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This week we learned about Diabetes Management Including Hypoglycaemia, IV Insulin Infusions, and Insulin Pumps.

We took over Beth’s care at around 0830 hrs. A set of observations were attended, and noted a MEWS score of 2, with a heart rate of 110bpm and a BGL of 22mmol/l at 0845hrs. The patient voiced feeling nauseated and had significant pain at a level of 7/10, prompting us to administer PRN Ondansetron 4mg and 5mg Oxycodone as per medication chart with good effects. As Beth had an elevated blood sugar level, we considered administering a glucose infusion, but we followed the policy of administering 0.9% sodium prior to the infusion in order to maintain the electrolytes. At around 0930 hrs, we performed another set of Obs, which showed an increase in MEWS score to 4, 2 for increased heart rate and 2 for respiration rate. To address the shortness of breath, we repositioned the patient to semi-fowler position as a part of our intervention.
The BGL was recorded at 19.1mmol/l around 1000hrs and complying with ACT health clinical guidelines, we continued monitoring Beth’s BGL hourly during the first 24 hours of glucose infusion and then every 2nd hour once her BGL was stable.

references:
https://www.google.com/search?q=About+https://health.act.gov.au/sites/default/files/2018-09/Diabetes%2520Management%2520Including%2520Hypoglycaemia,%2520IV%2520Insulin%2520Infusions%2520and%2520Insulin%2520Pumps%2520(Adults%2520only).docx&tbm=ilp&ilps=AB_Lh3oUdicqAvM_srAp_hDJHYeOvsErfw&biw=1366&bih=657&dpr=1

Chanif Chanif, & Dewi Prastika. (2019). Position of Fowler and Semi-fowler to Reduce of Shortness of Breath (Dyspnea) Level While Undergoing Nebulizer Therapy. South East Asia Nursing Research, 1(1), 14–19. https://doi.org/10.26714/seanr.1.1.2019.14-19

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Australian Capital Territory

Including results for "canberra hospital"

The Australian Capital Territory, known as the Federal Capital Territory until 1938, is a landlocked federal territory of Australia containing the national capital Canberra and some surrounding townships. It is located in southeastern Australian mainland as an enclave completely within the state of New South Wales. From Wikipedia

In their own words

The Australian Capital Territory (ACT) was granted self-government in 1988 with the first Legislative Assembly for the ACT coming into being in 1989. Before self-government, the ACT was administered by the Federal Parliament. From www.accesscanberra.act.gov.au

Web results about the source

From searches for the source's names
Site first indexed by Google

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Including results for "canberra hospital" The Australian Capital Territory, known as the Federal Capital Territory until 1938, is a landlocked federal territory of Australia containing the national capital Canberra and some surrounding townships. It is located in southeastern Australian mainland as an enclave completely within the state of New South Wales.

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This week we will be caring for Thomas who has a respiratory condition. And will be revising our knowledge of respiratory assessments which includes (inspection, auscultation, palpation, and percussion). As a part of the preparation, I have made myself familiar with Adventitious breath sounds and how to differentiate diseases related to those sounds.
Two youtube videos about Asthma helped me to reflect back on Anatomy and physiology, pathology, and pharmacology.

looking forward to work on Thomas's case in the lab

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After 2 hours of practice in clinical lab, we moved to seminar room to discuss further on DKA, its ma nagement, about the importance of electrolytes, anatomy and physiology, and pharmacology.
As a group we presented the symptoms of Hypoglycaemia and Hyperglycaemia.
We talked about our priorities and concerns while taking care of patients with DKA.

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As a group (A MESS), we presented the pathophysiology of chronic Bronchitis.

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Diabetic Ketoacidosis is a life-threatening complication of diabetes that occurs when there is a shortage of insulin in the body (Gupta, & Chhabra, 2019). Insulin is a hormone produced in the pancreas that helps to distribute blood sugar in different parts of our body, which our body further uses to produce energy. But when our body is unable to produce the required amount of Insulin, then it starts breaking down the fat in order to produce energy. Our body releases certain hormones during this procedure which we call ketones. High concentrations of Ketones acidify the blood leading to Ketoacidosis.

Symptoms of DKA include:

> high blood sugar levels

> excessive thirst

> frequent urination

> nausea and vomiting

> abdominal pain

>  confusion

> fruity-scented breath.

(Zhou et al., 2020)

DKA is commonly seen in people with type 1 diabetes, but it can also occur in people with type 2 diabetes, particularly those who are insulin-dependent. It can be triggered by various factors, such as illness, infection, medication changes, or missed insulin doses. Preventing DKA involves careful monitoring of blood sugar levels, taking insulin as prescribed, and promptly addressing any signs of illness or infections.

When a patient is presented with DKA, it is important to start them with IV fluids because due to excessive urination, nausea, and vomiting, they are more likely to have electrolyte imbalance in their body. Important electrolytes such as potassium, sodium, magnesium, calcium, Phosphate, etc.

Electrolytes:

When a patient is presented with DKA, the most common symptoms they present with are hyperglycemia, increased urination, vomiting, and excessive thrust. Due to frequent urination, our body loses a lot of fluids including potassium, sodium, phosphate, etc. which are essential electrolytes to maintain regular cardiac functions. Loss of these essential electrolytes may lead to cardiac arrest which may lead to death. It is important to restore hydration in patients with DKA because, unlike other cases, patients with DKA are presented with hypertension and there is a lot of chance that their Observation might get misjudged which can affect the patient’s condition. So, it is important to have an understanding of what needs to be done next when the patient comes with DKA symptoms. Also replacing electrolytes is equally important as maintaining the blood sugar level in patients with DKA because a lack of electrolytes may send the patient to a coma or may cause cardiac arrest and even death (Zhou et al.,2020).

References:

F. Bruder Stapleton. (2020). What Does Hypertension During DKA Mean for Fluid Management? NEJM Journal Watch. Pediatrics & Adolescent Medicine.

Gupta, & Chhabra, L. (2019). TAKOTSUBO CARDIOMYOPATHY IN DKA. Journal of the American College of Cardiology, 73(9), 2702–2702. https://doi.org/10.1016/S0735-1097(19)33308-X

Zhou, Thomas, L., Melson, E., Kolesnyk, A., Johnson, A., Ghosh, S., Narendran, P., & Kempegowda, P. (2020). Trends in aetiology, treatment and complications associated with diabetic ketoacidosis (DKA) – a 6-year study at a large tertiary care centre in the West Midlands, United Kingdom. Clinical Medicine (London, England), 20(Suppl 2), s68–s69. https://doi.org/10.7861/clinmed.20-2-s68

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1.     Time management in ED:

Time management is a critical aspect of the emergency department (ED), which involves prioritizing, coordinating, and executing patient care activities within a limited timeframe. Effective time management in the ED can lead to improved patient outcomes, reduced wait times, enhanced staff productivity, and increased patient satisfaction (Karbakhsh et al., 2020). However, the ED environment is often unpredictable, complex, and fast-paced, making it challenging for healthcare professionals to manage time effectively. Therefore, EDs must adopt strategies and tools to optimize time management.

One approach to managing time in the ED is to establish clear protocols and guidelines for patient care processes. For instance, EDs can develop standardized protocols for the triage, assessment, treatment, and discharge of patients. These protocols should be based on evidence-based practices and tailored to the unique needs and characteristics of the ED. By adhering to these protocols, healthcare professionals can save time, minimize errors, and improve patient outcomes (Karbakhsh et al., 2020).

Another essential aspect of time management in the ED is efficient patient flow. Patient flow refers to the movement of patients from the point of arrival to the ED to the point of disposition, such as admission, discharge, or transfer. To optimize patient flow, EDs can use a variety of tools, such as electronic health records, real-time patient tracking systems, and communication technologies. These tools enable healthcare professionals to coordinate care activities, share information, and prioritize patient needs efficiently.

Additionally, effective communication is critical for time management in the ED. Communication breakdowns can lead to delays, errors, and poor patient outcomes (Vizeshfar et al., 2022). To promote effective communication, EDs can adopt a multidisciplinary approach to patient care, involving physicians, nurses, pharmacists, social workers, and other healthcare professionals (Blackburn et al.,2019). By working collaboratively and communicating effectively, healthcare professionals can streamline care processes, reduce redundancies, and enhance patient safety (Blackburn et al.,2019).

In conclusion, time management is a critical aspect of ED operations, and healthcare professionals must adopt strategies and tools to optimize it. These include establishing clear protocols and guidelines, optimizing patient flow, promoting effective communication, and implementing continuous quality improvement initiatives. By focusing on these areas, EDs can improve patient outcomes, reduce wait times, and enhance staff productivity, leading to improved patient satisfaction and quality of care.

References:

Blackburn, Ousey, K., & Goodwin, E. (2019). Information and communication in the emergency department. International Emergency Nursing, 42, 30–35. https://doi.org/10.1016/j.ienj.2018.07.002

Karbakhsh Ravari, Farokhzadian, J., Nematollahi, M., Miri, S., & Foroughameri, G. (2020). The Effectiveness of a Time Management Workshop on Job Stress of Nurses Working in Emergency Departments: An Experimental Study. Journal of Emergency Nursing, 46(4), 548.e1–548.e11. https://doi.org/10.1016/j.jen.2020.03.013

Vizeshfar, Rakhshan, M., Shirazi, F., & Dokoohaki, R. (2022). The effect of time management education on critical care nurses’ prioritization: a randomized clinical trial. Acute and Critical Care, 37(2), 37(2), 202–208. https://doi.org/10.4266/acc.2021.01123

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Importance of pain management:

Pain management is a crucial aspect of patient care in nursing as it helps to relieve suffering and improve quality of life. Uncontrolled pain can have physical, emotional, and social consequences that can affect patients’ outcomes (Glowacki, 2015). Adequate pain management not only helps to improve patient comfort and satisfaction but also aids in promoting faster recovery, reducing the length of hospital stay, and minimizing the risk of complications (Glowacki, 2015).

Pain can be acute or chronic and can be caused by various factors such as surgery, injury, inflammation, or underlying medical conditions. It is essential to assess and manage pain appropriately as unrelieved pain can lead to physiological changes such as increased heart rate, blood pressure, and stress hormone levels, which can result in complications such as delayed healing, impaired immune function, and decreased mobility (Glowacki, 2015).

Effective pain management involves a multidisciplinary approach that includes a combination of pharmacological and non-pharmacological interventions. Pain medications such as opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and acetaminophen can help to relieve pain (Yoong et al., 2018), while non-pharmacological interventions such as relaxation techniques, physical therapy, and cognitive-behavioral therapy can help to improve coping mechanisms and reduce pain perception.

In conclusion, pain management is an integral part of patient care that should not be overlooked. It is essential to assess and manage pain appropriately to improve patient outcomes, reduce the risk of complications, and enhance patient comfort and satisfaction. A multidisciplinary approach that includes pharmacological and non-pharmacological interventions can help to achieve effective pain management.

References:

Brunkert, Simon, M., Ruppen, W., & Zúñiga, F. (2019). Pain Management in Nursing Home Residents: Findings from a Pilot Effectiveness‐Implementation Study. Journal of the American Geriatrics Society (JAGS), 67(12), 2574–2580. https://doi.org/10.1111/jgs.16148

Fatma, & Serife, K. (2017). Experience of Pain in Patients Undergoing Abdominal Surgery and Nursing Approaches to Pain Control. International Journal of Caring Sciences, 10(3), 1456–1464.

Glowacki. (2015). Effective pain management and improvements in patients’ outcomes and satisfaction. Critical Care Nurse, 35(3), 33–41. https://doi.org/10.4037/ccn2015440

Yoong, & Poon, P. (2018). Principles of cancer pain management: “An overview and focus on pharmacological and interventional strategies.” Australian Journal of General Practice, 47(11), 758–762. https://doi.org/10.31128/AJGP-07-18-4629

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I am replying Sarah’s discussion post on endometriosis where she has highlighted Jemima’s case study. Endometriosis is a condition where the tissue that normally lines the inside of the uterus grows outside of it, causing pain and discomfort. As of Sarah’s discussion question, there are various services available that we could talk to Jemima about, and treatment typically depends on the severity of the condition.

One of the first steps in seeking services for endometriosis is to consult with a healthcare provider, who can provide a diagnosis and develop a treatment plan. This may involve medication, such as hormonal birth control or pain relievers, or in severe cases, surgery to remove the endometrial tissue (Zondervan et al., 2020).

In addition to medical treatment, there are a variety of support services available for those with endometriosis. These may include counseling or therapy to help manage the emotional and psychological impact of the condition, as well as support groups where individuals can connect with others who are going through similar experiences (ACT Gov, 2023).

Alternative therapies, such as acupuncture or yoga, may also be helpful for Jemima in managing symptoms and improving her overall well-being.
Additionally, there are advocacy organizations and resources available to help individuals navigate the healthcare system and find appropriate care (Guo et al., 2021).

Overall, it is important for those with endometriosis to seek out appropriate medical care and support services to manage the condition and improve their quality of life.

References:

ACT Gov. (2023). Canberra Endometriosis Centre. Canberra Health Services. Retrieved March 7, 2023, from https://www.canberrahealthservices.act.gov.au/services-and-clinics/services/canberra-endometriosis-centre

Guo, Liu, F.-Y., Shen, Y., Xu, J.-Y., Xie, L.-Z., Li, S.-Y., Ding, D.-N., Zhang, D.-Q., & Han, F.-J. (2021). Complementary and Alternative Medicine for Dysmenorrhea Caused by Endometriosis: A Review of Utilization and Mechanism. Evidence-Based Complementary and Alternative Medicine, 2021, 1–14. https://doi.org/10.1155/2021/6663602

Zondervan, Becker, C. M., & Missmer, S. A. (2020). Endometriosis. The New England Journal of Medicine, 382(13), 1244–1256. https://doi.org/10.1056/NEJMra1810764

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Hi Sijan, great insight on Medication errors and the factors contributing to these errors. Medication errors are a significant and preventable cause of patient harm that can occur at any stage of medication use, including prescribing, dispensing, administering, and monitoring. As Sijan has discussed the factors and risks involved with medication errors, I will be focusing on some strategies that can help prevent those errors:
1.     Use electronic prescribing system such as Digital health record (DHR) to reduce the chances of errors associated with illegible handwriting and transcription errors (Australian Digital Health Agency, n.d.).

2.     Ensure that all healthcare providers involved in medication use have up-to-date information about the patient, including their medical history, allergies, and current medications.

3.     Use standardized medication order sets and protocols to ensure that medications are prescribed appropriately (National Library of Medicine, n.d.).

4.     Implement double-check procedures for high-risk medications, such as controlled drugs (National Library of Medicine, n.d.).

5.     Label medications clearly and use bar coding systems to ensure that the right medication is given to the right patient (Australian Digital Health Agency, n.d.).

6.     Provide ongoing education and training to healthcare providers on safe medication use, including how to identify and report medication errors (NPS medicine wise, 2017).

7.     Encourage patients to be active participants in their own medication management by providing education and resources to help them understand their medications and how to take them correctly (Kim et al., 2020).

8.     Develop and implement a medication safety program that includes ongoing monitoring and evaluation of medication use processes and outcomes (National Library of Medicine, n.d.).

By implementing these strategies, healthcare providers can reduce the risk of medication errors and improve patient safety

References:

Australian Digital Health Agency. (n.d.). Electronic prescriptions.  Retrieved April 23, 2023, from https://www.digitalhealth.gov.au/initiatives-and-programs/electronic-prescriptions

Kim, Kim, H. S., Kim, H. A., Chun, J., Kwak, M. J., Kim, M.-S., Hwang, J.-I., & Kim, H. (2020). Can patient and family education prevent medical errors? A descriptive study. BMC Health Services Research, 20(1), 269–269. https://doi.org/10.1186/s12913-020-05083-y

National Library of Medicine (n.d.) Medical error reduction and prevention - statpearls . Retrieved April 23, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK499956/

NPS MedicineWise. (2017, November 23). Medication safety training. Retrieved April 23, 2023, from https://www.nps.org.au/cpd/activities/medication-safety-training

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As Manisha has talked about the importance of Patient-Controlled Analgesia(PCA), I will be highlighting on some of the risks associated with the use of PCA.

Patient-controlled analgesia (PCA) is a method of pain management that allows patients to control their pain medication dosage within set limits by pushing a button on a pump. While this method has proven to be effective in managing pain, there are several disadvantages to patient-controlled drugs that should be considered.
1.     Risk of Overdose: One of the major disadvantages of patient-controlled drugs is the risk of overdose. Patients who are in pain may be tempted to push the button more frequently than they should, leading to an accumulation of the drug in their system. This can lead to respiratory depression, which can be life-threatening (John Hopkins, 2020).

2.     Reduced Awareness: Patients who are using patient-controlled drugs may become less aware of their surroundings, which can lead to falls or other accidents. This is especially true for patients who are elderly or have impaired mobility (Grissinger, 2008).

3.     Addiction: The use of patient-controlled drugs can lead to addiction, especially in patients who have a history of substance abuse. This can lead to long-term dependence on pain medication, which can be difficult to manage (John Hopkins, 2020).

4.     Increased Cost: Patient-controlled drugs can be more expensive than traditional pain management methods. The cost of the pump and associated equipment can add up quickly, and this may not be covered by insurance (Pritchard et al., 2017).

5.     Technical Issues: Patient-controlled drug pumps can malfunction or become dislodged, which can lead to underdosing or overdosing. This can be a serious problem if the patient is not closely monitored (Yi et al., 2013).

6.     Psychological Effects: Patients who use patient-controlled drugs may feel that they have lost control over their pain management. This can lead to feelings of frustration, anxiety, or depression.

7.     Risk of Infection: Patient-controlled drug pumps require the insertion of a catheter, which can increase the risk of infection. This is especially true for patients who are in the hospital, where the risk of infection is already high.

In conclusion, while patient-controlled drugs can be an effective method of pain management, but they come with several disadvantages which should be considered. And as healthcare professionals, we should be able to carefully weigh the risks and benefits of this method before recommending it to our patients.

References:

Grissinger. (2008). Safety and patient-controlled analgesia: part 2: how to prevent errors. P&T (Lawrenceville, N.J.), 33(1), 8–9.

Pain – patient controlled intravenous analgesia (PCIA) – adult. (n.d.). Retrieved April 23, 2023, from https://www.adhb.health.nz/assets/Documents/OIA/2022/02/Treatment-Guidelines-05.-Pain-Patient-Controlled-Intravenous-Analgesia.pdf

Patient-controlled analgesia pumps. Patient-Controlled Analgesia Pumps | Johns Hopkins Medicine. (2020, January 28). Retrieved April 23, 2023, from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/patientcontrolled-analgesia-pumps

Patient controlled analgesia - statpearls - NCBI bookshelf. (n.d.). Retrieved April 23, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK551610/

Pritchard, Smith, J. E., Creanor, S., Squire, R., Barton, A., Benger, J., Cocking, L., Ewings, P., Rockett, M., Eyre, V., & Hayward, C. (2017). The cost‐effectiveness of patient‐controlled analgesia vs. standard care in patients presenting to the Emergency Department in pain, who are subsequently admitted to hospital. Anaesthesia, 72(8), 953–960. https://doi.org/10.1111/anae.13932

Trocherie, Rogé, M., Pozzi, D., & Pons-Kerjean, N. (2022). 5PSQ-008 Assessment of patient-controlled analgesia (PCA) practices in a public hospital. European Journal of Hospital Pharmacy. Science and Practice, 29(Suppl 1), A119–A120. https://doi.org/10.1136/ejhpharm-2022-eahp.250

Yi, Kang, S., & Hwang, B. (2013). Drug overdose due to malfunction of a patient-controlled analgesia machine -A case report. Korean Journal of Anesthesiology, 64(3), 272–275. https://doi.org/10.4097/kjae.2013.64.3.272

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As a student nurse, I am excited to introduce myself as a dedicated and compassionate future healthcare professional. Throughout my education and clinical placement experiences, I have developed a deep understanding of the principles of nursing care and the importance of patient-centered care. I possess strong critical thinking and problem-solving skills that allow me to assess patient needs and develop effective care plans.

In addition, I possess excellent communication skills that allow me to build strong and therapeutic relationships with patients, families, and other healthcare team members. I look forward to being an advocate for my patients by educating them about their conditions, including them in decision-making, and respecting their choices and values. Because I believe active patient participation encourages positive outcomes. I am a natural leader and have demonstrated my ability to work collaboratively with other healthcare professionals to ensure the best possible outcomes for patients throughout my clinical placements.

Looking ahead, my goal is to transition to practice as a competent and confident nurse, equipped with the skills and knowledge to provide exceptional care to my patients. I am committed to continuing my professional development by seeking out opportunities for continuous learning and growth, and by pursuing advanced degrees and certifications in specialized areas of nursing.

Ultimately, my goal is to become a competent and compassionate registered nurse who provides exceptional patient care. This involves acquiring the necessary knowledge, skills, and clinical experiences to effectively assess, diagnose, and treat patients across their lifespan. And to make a meaningful difference in the lives of my patients and their families. I am confident that my skills, dedication, and passion for nursing will enable me to achieve these goals and excel as a Registered Nurse.

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Asthma

Asthma is a chronic respiratory condition that affects the airway and gets worse when exposed to triggers such as dust, cold, flu, etc. Asthma is a condition when the airway becomes narrower due to inflammation making it difficult to breathe which leads to symptoms such as wheezing, coughing, and difficulty breathing. Asthma is usually managed by inhalers and puffers and it can sometimes flare up and make it harder for the person to breathe, this condition is known as an asthma attack.

Common symptoms:

Ø Wheezing

Ø Coughing

Ø Breathlessness

Ø Chest tightness

Ø Tiredness

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https://doi-org.ezproxy.canberra.edu.au/10.1111/ans.12524

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https://trauma.reach.vic.gov.au/guidelines/paediatric-trauma/key-messages

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The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This paediatric trauma guideline provides advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe injuries.

This guideline is developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provide early care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS.

These guidelines provide the user with accessible resources to effectively and confidently provide early care for critically injured patients. They provide up-to-date information for front-line healthcare clinicians. The guideline has followed the AGREE II methodology for guideline development and is under the auspice of the Victorian State Trauma Committee (VSTC).

Clinical emphasis points

Initial assessment of a seriously injured child should follow the same structured approach as that of adult assessment; life-threatening injuries should be rapidly identified and managed.

Delayed management of the obstructed airway and inadequate fluid resuscitation are two of the most preventable causes of death in paediatric patients.

Endotracheal intubation must be verified with CO2 detection.

The necessity of frequent reassessment cannot be overemphasised.

The family of the child with a significant trauma requires appropriate support and explanation.

The main goal of early care is to ensure optimum resuscitation in the emergency setting as well as activation of the retrieval network, with timely transfer to an appropriate facility.

Specific actions to implement updated guidelines in the workplace environment are essential to ensure they are utilised in the best way possible.

For all paediatric trauma patients, PIPER is the first point of call to initiate early retrieval and transfer (1300 137 650). PIPER will coordinate connection to the paediatric trauma physician and retrieval services as required.

It is key to ensure the level of care is maintained from primary facility throughout the retrieval to reach the MTS.

Principles of early management in the paediatric
patient are the same as for adults
Image used with permission from Ambulance Victoria

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Paediatric Trauma-Key Messages | Trauma Victoria

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The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This paediatric trauma guideline provides advice on the initial management and transfer of major trauma patients who present to Victorian health services with severe injuries.

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https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0256027#sec007

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Kate Curtis,

Sarah Kourouche,

Stephen Asha,

Julie Considine,

Margaret Fry,

Sandy Middleton,

Rebecca Mitchell,

Belinda Munroe,

Ramon Z. Shaban,

Alfa D'Amato

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Abstract

Background

Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury-respiratory support, analgesia and complication prevention. ChIP was implemented using a multi-faceted implementation plan developed using the Behaviour Change Wheel.

Methods

This controlled pre-and post-test study (two intervention and two non-intervention sites) was conducted from July 2015 to June 2019. The primary outcome measures were unplanned Intensive Care Unit (ICU) admissions, non-invasive ventilation use and mortality.

Results

There were 1790 patients included. The intervention sites had a 58% decrease in non-invasive ventilation use in the post- period compared to the pre-period (95% CI 0.18-0.96). ChIP was associated with 90% decreased odds of unplanned ICU admissions (95% CI 0.04-0.29) at the intervention sites compared to the control groups in the post- period. There was no significant change in mortality. There were higher odds of health service team reviews (surgical OR 6.6 (95% CI 4.61-9.45), physiotherapy OR 2.17 (95% CI 1.52-3.11), ICU doctor OR 6.13 (95% CI 3.94-9.55), ICU liaison OR 55.75 (95% CI 17.48-177.75), pain team OR 8.15 (95% CI 5.52 --12.03), analgesia (e.g. patient controlled analgesia OR 2.6 (95% CI 1.64-3.94) and regional analgesia OR 8.8 (95% CI 3.39-22.79), incentive spirometry OR 8.3 (95% CI 4.49-15.37) and, high flow nasal oxygen OR 22.1 (95% CI 12.43-39.2) in the intervention group compared to the control group in the post- period.

Conclusion

The implementation of a chest injury care bundle using behaviour change theory was associated with a sustained improvement in evidence-based practice resulting in reduced unplanned ICU admissions and non-invasive ventilation requirement.

Citation: Curtis K, Kourouche S, Asha S, Considine J, Fry M, Middleton S, et al. (2021) Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation. PLoS ONE 16(10): e0256027. https://doi.org/10.1371/journal.pone.0256027

Editor: Zsolt J. Balogh, John Hunter Hospital and University of Newcastle, AUSTRALIA

Received: April 5, 2021; Accepted: July 28, 2021; Published: October 7, 2021

Copyright: © 2021 Curtis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: The datasets generated and/or analysed during the current study are not publicly available due to ethical constrictions (NSW Population Health Research ethics committee) but are available from the corresponding author on reasonable request to the ethics committee. The data contains potentially sensitive information in a large data set. Data cannot be shared publicly because of ethical considerations (NSW Population Health Research ethics committee). Data are available from the NSW Population Health Research Ethics Committee (contact via website https://www.cancer.nsw.gov.au/research-and-data/nsw-population-health-services-research-ethics-com) or Email: CINSW-Ethics@health.nsw.gov.au or phone: +612 8374 5689 (Ethics Officer) for researchers who meet the criteria for access to confidential data.

Funding: This research has been supported by funding from the HCF Research Foundation Australia (KC, SA, JC, RM, RZS, MF, SM). SK was funded by a scholarship from the HCF Research Foundation (AU). High flow oxygenation machines were donated by Fisher and Paykel. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The funding does not alter our adherence to PLOS ONE policies on sharing data and materials.

Introduction

Blunt chest injury leads to significant morbidity and mortality [ 1]. Significant force is needed to fracture the ribs or sternum [ 2]. A damaged chest wall impairs normal breathing by hindering chest movement due to pain [ 3]. If not treated promptly with sufficient analgesia, physiotherapy and respiratory support, complications such as pneumonia and respiratory failure frequently occur, causing death, long-term pulmonary impairment [ 4], delayed recovery and increased resource use [ 5, 6]. Care protocols and pathways exist but their use is irregular, and evaluation of blunt chest injury combined interventions is required [ 7].

To address this clinical-practice gap we developed a chest injury care bundle (ChIP), consisting of an early notification system and care bundle for patients presenting through the emergency department (ED) with isolated blunt chest injury ( Fig 1), through an integrative review of the literature [ 8]. A care bundle is a set of evidence-based interventions that when delivered together improve health outcomes more than if they were administered separately [ 9]. The ChIP care bundle provided guidance in three key pillars of care for patients with blunt chest injury-respiratory support, analgesia and complication prevention. ChIP was implemented with a robust and effective implementation plan [ 10] informed by behaviour change theory [ 11]. The aim of this study was to identify the effects of this multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in two centres in regional New South Wales (NSW), Australia.

Materials and methods

Study population and setting

This was a controlled pre-and post-test study with two intervention and two non-intervention sites conducted between 1 July 2015-21 Nov 2017 (pre) and 22 November 2017 and 30 June 2019 (post). Patients were included in the study if they had a mechanism of injury suggesting isolated blunt chest trauma, were 18 years or older, admitted to hospital, and had either a radiological or clinical diagnosis of rib or sternum fracture. Patients were excluded if: their injury occurred while in hospital as this made the activation system not possible; had cognitive impairment rendering patients unable to participate in the care bundle; were intubated prehospital or in the ED; or had an injury requiring urgent operative intervention. The intubated and urgent operative patients were excluded as they may have received other pain management in the ICU or after operating theatre relating to the operation rather than for blunt chest injury. All blunt chest injury patients were included, not just those who met ChIP criteria due to expected implementation flow on effect into usual care [ 12].

The two intervention sites were two hospitals in the same local health district in regional NSW, Australia, and were matched to two hospital sites in metropolitan Sydney with similar bed numbers, staffing, case mix, resources, and chest injury case numbers according to previous years data. All four sites had ICU capability, surgical team, pain services and physiotherapists on site [ 13]. The two intervention sites were a 500-bed regional trauma centre treating approximately 70,000 emergency presentations annually (Site A) [ 14] and a 200-bed rural/regional hospital treating approximately 40,000 emergency presentations annually (Site B) [ 15]. ChIP was implemented at the intervention sites on the 22 November 2017.

The non-intervention sites were a 300-bed centre metropolitan centre with 36,000 presentations annually (Site C) and a 200-bed hospital with 32,000 emergency presentations annually (Site D) [ 16]. The non-intervention-sites continued with standard care.

Based on feasibility studies conducted in 2011 and 2014 [ 17, 18], a sample size of 788, with 394 patients in each arm was required to demonstrate a significant reduction in non-invasive ventilation (as an indication of respiratory deterioration) to detect a clinically important reduction in complications (10%), at alpha 0.05.

The intervention-ChIP

Patients with blunt chest injury and ongoing pain after a single dose opioid analgesia or difficulty in coughing or taking a deep breath despite analgesia were eligible for activation of ChIP. Activation was via a paging system activated by ED clinicians (nursing or medical staff) that notified the surgical registrar, pain team, physiotherapist and intensive care unit (ICU) doctor and ICU liaison nurse. After hours, the pager notified the surgical registrar and ICU doctor. If needed overnight, the anaesthetic registrar could be contacted for pain management, as the pain service did not operate overnight. There was no physiotherapy cover overnight so the physiotherapist reviewed ChIP patients the following working day. The aged care or general medicine teams could also be contacted if required at clinician discretion per clinical need.

Implementation of ChIP

Implementing models of care with multidisciplinary teams can be challenging as health care disciplines often have different priorities, understandings, roles and expectations about care delivery despite all having a shared goal of improving patient care [ 19]. A plan for the implementation of ChIP was developed using the four-step approach recommended by French et al. [ 20] outlined below:

1. Step 1. Who needed to do what differently
The clinician behaviour to be changed was to activate and implement the ChIP care bundle [8]. ChIP required ED clinicians to identify eligible patients and activate the ChIP call, while other non-ED based clinicians responded to the ChIP activation by reviewing the patient and initiating tailored patient care guided by the ChIP protocol.

2. Step 2. Which barriers and enablers needed to be addressed
To identify facilitators and barriers to ChIP implementation, a survey based on the Theoretical Domains Framework [21] was administered to almost 200 staff across 12 hospital departments [10, 22]. Nine facilitators and six barriers were identified across eight domains of the Theoretical Domains Framework and are described in detail elsewhere [10].

3. Step 3. What behaviour change techniques could overcome the modifiable barriers and enhance the enablers
The identified Theoretical Domains Framework domains were mapped using the Behaviour Change Wheel to develop implementation strategies and presented in detail elsewhere [10]. Seventeen behaviour change techniques were identified (see S1 File). The implementation strategies used were: i) face-to-face educational sessions, including a video featuring local staff including managerial staff demonstrating their support: https://youtu.be/VlMz1PjzmBk; ii) audits and feedback to provide staff with data on their progress; and iii) reminders in the form of flyers, an icon prompt on the electronic medical record, and email and newsletter notification [10] (see S2 File). There was also a clinical champion at each site.

4. Step 4. Measurement of how well ChIP was implemented
The fidelity, dose and reach of the implementation of ChIP, and the impact of ChIP on patient and health service outcomes. The fidelity of the implementation of ChIP was high with almost all (97.6%) of the strategies either fully (76.2%) or partially (21.4%) followed [23]. Evaluation of fidelity of ChIP delivery (i.e. whether the intervention was delivered as intended) found that ChIP was delivered to 97.1% of eligible isolated blunt chest injured patients at the intervention sites [24]. The current study investigates the impact of ChIP on all patients with blunt chest injury not just those who had a ChIP activation (to account for 'clinical creep' of the ChIP interventions into usual care) and health service outcomes.

Outcome measures

The primary outcome measures were reduction in non-invasive ventilation use, unplanned ICU admissions, and mortality rates. Non-invasive ventilation (NIV) was defined as the need for NIV ventilatory support as determined by the treating medical staff. Unplanned ICU admissions were admissions to the ICU where the admission was not planned from ED. ICU stays post a planned operative procedure were excluded. Mortality was measured for patient deaths in hospital. Patients receiving planned palliative care were identified through medical records.

Secondary outcome measures of pulmonary embolism, deep vein thrombosis, delirium, and urinary tract infections were defined according to the International Statistical Classification of Disease version-10 Australian modification (ICD-10-AM) code definitions. Pneumonia was defined as radiological evidence of pulmonary air-space opacification, together with medical record documentation of a clinical diagnosis of pneumonia and treatment with antibiotics [ 25]. Rapid response team activations were defined as hospital responses to a deteriorating patient according to the NSW Health state policies for deteriorating patients [ 26].

Data sources and collection

Patients were identified through the state database the NSW Admitted Patient Data Collection (APDC) according to preselected ICD-10-AM codes (see S3 File). Patient medical records were screened retrospectively for inclusion and data collection. The data collection period was from 01 July 2015 to 21 November 2017 (pre) and from 22 November 2017 to 30 June 2019 (post).

Once included, patient data were obtained from two sources: i) the APDC provided demographic data such as age and sex, ICU/hospital length of stay and procedures; ii) the site medical records were used to collect other clinical treatments and data relating to adherence to the ChIP protocol such as time to analgesia and administration of high flow nasal prong oxygen; unplanned admission to ICU and commencement of non-invasive ventilation. Data were collated and de-identified prior to analysis.

Clinical information included injury(s), mechanism of injury, injury date and time, injury severity score, Charlson Comorbidity Index (CCI), and whether patients received a trauma call activation. Injury data were collected according to the Abbreviated Injury Scale. The injury severity score (ISS) and the New Injury Severity Score (NISS) are internationally recognised scoring systems for the combined effects of trauma and were calculated from the abbreviated injury scores [ 27]. The injury severity score ranges from 1 to 75, with a score ≥15 indicating severe injuries. The NISS has been included as it may be a better predictor for blunt injury and does not discriminate for body region in the score [ 28].

The CCI is a scoring system that identifies and assigns weights for 17 pre-existing comorbidities based on their association with mortality [ 29]. Polytrauma was defined as a patient with ≥2 abbreviated injury scores ≥2 in two or more body regions. If a trauma call was activated in the ED for patients presenting with severe injuries or a high-risk mechanism of injury per local policy this was noted as an additional team response had been activated and that these patients had the potential for severe injury.

Analysis

Statistical analyses were performed using SPSS v26 (SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp). Descriptive analysis of pre- and post-period groups at both intervention and control sites. Differences in patient characteristics, clinical outcomes, and healthcare utilization pre- compared to post-period for the intervention group and control group and to compare intervention to control in the post- period. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using marginal logistic or linear regression and ORs were adjusted for age, ISS, mechanism of injury and CCI. A p-value of <0.05 was considered statistically significant. Temporal changes for health service outcomes between groups, high flow nasal oxygen and analgesia over the research period were examined.

Ethics and reporting

Research conducted as part of this study adhered to the National Statement on Ethical Conduct in Human Research by the Australian National Health and Medical Research Council [ 30], and was approved by the NSW Population & Health Services Research Ethics Committee (HREC/17/CIPHS/56). Study methods were reported in line with The Standards for Reporting Implementation Studies (STaRI) [ 31] (see S4 File) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement [ 32] (see S5 File).

Results

There were 1790 patients included in the final analysis. ChIP was activated for 68.4% (n = 409) of post-period presentations at intervention sites. At the invention sites, the pre- (n = 601, 50.1%) and post-period groups (n = 598, 49.9%) were similar in demographics, mode of arrival, mechanism of injury and severity of injuries sustained ( Table 1).

The pre-period group had a higher proportion of trauma calls despite no difference to mechanism or severity of injury (ISS/NISS, p < 0.01). At control sites (n = 591), there were no differences pre- and post- the implementation date.

In the post-period, patients at the intervention sites (n = 1199) were younger, had a lower CCI, though there were similar frequencies of asthma, COPD and other chronic lung conditions compared to the control hospitals (n = 691). The patients at intervention sites had less falls and higher ISS/NISS scores compared to control sites in the post-period. The injuries were similar across sites; however, internal lung injuries were more common at intervention sites.

Clinical and health service outcomes

Intervention site patients had a 58% decrease in NIV use in the post- compared to the pre-period (OR 0.42; 95% CI 0.18-0.96) ( Table 2). In the post-period, no difference was seen between intervention and control sites for NIV use. Hospital length of stay increased by 1 day at intervention sites post-period compared to pre-period (p < 0.001).

Unplanned ICU admissions were 90% less likely at the intervention sites compared to the control groups in the post-period (OR 0.1; 95% CI 0.04-0.29). There was a 69% decrease in unplanned ICU admissions in the post- compared to the pre-period group at the intervention sites compared to no change in the control groups (OR 0.31; 95% CI 0.12-0.78). There were no differences in unplanned ICU length of stay.

In the post-period, patients at control sites were 73% more likely to have urinary tract infection (OR 0.27; 95% CI 0.14-0.52) compared to intervention sites. There were no differences identified for mortality (including palliated and non-palliated patients), delirium, pneumonia, mechanical ventilation, deep vein thrombosis, nor pulmonary embolism.

There was no significant difference between control and intervention sites for activation of rapid response teams following ChIP implementation. However, activation of rapid response teams increased by OR of 2.5 at the control sites (95%CI 1.5-4.26), whereas they remained stable at the intervention site during pre- and post-period (OR 1.31; 95% CI 0.97-1.78).

Length of hospital stay was not significantly different between intervention and control groups though at intervention sites post-period was longer by 1 day compared to pre-period (p < 0.001).

Clinical care

At intervention sites, the post-period group had higher odds of health service reviews (surgical, physiotherapy, ICU, and pain team) compared to pre-period patients ( Table 3). At the control sites, surgical reviews were 31% lower odds in the post-period group OR 0.69 (95% CI 0.49-0.98) but OR for physiotherapy reviews were 1.99 times higher odds (95% CI 1.42-2.78) than the pre-period group. Patients were more likely to receive high flow nasal oxygen, and patient education post-period at both intervention and control sites compared to pre-period.

In the post-period, patients at the intervention sites had higher odds between 2 and 8 of receiving health service reviews compared to patients at control sites. Intervention site patients had 2.6 (95% CI 1.64-3.94) times odds of getting a patient-controlled analgesia during their stay and 8.8 (95% CI 3.39-22.79) times odds of receiving regional analgesia compared to the control sites in the post-period. There was no difference in analgesia provision at control sites.

In the post-period, there were 22.1 higher odds for high flow nasal oxygen use (95% CI 12.43-39.2), and 8.3 (95% CI 4.49-15.37) higher odds for incentive spirometry between intervention and control groups. There was no difference for education delivery for the intervention group compared to the control group in the post-period(OR 1.4; 95% CI 0.99-1.98).

Sustainability

Temporal analysis demonstrated an increase in health service reviews (surgical, physiotherapy, ICU team, and pain team) at intervention sites over time, which was sustained over the post-period with a slight increase in the months leading up to implementation ( Fig 2). There were no changes in specialist review use or processes at the control sites. At the intervention sites, high flow nasal oxygen and regional analgesia use increased over time and was sustained over the 19-month post-period. There were no changes in the use of high flow nasal oxygen and regional analgesia at the control sites (see S6 File).

Discussion

Implementation of ChIP was associated with reduced NIV use and reduced unplanned ICU admissions in patients with blunt chest injury. There were no changes in mortality and the secondary outcomes of pneumonia, delirium, deep vein thrombosis or pulmonary embolism. Specialist reviews and evidence-based practices increased and were sustained over the 19-month post- period in the intervention sites. There were some increases in use in the quarter leading up to implementation date, which can be explained by the training and stakeholder meetings that were occurred in the lead up to implementation.

The findings from this study are similar to evaluations of protocols for blunt chest injury previously reported. However, previous studies only examined patients 65 years or older [ 33, 34] and those with three or more rib fractures [ 6, 33, 34]. A more recent study found reduced hospital length of stay and reduced pulmonary complications with bundled interventions (i.e. analgesia, multidisciplinary reviews, imaging and surgical intervention) delivered through a computerised clinical decision support intervention for blunt chest injury [ 35].

Though improvements have been made in using implementation science in the emergency and critical care context, most studies have investigated facilitators and barriers rather than conducting an evaluation of the implementation [ 36]. There are many instances of less than adequate implementation results in the ED setting where clinician behaviour change is difficult to achieve [ 37- 40]. Successful implementation needs planning and strategies that address the complexity and politics of health care systems, individual practitioners, managers, context as well as strong organisational support and patronage which is influential to normalise a new practice among staff [ 19]

Methodological considerations and limitations

A strength of this study is the quality of implementation using implementation science principles, including a theoretically informed intervention, proven implementation strategies targeting identified barriers and facilitators. Further, the implementation included plans for the sustainability of ChIP long-term which has been reflected in the long-term maintenance of ChIP. Implementation evaluation of new protocols and guidelines is important to consider in the effectiveness of chest injury protocols [ 7]. Only one other study reported using implementation science principles for to evaluate the implementation of an intervention for blunt chest injury, reporting high adherence and resulting in decreased hospital length of stay [ 35] with one other study reporting low adherence without the use of implementation theory [ 33]. Another strength is the rigour of the evaluation examining fidelity, which is not often done.

There were limitations to this study. The study was not randomised as this was a proof-of-concept study with limited funding, hence, a multisite controlled pre-post-trial was used as a pragmatic solution. Identification of patients for inclusion relied on the accuracy of ICD-10-AM coding, which can be problematic. The authors acknowledge that though the odds ratios were large, the effect sizes were small for NIV. The hospitals were matched with available presentation data prior to commencement of the study; however, the hospitals in the intervention group had higher numbers of patients with chest injury. It is possible that these sites simply saw more chest injury than the control sites given geographic location and population (regional vs metro).

ChIP relies on clinical decisions in real-time; therefore, without very clear documentation it can be difficult to ascertain if a patient meets criteria post-hoc. Therefore, all patients with chest injury were included in the analysis rather than only those with documented pain on breathing and ongoing pain after analgesia. A sub-analysis of patients meeting ChIP criteria (ongoing pain after analgesia or difficulty in coughing or taking a deep breath despite analgesia) was attempted; however, patient numbers in the pre-period group and the control groups were limited and the sub-analysis therefore was not feasible.

A large proportion (70%) of patients presented out of hours (after 4pm or on a weekend). Although the intervention was designed to ensure targeted patient care 24/7, sub analysis of the outcomes of this group was not conducted.

There were no prespecified criteria for ChIP patient transfer to ICU. This decision was at clinician discretion. A small element of clinician bias amongst the few familiar with the study at the intervention sites is plausible, however, the lack of significant change in the incidence of patient deterioration does not infer this.

Conclusion

The results from this study have demonstrated that ChIP is a safe and effective option to reduce complications in patients with blunt chest injury. Further, it has demonstrated the importance a well-developed implementation strategy for long-term sustainable success. Upscale and spread with rigorous evaluation, including a cost-benefit analysis, should be considered with a Phase 4 translational trial of ChIP.

The high-fidelity theory-based implementation of a chest injury care bundle was associated with significant improvement in evidence-based practice resulting in sustained change in clinical practice and reductions in unplanned ICU admissions and NIV, indicating fewer patient complications. ChIP should be translated more widely for treatment of blunt chest injury patients.

Acknowledgments

Dr Mary Lam (biostatistician) for analysis. Margaret Muteithia, Jack Lyons and Ian Carey for data collection.

References

1. 8. Kourouche S, Buckley T, Munroe B, Curtis K. Development of a blunt chest injury care bundle: An integrative review. Injury. 2018;49(6):1008-23. https://doi.org/10.1016/j.injury.2018.03.037 pmid:29655592

2. 13. NSW Health. Hospitals, Health Services. 2017. Available from: https://www.health.nsw.gov.au/Hospitals/Pages/default.aspx.

3. 14. NSW Health. Wollongong Hospital. 2019. Available from: https://www.islhd.health.nsw.gov.au/hospitals/wollongong-hospital.

4. 15. NSW Health. Shoalhaven Hospital. 2019. Available from: http://www.islhd.health.nsw.gov.au/hospitals/shoalhaven.

5. 16. The Bureau of Health Information. Healthcare observer. 2019 [updated 07/11/19]]. Available from: http://www.bhi.nsw.gov.au/Healthcare_Observer.

6. 23. Kourouche S, Curtis K, Munroe B, Watts M, Balzer S, Buckley T. Implementation strategy fidelity evaluation for a multidisciplinary Chest Injury Protocol (ChIP). [Preprint]. 2021, cited 2021 April 6,. https://doi.org/10.21203/rs.3.rs-98328/v1

7. 30. National Health and Medical Research Council (NHMRC). The National Statement on Ethical Conduct in Human Research 2017 (updated 2018). Australia: Australian government, 2018.

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surgical and invasive medical procedures

# data[].attributes.attachment_link.title
Impact of a care bundle for patients with blunt chest injury (ChIP): A multicentre controlled implementation evaluation

# data[].attributes.attachment_link.description
Background Blunt chest injury leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes. ChIP provides guidance in three key pillars of care for blunt chest injury-respiratory support, analgesia and complication prevention.

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Padlet (The Health of First Nations People)

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Chronic obstructive pulmonary disease (COPD) is a chronic respiratory illness that causes the airways in the lungs to become inflamed, narrow, and obstructed, making it difficult to breathe.

COPD is a term used to describe a group of respiratory conditions, including chronic bronchitis and emphysema, that cause long-term damage to the lungs. The most common cause of COPD is smoking, although exposure to air pollution, secondhand smoke, and other lung irritants can also contribute to the development of the disease.

Symptoms of COPD include coughing, wheezing, shortness of breath, and chest tightness. These symptoms usually worsen over time, and can significantly impact a person's quality of life. In the advanced stages of the disease, COPD can lead to respiratory failure, heart failure, and other complications.

There is currently no cure for COPD, but treatment options can help manage symptoms and slow the progression of the disease. Treatment may include medications such as bronchodilators, which help open up the airways, and corticosteroids, which reduce inflammation. Oxygen therapy may also be used in more severe cases to improve breathing.

In addition to medical treatment, lifestyle changes can also be beneficial for people with COPD. Quitting smoking is the most important step in preventing further damage to the lungs, and avoiding exposure to lung irritants can also help. Exercise and pulmonary rehabilitation can improve breathing and overall physical fitness.

COPD is a chronic respiratory disease that causes long-term damage to the lungs and can significantly impact a person's quality of life. While there is no cure for the disease, treatment options, and lifestyle changes can help manage symptoms and slow its progression. It is important for individuals at risk of COPD to take steps to prevent the disease by quitting smoking and avoiding lung irritants.

Liu, Parikh, M., Bluemke, D. A., Balte, P., Carr, J., Dashnaw, S., Poor, H. D., Gomes, A. S., Hoffman, E. A., Kawut, S. M., Lima, J. A. C., McAllister, D. A., Prince, M. A., Vogel‐Claussen, J., & Barr, R. G. (2018). Pulmonary artery stiffness in chronic obstructive pulmonary disease (COPD) and emphysema: The Multi‐Ethnic Study of Atherosclerosis (MESA) COPD Study. Journal of Magnetic Resonance Imaging, 47(1), 262–271. https://doi.org/10.1002/jmri.25753

Rodrigo‐Muñoz, Rial, M. J., Sastre, B., Cañas, J. A., Mahíllo‐Fernández, I., Quirce, S., Sastre, J., Cosío, B. G., & Del Pozo, V. (2019). Circulating miRNAs as diagnostic tool for discrimination of respiratory disease: Asthma, asthma‐chronic obstructive pulmonary disease (COPD) overlap and COPD. Allergy (Copenhagen), 74(12), 2491–2494. https://doi.org/10.1111/all.13916

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Nursing interventions for trauma patients:

Accidental traumas refer to injuries sustained by a person in different parts of their body due to a single event, such as a car accident or a fall. Nursing interventions for multiple traumas involve a comprehensive approach to managing the physical, emotional, and psychological needs of the patient.

The first step in nursing intervention for multiple traumas is to assess the patient's condition and prioritize their needs. Airway, breathing, and circulation are the most critical concerns, and any life-threatening injuries must be addressed immediately. The nurse should also assess for pain, bleeding, and signs of shock.

Once the patient is stabilized, nursing interventions for multiple traumas include monitoring vital signs, administering medications, and providing wound care. The nurse may also assist with diagnostic tests, such as X-rays or CT scans, to identify any hidden injuries.

In addition to physical care, nursing interventions for multiple traumas also include emotional and psychological support. Patients may be in shock or experiencing anxiety and fear, and the nurse can provide comfort and reassurance while explaining procedures and treatment options.

Collaboration with other healthcare professionals, such as doctors and physical therapists, is also crucial in the nursing intervention for multiple traumas. A multidisciplinary team approach can help ensure the best possible outcome for the patient and optimize their recovery.

In conclusion, nursing interventions for multiple traumas involve a comprehensive approach to managing the physical, emotional, and psychological needs of the patient. Early assessment, prioritization of needs, and collaboration with healthcare professionals are critical to ensure the best possible outcome for the patients.

Camilo Ferreira, Moorhead, S. A., Zuchatti, B. V., Correia, M. D. L., Montanari, F. L., & Duran, E. C. M. (2022). Nursing interventions and activities for patients with multiple traumas: An integrative review. International Journal of Nursing Knowledge. https://doi.org/10.1111/2047-3095.12401

Mota, Cunha, M., Santos, E., Figueiredo, Â., Silva, M., Campos, R., & Margarida Reis Santos. (2021). Effectiveness of prehospital nursing interventions in stabilizing trauma victims. Revista de Enfermagem Referência, V(6). https://doi.org/10.12707/RV20114

Kim, Kim, G.-U., Lee, W., & Park, J. (2021). Developing an Internet-Based Trauma Recovery Nursing Intervention Based on Swanson’s Theory of Caring for Trauma Recovery. International Journal of Environmental Research and Public Health, 18(13), 6715–. https://doi.org/10.3390/ijerph18136715