into family needs. Examination of the pilot data supported the reliability and validity of the tool and produced findings that challenge nurses to move beyond traditional practice that has excluded families from being an integral part of caring for critically ill patients in EDs.

Family member presence during resuscitation in the emergency department: an Australian perspective

Objective: The practice of family member presence during resuscitation in the ED has attracted widespread attention over the last few decades. Despite the recommendations of international organizations, clinical staff remain reluctant to engage in this practice in many EDs. This paper separates the evidence from opinion to determine the current state of knowledge about this practice.

Methods: A search strategy was developed and used to locate research based publications, which were subsequently reviewed for the strength of evidence providing the basis for recommendations.

Results: The literature was examined to reveal what patients and their family members want; the outcomes of family presence during resuscitation for patients and their family members; staff views and practices regarding family presence during resuscitation. Findings suggest that providing the opportunity to be with their critically ill family member is both important to and beneficial for families, however, disparity in staff views has been identified as a major obstacle to family presence during resuscitation. Examination of published guidelines and staff practices described in the literature revealed consistent elements.

Conclusion: Although critics point to the lack of rigour in this body of literature, the current state of knowledge suggests merit in pursuing future research to examine and measure effects of family member presence during resuscitation on patients, family members and healthcare providers.

The diversity of emergency code telephone numbers in Australian hospitals: the feasibility of an Australian standard emergency code

This study explored the diversity of emergency code telephone numbers currently in use in Australian hospitals and examined the feasibility of a standard emergency code telephone number for all Australian hospitals, based on the United Kingdom experience. An email and telephone convenience survey of Australian hospitals from six states and two territories was conducted. Of the 108 hospitals surveyed, seven did not use a telephone number system and used a button/ pager system to call an emergency. Of the 101 hospitals surveyed that used a telephone number system, 40 different emergency telephone numbers were in place, and in nine hospitals the telephone number used for Code Blue (medical emergency) was different to the telephone number used for other emergency codes. With increasing mobility of staff across hospitals, uniformity of emergency code telephone numbers is required to reduce confusion, potential danger and improve staff response in emergency situations. A single Australian standard emergency telephone number for all Australian hospitals is advocated.

What determines Australia's response to emergency and natural disasters

This article examines the determinants of Australia's response to emergencies and natural disasters. It examines the response from the Australian public by examining contributions made to the appeals of the country's largest Non-Governmental Organisation: World Vision of Australia. It also examines the response of the Australian Government. The data include 43 emergencies and natural disasters since 1998. Results suggest that the responses from both the public and government are positively associated with the number of people affected, media coverage, and the level of political and civil freedom in the country where the event occurred. The type and location of the emergency or disaster are important for the public's response. Differences between public and government donations exist: support from the Australian Government is positively associated with smaller countries and there is some evidence that the public donates more to events occurring in larger and poorer countries.

Knowledge and attitudes of ED staff before and after implementation of the emergency nurse practitioner role

Introduction
The Emergency Nurse Practitioner (ENP) role was implemented in the Emergency Department (ED) at The Northern Hospital (TNH) in April 2004. Implementation of the ENP role occurred as part of a Department of Human Services funded project to establish the ENP model as an effective and sustainable model of care delivery in Victorian EDs.

Aim
The aim of this study was to examine the attitudes and knowledge of ED medical and nursing staff prior to, and following, implementation of the ENP role.

Methods
The design was a pre-test/post-test design and the Northern Emergency Nurse Practitioner Staff Survey was used for data collection. A total of 104 ED staff completed the pre-test survey and the post-test survey was completed by 79 ED staff.

Results
The attitudes and knowledge of ED medical and nursing staff changed significantly during implementation of the ENP role. Pre-test data indicated that staff were generally supportive of the role but had a poor understanding of the requirements for endorsement and how the role would function in clinical practice. Post-test data showed significant increases in support for the ENP role, a greater understanding of the requirements to become an ENP and increased understanding of the logistics and functions of an ENP.

Conclusion
The implementation of the Nurse Practitioner role within the emergency department of The Northern Hospital, Victoria Australia has been a positive experience for both medical and nursing staff.

Interventions for educating children who have attended the emergency room for asthma (Review)

Background: Asthma is one of the most common reasons for paediatric admissions to hospital, with substantial cost to the community. There is some evidence to suggest that many hospital admissions could be prevented with effective education about asthma and its management.
Objectives: To conduct a systematic review of the literature in order to identify whether asthma education leads to improved health outcomes in children who have attended the emergency department for asthma.
Search strategy: We searched the Cochrane Airways Group trials register, including MEDLINE, EMBASE, and CINAHL databases, and reference lists of trials and review articles.
Selection criteria: Randomised controlled trials or controlled clinical trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months. Data collection and analysis:Two reviewers independently assessed trial quality and extracted data. Study authors were contacted for additional information.
Main results: Eight trials involving 1407 patients were included, in all the education was provided by nurses or researchers. Compared to control (usual care or lower intensity education) education did not reduce subsequent emergency department (ED) visits [4 trials; relative risk (RR)= 0.87, 95% confidence interval (CI) 0.37 to 2.08], hospital admissions [5 trials; RR=0.74, 95% CI 0.38 to 1.46] and unscheduled doctor visits [5 trials; RR= 0.74, 95% CI 0.49 to 1.12). Each analysis showed evidence of heterogeneity among the studies (P<0.01). Subgroup analyses by the overall difference in scale of intervention between treatment and control groups (comprehensive programme versus information only) or the timing of the intervention/recruitment (early versus delayed) gave similar results to the main analysis and still revealed significant heterogeneity between trials. Authors' conclusions: On the basis of the published trials, there is no firm evidence to support the use of asthma education for children who have attended the emergency department for asthma as a means of reducing subsequent ED visits, hospital admissions or unscheduled doctor visits. Some trials appeared to show clear evidence of benefit, but reasons for differences between these and the negative studies is not clear. More research is required.

Sculpting fog: attempting to define "acceptable risk" in emergency services.

There is currently no consensus as to how “acceptable risk” should be defined in emergency service response. Attempts to address this have relied upon the assumption that a probabilistic model of risk can be calculated and that acceptable levels of risk can be determined. Examples of this process can be seen in a number of emergency services, e.g. dynamic risk assessment utilised by a number of fire services.