Enrico Lumini

Interventions to reduce the risk of violence toward emergency department staff: current approaches

Introduction The phenomenon of workplace violence in health care settings, and especially in the emergency department (ED), has assumed the dimensions of a real epidemic. Many studies highlight the need for methods to ensure the safety of staff and propose interventions to address the problem. Aim The aim of this review was to propose a narrative of the current approaches to reduce workplace violence in the ED, with a particular focus on evaluating the effectiveness of emergency response programs. Methods A search was conducted between December 1, 2015 and December 7, 2015, in PubMed and CINAHL. Ten intervention studies were selected and analyzed. Results Seven of these interventions were based on sectoral interventions and three on comprehensive actions. Conclusion The studies that have attempted to evaluate the effectiveness of interventions have shown weak evidence to date. Further research is needed to identify effective actions to promote a safe work environment in the ED.

Lateral hostilities among nurses employed in intensive care units, emergency departments, operating rooms, and emergency medical services: a national survey in Italy

Background:Lateral hostilities (LHs) are “nasty, unkind, aggressive behavior between colleagues working at comparable organizational levels.” When LHs occur “at least once a week for a period of not less than 6 months,” they become “bullying.” The frequency of lateral violence in health care literature varies from 5.7% to 65%. Objectives:The aim of this study was to explore the extent of LH and the effects on the quality of lives of Italian nurses working in prehospital emergency medical system, emergency department, intensive care unit, and operating rooms. Methods:A descriptive study was conducted through an online survey in the Web site of the National Italian Association of Critical Care Nurses (ANIARTI). Results:A total of 1504 nurses filled up the questionnaire, with 1202 valid data entries (79.9%). Of this group, 739 (61.5%) were women and 951 (79.1%) had experienced some form of LH at least once in the last 12 months, whereas 269 (22.4%) felt to be victims of bullying. The number of transfers to other departments/services due to LH was 43 cases (3.6%), and 829 (69%) experienced psychophysical disorders attributed to LH experienced in the span of the year. Discussion:Lateral hostility is a frequent occurrence that calls for implementation of management policies to achieving an overall improvement of the work environment climate.

Ostilità laterali nei gruppi infermieristici di area critica.Indagine su cinque presidi ospedalieri della regione Toscana

Le ostilita laterali (LH) sono una delle forme di violenza sul posto di lavoro, costituita da una varieta di interazioni crudeli, scortesi, antagonistiche che avvengono tra persone agli stessi livelli gerarchici nelle organizzazioni. Questo fenomeno, che puo colpire dal 5.7% e il 65% degli infermieri, determina riduzione della motivazione lavorativa, sintomi e disturbi psicofisici e in taluni casi, l’abbandono precoce della professione. Obiettivo. Quantificare in 5 ospedali toscani, la diffusione del fenomeno delle LH tra gli infermieri di pronto soccorso e terapia intensiva, e le sue conseguenze sulla qualita di vita psicofisica e professionale. Metodo. Studio descrittivo-esplorativo, con questionario a risposte chiuse. Risultati. Hanno risposto 360/444 infermieri (81%), di cui 239 femmine (66.4%); 294 (81.6%) sono stati oggetto di LH nell’arco degli ultimi 12 mesi. Chiacchiericci, lamentele fatte alle spalle, e commenti sarcastici, sono le forme di LH piu frequenti. Le LH avvengono maggiormente nei pronto soccorso rispetto alle terapie intensive (rispettivamente 90% e 77%; p=0.0038). Non ci sono differenze statisticamente significative per genere, eta anagrafica, ne anni di servizio. Il 17.7% ha fatto domande di cambio reparto per le LH subite, e nel 6.9% lo ha effettivamente cambiato. Il 6.9% ha pensato di lasciare la professione infermieristica; 235/444 (65.2%) hanno accusato almeno un disturbo attribuito ad LH nell’arco dell’anno. I piu riportati sono morale ridotto, ansia e disturbi del sonno. Conclusioni. La presenza di LH e di disturbi correlati e elevata nei contesti di area critica e comporta una ridotta qualita di vita professionale e psicofisicaLateral hostilities among emergency and critical care nurses. Survey in five hospitals of Tuscany Region. Introduction. Lateral hostilities (LHs) are a kind of workplace violence. They are defined as varieties of cruel, rude, antagonistic interactions between people at the same hierarchical level. Nurses are affected by LH from 5.7% to 65%, leading to reduced work motivation, psycho-physical disorders, and in some cases, drop out of the nursing profession. Objective. To quantify the LHs among nurses in the emergency departments (ED) and intensive care units (ICU) in 5 hospitals of Tuscany (Italy). To show the impact on the quality of their psycho-physical and professional lives. Method. Exploratory-descriptive study, through closed-ended questionnaire. Results. 360/444 nurses (81%); 294 (81.6%) were victims of LHs during the past 12 months. Gossiping, complaints shared with others without discussing with the concerned person, and sarcastic comments were the most reported LHs. LHs occur more in EDs than ICUs (respectively 90% and 77%; p=0.0038). No statistically significant differences were observed for gender, age, or years of experience. The 17.7% of nurses asked to be moved from the ward, and 6.9% left it; 6.9% respondents had thought to leave the nursing profession; 235 (65.2%) experienced at least one LHs related disorder during the last year. Most reported symptoms were low morale, anxiety, and sleep disturbances. Conclusions. The incidence of LH and related disorders is high in EDs and ICUs, determining a low professional and psycho-physical quality of life.

Off-label utilization of a rigid cervical collar during noninvasive positive pressure ventilation of a patient affected by severe kyphoscoliosis.

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Violence towards emergency nurses: A narrative review of theories and frameworks

INTRODUCTION Workplace Violence in the health environment is a growing issue worldwide. Emergency department have been identified asa high-risk setting for Workplace Violence and emergency nurses are most exposed to this phenomenon. To address workplace violence in the ED effectively, it is critical to understand frameworks established in the literature to assist in development of appropriate interventions and corrective measures. An overview of available theories of violence towards emergency nurses in the literature is presented herein in the format of a narrative review. METHODS A search of international literature on WPV theories was conducted in three databases: PubMed, CINAHL, Scopus, and Proquest Central. Articles concerning theories that have direct implications for patient-related violence (client-on-worker Type 2 Violence) in the emergency department were sought. RESULTS Four hundred and fifty-nine articles were found. Applying established inclusion and exclusion criteria, fourteen of these were included in the review. In the international literature there are 24 theories and frameworks pertaining to violence towards nurses in the emergency department which describe different intervention strategies based on these. DISCUSSION Both the theories on violence developed by nurses and those derived from other disciplines are complex and many key elements are invariably intertwined. Understanding such theories might be useful to manage violence towards emergency nurses with greater effectiveness.

Forehead oximetry: Another (little) brick in the wall

To the Editor: In regard to the article by Schallom and colleagues recently published in Heart and Lung, we would like to contribute to the international discussion about the measurement of pulse oximetry with the use of forehead sensors in patients with potential tissue hypoperfusion by reporting briefly the results of our study published only in Italian. During August and November of 2005, in the clinical setting of the emergency department of Azienda Ospedaliera Universitaria Careggi, a 1700-bed university urban hospital in Florence, Italy, we performed a prospective study to compare the reliability of the measurements obtained from a Max-fast Nellcor forehead sensor (Nellcor; Pleasanton, CA) connected to the N-595 pulse oximeter with the measurements obtained from a DS100 A Nellcor finger sensor connected to the multiparametric monitor Siemens SC 7000 (Siemens AG Medical Solution; Munich, Federal Republic of Germany). The inclusion criteria were as follows: