K. Sue Hoyt

NURSE PRACTITIONER DELPHI STUDY: COMPETENCIES FOR PRACTICE IN EMERGENCY CARE

INTRODUCTION The Emergency Nurses Association (ENA) convened a Nurse Practitioner (NP) Validation Work Team and conducted a Delphi study to verify and gain consensus on professional and clinical competencies for NPs in emergency care. This document describes entry-level competencies for NPs practicing in emergency care, regardless of setting. METHODS A Delphi study was conducted from September 2007 to May 2008 with a national sample of credentialed NPs in emergency care. Using online questionnaires, three rounds were sent to the NPs to reach group consensus. Participants were asked to rate the importance and frequency of performance for each competency as well as list competencies they felt were not addressed in the questionnaires. RESULTS The list of competencies was reduced from 111 to 83. In 2008, a Consensus Panel Meeting was convened to validate the Delphi study findings and gain consensus from a multidisciplinary group of stakeholders. Several organizations participated in the meeting (ie, AAEM, AANP, AACN, ACEP, ACNP, ANA, ANCC, BCEN, CCNE, NCSBN, and NONPF). The stakeholders approved a list of 60 entry-level competencies. DISCUSSION There are implications for NPs in the following areas: 1) education, for use in academic settings as a foundation for curricula; 2) practice, emphasizing the unique aspects of practice for the NP in emergency care; and 3) research, including the development of advanced competencies for NPs in emergency care.

RAPID team triage: one hospital's approach to patient-centered team triage.

Patients who present to the emergency department want definitive care by a health care provider who can perform an initial assessment, initiate treatment, and implement a disposition plan. The traditional “nurse triage” model often creates barriers to the process of rapidly evaluating patients. Therefore, innovative strategies must be explored to improve the time of patient arrival to the time seen by a qualified provider in order to complete a thorough medical screening examination. One such approach is a rapid team triage system that provides a patient-centered process. This article describes the implementation of a rapid team triage model in an urban community hospital.

Methicillin-resistant Staphylococcus aureus (mrsa) Infection

Staphylococcus aureus is a commonly found bacteria on the skin and in the nares of healthy people (Centers for Disease Control and Prevention, 2006). However, when bacteria cause an infection, it is the primary reason patients present to emergency departments with skin and soft tissue infections (SSTIs). The SSTIs have changed over the past four decades from methicillin-susceptible S. aureus to methicillin-resistant S. aureus (MRSA). Formerly hospital acquired, these community-acquired infections are now referred to as community-acquired MRSA (CA-MRSA). Therefore, healthcare providers now need to be more vigilant in assessing, diagnosing, and treating CA-MRSA. The treatment plan should consist of pharmacotherapy (e.g., combination therapy) and may also include incision and drainage where indicated. Treatment plans must meet the needs of the patients and match the severity of the infection. In addition to the recognition of MRSA in at-risk populations and educating the patient, the education of advanced practice nurses is also an important aspect if the spread of MRSA within the community is to be contained. This article discusses current MRSA assessment, diagnosis, and treatment recommendations. The article concludes with a MRSA case study.

Peer Review for Professional Publications

The primary responsibility of peer review is to ensure high-quality professional publications. The purpose of this article is to outline the responsibilities for both the publication and the reviewer. This article also discusses the review process and some of the benefits of the peer review process.

Assessment of acute hand injuries: part I.

More than 140,000 hand injuries occur yearly, and an estimated 5 days of loss of work per patient occurs (Bureau of Labor Statistics, 2012). Advanced practice registered nurses (APRNs) are responsible for managing many of these injuries in primary and emergency care settings. Hand injuries are responsible for approximately 10% of all emergency department visits annually (P. Shayne, S.H. Plantz, & F. Talavera, 2012). This article reviews approaches to the assessment of the patient with a hand injury and establishes a process for basic identification of the hand structures and function. Approaches to history taking and specific evaluations for the hand will be discussed and examples of the assessments will be provided. Diagnostic approaches to support physical findings will be discussed, and methods of radiologic assessment will support the audience in making appropriate diagnosis in relation to hand injuries. This is Part I of a three-part series that will validate the approaches to hand assessment for adults and children and identify specific injuries and their management for the APRN.

Esophageal Foreign Body in a 13-Month-Old

Ingestion of a foreign body (FB) is a common occurrence for pediatric patients presenting to the emergency department (ED) for emergent care. The purpose of this article is to present the case of a 13-month-old pediatric patient who presented to the ED with an incidental complaint (i.e., foot laceration) and was also found to have a FB in the esophagus. The assessment, diagnostics, patient management, and implications for advanced practice nurses who care for pediatric patients with FBs of the aerodigestive tracts are discussed herein.

Making a Case for Entrustable Professional Activities for Nurse Practitioners in Emergency Care

The word “trust” is a belief in the ability, reliability, and/or strength of an individual. Trust in a provider is an important element for safe patient care. Patients need to trust their providers, and health care providers need to trust each other when practicing in a collaborative environment such as emergency care. In teaching settings, for example, preceptors must decide when and for what tasks they entrust nurse practitioner (NP) students, postgraduate NP fellows, and novice NPs to assume clinical responsibilities with heavy to light supervision or no supervision at all.

Too much information.

Stop! Don’t forward that e-mail (or copy it to everyone under the sun)—at least not yet. Have you carefully considered who needs to know and what they need to know about the message you are forwarding? Have you examined the content closely to see whether there is further information or clarification necessary for the application of the information in the emergency department (ED)? Or, are you a vector of information overload? Like the boy who cried “wolf,” filling up people’s mailboxes with nonessential, nonapplicable, or incomplete information almost ensures that they won’t pay attention to the messages that really are important. It’s a classic case of TMI (too much information), a condition that has reached pandemic proportions. Translation and communication of information is the responsibility of all leaders and a key role for advanced practice nurses. In fact, one could argue that information brokering is the very essence of the clinical nurse specialist role. So, how do we do our jobs while helping prevent the spread of information overload? To be an effective conduit of information, consider the following Five Rights of Information Dissemination before you hit the Send button.

Mastoiditis Masquerading as Otitis Media

Mastoiditis represents one of the most clinically challenging diagnoses encountered by advanced practice nurses in emergency care. Malignant mastoiditis is a potentially fatal infection that invades and destroys underlying structures (Nuber & Muller, 2000). Management of patients with mastoiditis includes correction of underlying conditions, ear hygiene, cultures for the identification of pathogens, appropriate antibiotic therapy, and surgical intervention in selected cases. The purpose of this article is to discuss the assessment, differential diagnoses, and management of patients who present with a high index of suspicion for mastoiditis using an actual case presentation. Failure to recognize this disease may results in increased morbidity and even mortality, especially in immunocompromised patients.

Differential Diagnosis of a Patient Presenting With a Knee Effusion

Knee injuries represent some of the most clinically challenging musculoskeletal disorders in emergency department patients. One of these is knee effusion. Knee joint swelling may be due to inflammation, infection, trauma, or other causes. The purpose of this article is to discuss the assessment and management of patients with knee effusions via an actual case presentation. It is imperative for the healthcare provider to appropriately assess and manage the patient with a knee effusion since it may be a septic joint. Failure to recognize the severity of the problem may lead to increased morbidity and mortality.